Question
I have a five-year-old client who has extremely large tonsils (i.e. they almost touch at midline). She has difficulty with production of velars in all positions, as well as a slight tongue protrusion. She also takes medication for xerostomia. She can easi
Answer
There is insufficient information provided about this five year old child to provide a detailed response to the question regarding the child's inability to produce velar sounds. In light of this, I can only provide limited comments on several observations included in the question:
It is not surprising, certainly not alarming, that a five year old is unable to produce velar sounds. What is not reported in the question is what this child is doing for velars? Is she is substituting /t/ for /k/? If so, I would not be too concerned as she is only five years old. If, on the other hand, she is substituting a glottal stop for velar sounds, this should be addressed.
A five year old on medication for xerostomia (dry mouth) is an unusual situation. There could be a blockage of the parotid salivary glands, or Wharton's duct (the excretory duct for the submaxillary gland). A dry mouth can easily lead to some obligatory mouth breathing; hence, the slight tongue protrusion.
The large, "kissing" tonsils are probably not related to the lack of velar productions, even though large tonsils can displace the faucial pillars laterally and impede full elevation of the velum. A tonsillectomy should not be offered as a viable option to permit velar sounds to be made. I would not refer this child to an ENT for surgical evaluation. The family pediatrician can monitor the tonsils from a medical standpoint, unrelated to velar productions. If a tonsillectomy is recommended for medical reasons, I would not expect velar productions to magically appear following the surgery.
The lack of velar sound productions and a slight tongue protrusion suggests the need to evaluate oral diadochokinetic patterning. Does the tongue tip show a normal ability to elevate on anterior sounds? This child may be a bit slow in mastering tongue elevation for velar and anterior sounds.
In response to the request for a therapy suggestion, try holding the front of the tongue tip down with a tongue blade while having the child attempt a velar sound. The back of the tongue should elevate to make the stop consonant. If successful, this is a method to use in therapy. If no elevation is seen while holding down the tongue tip, this would suggest a maturational difficulty in tongue elevation. Depending on what the child is doing for velar sounds, i.e., omitting or substituting, will help you determine whether to work on getting velar productions or leaving the child alone for now.
Robert M. Mason, DMD, Ph.D. is a speech-language pathologist (CCC-ASHA Fellow), a dentist, and orthodontist. He is a Past President of the American Cleft Palate-Craniofacial Association, a professional, interdisciplinary organization specializing in problems associated with facial and oral deformities. Dr. Mason has studied and written extensively about orofacial examination, developmental problems related to the tongue, and the anatomy and physiology of the speech and hearing mechanisms. His reports have appeared in speech, dental, medical, and plastic surgical journals and texts. He is considered to be an expert in tongue thrusting, tongue tie, and other problems related to tongue functions and speech.
Robert Mason Dmd, Ph.D
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