Reliability of the hazelbaker assessment tool for lingual frenulum function

Lisa H Amir, Jennifer P James, Susan M Donath, Lisa H Amir, Jennifer P James, Susan M Donath

Abstract

Background: About 3% of infants are born with a tongue-tie which may lead to breastfeeding problems such as ineffective latch, painful attachment or poor weight gain. The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) has been developed to give a quantitative assessment of the tongue-tie and recommendation about frenotomy (release of the frenulum). The aim of this study was to assess the inter-rater reliability of the HATLFF.

Methods: Fifty-eight infants referred to the Breastfeeding Education and Support Services (BESS) at The Royal Women's Hospital for assessment of tongue-tie and 25 control infants were assessed by two clinicians independently.

Results: The Appearance items received kappas between about 0.4 to 0.6, which represents "moderate" reliability. The first three Function items (lateralization, lift and extension of tongue) had kappa values over 0.65 which indicates "substantial" agreement. The four Function items relating to infant sucking (spread, cupping, peristalsis and snapback) received low kappa values with insignificant p values. There was 96% agreement between the two assessors on the recommendation for frenotomy (kappa 0.92, excellent agreement). The study found that the Function Score can be more simply assessed using only the first three function items (ie not scoring the sucking items), with a cut-off of </=4 for recommendation of frenotomy.

Conclusion: We found that the HATLFF has a high reliability in a study of infants with tongue-tie and control infants.

Figures

Figure 1
Figure 1
Dot-plot of new Function Score.

References

    1. Ballard JL, Auer CE, Khory JC. Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110:e63. doi: 10.1542/peds.110.5.e63.
    1. Ballard J, Chantry C, Howard CR. ABM Clinical Protocol #11: Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad
    1. Marmet C, Shell E, Marmet R. Neonatal frenotomy may be necessary to correct breastfeeding problems. J Hum Lact. 1990;6:117–121.
    1. Notestine GE. The importance of the identification of ankyloglossia (short lingual frenulum) as a cause of breastfeeding problems. J Hum Lact. 1990;6:113–115.
    1. Nicholson WL. Tongue-tie (ankyloglossia) associated with breastfeeding problems. J Hum Lact. 1991;7:82–84.
    1. Jain E. Tongue-tie: its impact on breastfeeding. AARN News Lett. 1995;51:18.
    1. Lalakea ML, Messner AH. Ankyloglossia: does it matter? Pediatr Clin North Am. 2003;50:381–397. doi: 10.1016/S0031-3955(03)00029-4.
    1. Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health. 2005;41:246–250. doi: 10.1111/j.1440-1754.2005.00604.x.
    1. The Royal Women's Hospital Clinical Practice Guideline: Management of infants with tongue-tie
    1. Griffiths DM. Do tongue ties affect breastfeeding? J Hum Lact. 2004;20:409–414. doi: 10.1177/0890334404266976.
    1. Amir LH, James JP, Beatty J. Review of tongue-tie release at a tertiary maternity hospital. J Paediatr Child Health. 2005;41:243–245. doi: 10.1111/j.1440-1754.2005.00603.x.
    1. Woolridge MW. The 'anatomy' of infant sucking. Midwifery. 1986;2:164–171. doi: 10.1016/S0266-6138(86)80041-9.
    1. Neifert MR. Breastmilk transfer: positioning, latch-on, and screening for problems in milk transfer. Clin Obstet Gynecol. 2004;47:656–675. doi: 10.1097/01.grf.0000136183.12304.96.
    1. Langton D, Ramsay D, Jacobs S, Gollow I, Simmer K. Efficacy of frenulotomy for ankyloglossia in breast-fed infants. Perinatal Society of Australia and New Zealand, 8th Annual Congress, Sydney, Australia. 2004. p. 44.
    1. Hazelbaker AK. The assessment tool for lingual frenulum function (ATLFF): Use in a lactation consultant private practice. Pasadena, California, Pacific Oaks College; 1993.
    1. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. 2nd. Boston, Little, Brown and Company; 1991.
    1. Streiner DL, Norman GR. Health Measurement Scales: A Practical Guide to their Development and Use. Oxford, Oxford University Press; 2001.
    1. Ricke LA, Baker NJ, Madlon-Kay DJ, DeFore TA. Newborn tongue-tie: prevalence and effect on breast-feeding. J Am Board Fam Pract. 2005;18:1–7.
    1. Bandolier Tongue-tie: ankyloglossia. Bandolier "Evidence based thinking about health care". 2004;124:2.
    1. Srinivasan A, Feldman P. Ankyloglossia in breastfeeding infants: new and existing evidence about frenotomy and maternal nipple pain: ; Chicago, USA. International Location Consultant Association Conference and Annual Meeting, Chicago, USA. 2005. pp. 139–142.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever