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

Diane J. Madlon-Kay, Lori A. Ricke, Nancy J. Baker, Terese A. DeFor

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)353-357
Number of pages5
Issue number3
StatePublished - Sep 2008

Bibliographical note

Funding Information:
This study was funded by the HealthPartners Research Foundation.


  • Ankyloglossia
  • Breast feeding
  • Tongue-tie


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