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The development of a tongue assessment tool to assist with tongue-tie identification
  1. Jenny Ingram1,
  2. Debbie Johnson1,
  3. Marion Copeland2,
  4. Cathy Churchill3,
  5. Hazel Taylor4,
  6. Alan Emond1
  1. 1School of Social and Community Medicine, University of Bristol, Bristol, UK
  2. 2Midwifery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
  3. 3Neonatal Intensive Care Unit, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
  4. 4R&I, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Jenny Ingram, Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, UK; jenny.ingram{at}


Aim To produce a simple tool with good transferability to provide a consistent assessment of tongue appearance and function in infants with tongue-tie.

Methods The Bristol Tongue Assessment Tool (BTAT) was developed based on clinical practice and with reference to the Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF). This paper documents 224 tongue assessments using the BTAT. There were 126 tongue assessments recorded using the BTAT and ATLFF tools to facilitate comparisons between them. Paired BTAT assessments were obtained from eight midwives who were using the new assessment tool.

Results There was acceptable internal reliability for the four-item BTAT (Cronbach's α=0.708) and the eight midwives who used it showed good correlation in the consistency of its use (ICC=0.760). The BTAT showed a strong and significant correlation (0.89) with the ATLFF, indicating that the simpler BTAT could be used in place of the more detailed assessment tool to score the extent of a tongue-tie. Midwives found it quick and easy to use and felt that it would be easy to teach to others.

Conclusions The BTAT provides an objective, clear and simple measure of the severity of a tongue-tie, to inform selection of infants for frenotomy and to monitor the effect of the procedure.

  • frenotomy
  • breastfeeding

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