Elsevier

Midwifery

Volume 24, Issue 3, September 2008, Pages 353-357
Midwifery

Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function

https://doi.org/10.1016/j.midw.2006.02.005Get rights and content

Abstract

Objective

the Assessment Tool for Lingual Frenulum Function (ATLFF) is the only available tool designed to assess newborn babies for the severity of tongue-tie. The aim of this study was to describe the ATLFF scores obtained on a series of 148 tongue-tied newborn babies.

Design

prospective case series.

Setting

a 420-bed community hospital in St. Paul, Minnesota, USA.

Participants

newborn babies admitted to the normal newborn nursery from October 1, 2000 to May 1 2002.

Measurements and findings

all babies in the nursery were examined for tongue-tie. One-hundred and forty-eight tongue-tied babies were examined using the ATLFF by at least one of three examiners. The ATLFF could not be completed on five babies. Of the remaining babies, 40 (28%) received ‘perfect’ scores, five (3.5%) received ‘acceptable’ scores, and 19 (13.3%) received ‘function impaired’ scores. The remaining 79 (55.2%) babies received scores that did not fall into any of the three categories of scores. The inter-rater agreement on whether or not the baby had a score of ‘function impaired’ on the ATLFF was moderate (kappa=0.44).

Key conclusions and implications for practice

few tongue-tied babies had a score of ‘function impaired’ on the ATLFF. It is a major limitation of the ATLFF that it does not classify most babies. The development and testing of a useful tool to determine which tongue-tied babies will have difficulty with breast feeding remains a research priority.

Introduction

Tongue-tie, or ankyloglossia, in the newborn baby has been shown to be associated with increased breast feeding problems and decreased breast feeding duration (Messner et al., 2000; Ricke et al., 2005) However, most tongue-tied babies do breast feed successfully (Messner et al., 2000; Ricke et al., 2005), and it would be useful for clinicians to have a tool to identify which tongue-tied babies are likely to have breast feeding problems.

The Assessment Tool for Lingual Frenulum Function (ATLFF) was designed by Hazelbaker (1993) to systematically assess breast fed newborn babies suspected of being tongue-tied, and whose possible tongue-tie was affecting breast feeding. The Academy of Breastfeeding Medicine recommends the ATLFF as a method of assessing ankyloglossia in its protocol on this topic (Ballard et al., 2004). However, little information on the use of the ATLFF has been published (Hazelbaker, 1993; Ballard et al., 2002; Amir et al., 2005; Ricke et al., 2005).

The aim of this study was to describe the ATLFF scores obtained from a large series of tongue-tied newborn babies. In addition, we wished to determine the inter-rater reliability of the examinations.

Section snippets

Methods

The study took place at Regions Hospital, a 430-bed hospital in St. Paul, Minnesota, USA, with about 2200 births annually. Newborn babies at the hospital typically spend 2–4 hours after birth in the nursery being assessed and observed by nursery nurses. This occurs while the mothers are being moved from the labour suite and orientated to the postpartum floor. The babies return to the nursery for examinations by a doctor each morning. The HealthPartners Institutional Review Board approved the

Findings

One hundred and forty-eight babies were identified as having tongue-tie by the nursery nurses and confirmed by the investigators. The ATLFF could not be completed on five babies, usually because the baby was too sleepy to complete the function items. Two of the three investigators (LAR and DJM-K) examined 95% of the babies. The repeat examinations occurred either on the same day or on consecutive days. Their inter-rater agreement initially on whether or not the baby had a score of ‘function

Discussion

Reported here is the largest case series to date of tongue-tied newborn babies examined using the ATLFF. Relatively few babies (13.3%) scored as ‘function impaired’ or ‘acceptable’ (3.5%), and many more scored as ‘perfect’ (28%). However, a major flaw of the tool is that 55.2% of the scores of babies did not fall into any of the three categories.

During the study, we communicated with Ms. Hazelbaker about the ATLFF scoring system, and queried the high number babies who did not fall into any of

Conclusion

We describe the findings of ATLFF examinations of 148 tongue-tied newborn babies. The ATLFF did not classify the score of 55% of the babies, which is a major limitation of the tool. The development and testing of a useful tool to determine which tongue-tied babies will have difficulty with breast feeding remains a research priority.

Acknowledgement

This study was funded by the HealthPartners Research Foundation.

References (7)

  • L.A. Amir et al.

    Review of tongue-tie release at a tertiary maternity hospital

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  • Ballard, J., Chantry, C., Howard, C. R., 2004. Academy of Breastfeeding Medicine Clinical Protocol #11: Guidelines for...
  • J.L. Ballard et al.

    Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad

    Pediatrics

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There are more references available in the full text version of this article.

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