• Dr Kate Naylor

How do you assess my baby for tongue tie?

Updated: Aug 24, 2020

First of all, what IS a tongue tie?

It's important to know that everyone has a small fold of the skin under their tongue, which is sometimes called a "lingual frenulum". When describing this to parents, we used to call this a "tight band", or a "cord", but new anatomical information reveals it is actually just a fold of the mucosa lining the floor of the mouth.


Some babies are born with a particularly tight frenulum under their tongue. But this doesn't always require treatment, it really just depends on how much this restricts their tongue movement. Studies indicate that the incidence of tongue tie is between 4-11% of infants. However the studies are hard to compare, as there have historically been inadequate numbers of infants studied, and a variable use of diagnostic criteria. To this day, there is controversy over the "definition" of tongue tie.


I often hear of Mums being told their baby has "a bit of a tongue tie" or a "minor tongue tie". Regardless of how this baby's lingual frenulum looks, it's really the tongue's function that is important. If the mothers nipples are sore and cracked, and the breastfeeding is getting really hard over days and weeks, it is important to assess the baby's tongue for tongue tie.


How do I assess for tongue tie?

There exist 2-3 commonly used scoring systems for tongue tie assessment. I tend to use the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), formulated by Dr Alison Hazelbaker in the USA. This has been found to be highly reliable in a study done by Melbourne GP Lactation Consultant and researcher Dr Lisa Amir and her colleagues. See the study results here.


I have been using the HATLFF tool for so long that it is now an innate part of my assessment, and I can show you the different elements of this during our consultation if required. Basically, if the baby scores highly enough, then tongue tie causing restriction of tongue mobility is very likely and frenotomy (the procedure of cutting the lingual frenulum with small, sharp scissors) is indicated.

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