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Many children that have a tongue-tie do not experience  any speech impediments because they are able to adapt adequately as they grow and mature. Conversely, other children do not adapt well and do experience impediments with their speech.  By the age of three the sounds of L, R, T, D, N, TH, SH, and Z are beginning to be articulated by children. By the age of four, if a child’s speech is struggling with the sounds mentioned, or if other non-family members find it difficult to understand them, it is usually necessary to get a speech evaluation. A child with a tongue-tie may have  a lisp, talk slowly and/or softly, and have a difficult time talking when speaking fast or when they are tired. Treatment of tongue-tie for speech related concerns should always be  in conjunction with prior speech pathology evaluation and postoperative speech therapy.  Many children improve in their articulation on the same day of treatment, and others need a little more time to retrain their tongue to function properly. Follow-up speech therapy after treatment is always recommended for best results.