Lingual Frenulum Function (Ankyloglossia)
Assessment of feeding and screening for ankyloglossia (tongue-tie) may be considered in breast or bottle-fed infants in response to concerns regarding feeding adequacy, feeding as a positive experience, development and efficiency.
Controversy exists regarding the clinical significance of ankyloglossia (Canadian Paediatric Society, 2015). Current evidence suggests that most newborns with ankyloglossia are able to breastfeed successfully. However, there is less evidence regarding the role of ankyloglossia in infants who are not breastfed and have feeding difficulties (Francis, Krishnaswami, & McPheeters, 2015).
Practical objective criteria for diagnosing ankyloglossia have yet to be validated, partially due to the lack of a universally accepted definition of ankyloglossia. The Canadian Paediatric Society recommends a thorough intraoral examination, including evaluation of tongue structure and function be performed in newborns with feeding difficulties to rule out other oral anomalies that may be contributing to breastfeeding difficulties (Canadian Paediatric Society, 2015). This recommendation is endorsed in the Alberta Health Services’ Ankyloglossia: Assessment and Treatment in Newborns Clinical Practice Tool, which states a diagnosis of a tongue-tie may not be made prior to completion of an infant feeding assessment and lingual frenulum functional assessment.
Validated methods are recommended for assessing, interpreting, and reporting results of an infant feeding assessment and lingual frenulum functional assessment, and a thorough intraoral examination, including evaluation of tongue structure and function is recommended for all children. The Hazelbaker Assessment Tool for Lingual Frenulum Function TM© (HATLFFTM©) has been recommended by Alberta Health Services. If using this tool, the following should be considered:
- The HATLFFTM© is a screening tool (insufficient as a predictor of breastfeeding outcomes)
- The HATLFFTM© is highly operator dependent and should be completed by a health professional who has completed requisite administration training (training and experience greatly impacts validity of this tool)
- The HATLFFTM© should be considered in its entirety, including interpretation and recommendations
Ankyloglossia: Assessment and Treatment in Newborns (AHS Staff Login required)
MyHealth.Alberta.ca: Tongue Tie