Classification of ankyloglossia according to Kotlow (based on the "free tongue" length)_
| Normal, clinically acceptable range of "free tongue" >16mm | |
|---|---|
| Class 1: mild ankyloglossia | 12-16 mm |
| Class II: moderate ankyloglossia | 8-11 mm |
| Class III: severe ankyloglossia | 3-7 mm |
| Class IV: complete ankyloglossia | <3 mm |
Diagnostics of ankyloglossia according to Hazelbaker (Hazelbaker, The Assessment Tool for Lingual Frenulum Function)_
| Function items | Appearance items |
|---|---|
| Lateralization | Appearance of tongue when lifted |
| 2 – complete | 2– round or square |
| 1 – body of tongue but not tongue tip | 1 – slight cleft in tip apparent |
| 0–none | 0– heart-shaped |
| Lift of tongue | |
| 2–tip to mid-mouth | Elasticity of frenulum |
| 1 – only edges to mid-mouth | 2–very elastic |
| 0 – tip stays at alveolar ridge or tip rises | 1 – moderately elastic |
| to mid-mouth with jaw closure | 0 – little or no elasticity |
| Extension of tongue | Length of lingual frenulum when tongue lifted |
| 2–tip over lower lip | 2–>1 cm |
| 1 – tip over lower gum only | 1–1 cm |
| 0 – neither of the above or mid-tongue humps | 0–<1 cm |
| Spread of anerior tongue | Attachment of lingua frenulum to tongue |
| 2 – complete | 2 – posterior to tip |
| 1 – partial | 1 – at tip |
| 0– little or none | 0– notched |
| Cupping of tongue | Attachment of lingual frenulum to inferior alveolar ridge |
| 2 – entire edge, firm cup | 2 – attached to floor of mouth or well below ridge |
| 1 – side edges only, moderate cup | 1 – attached just below the ridge |
| 0 – poor or no cup | 0– attached at ridge |
| Peristalsis | |
| 2 – complete anterior to posterior (originates at tip) | |
| 1 – partial (orignates posteriori to tip) | |
| 0 – none or reverse peristalsis | |
| Snap-back | |
| 2 – none | |
| 1 – periodic | |
| 0 – frequent or with each suck | |
| Scoring: | |
| 14 – perfect score | |
| 11 – acceptable if appearance item score is 10 | |
| <11 – tongue function impaired (frenotomy should be considered) | |
| Frenotomy is necessary if function score is <11 and appearance score is <8 | |
Classification of ankyloglossia according to Coryllos_
| Type 1 | Fine and elastic frenulum; the tongue is anchored from the tip to the alveolar ridge and it is found to be heart-shaped |
|---|---|
| Type II | Fine and elastic frenulum; the tongue is anchored 2-4 mm from the tip near the alveolar ridge |
| Type III | Thick, fibrous non-elastic frenulum; the tongue is anchored from its middle to the floor of the mouth |
| Type IV | The frenulum cannot be seen but palpated; it has a fibrous and/or thick and shiny submucous anchoring from the base of the tongue to the floor of the month |
Infant Breastfeeding Assessment Tool (IBFAT)_
| 3 | 2 | 1 | 0 | |
|---|---|---|---|---|
| To get the baby to begin this feed, did you have to: | Just place the baby on the breast, as no effort was needed | Use mild stimulation, such as unbundling, patting, burping | Unbundle baby, sit baby back and forward, rub baby's body or limbs at the beginning and during the feed | Could not be aroused |
| Rooting (at touch of nipple to cheek, baby's head turns toward the nipple, the mouth opens, and baby attempts to fix mouth on the nipple) When the baby was placed at the breast he/she: | Rooted effectively at once. | Needed some coaxing, prompting/ /encouragement to root | Rooted poorly even with coaxing | Did not try to root |
| How long from placing baby he/she at the latch breast does on and start to feed well? | 0–3 minutes | 3–10 minutes | Over 10 minutes | Did latch not at all |
| Which of the following phrases best describes the baby's feeding pattern at this feed? | Sucked well on one or both breasts | Sucked fairly well (sucked off and on but needed some encouragement) | Sucked poorly, weak sucking, some sucking for short periods | Baby did not suck |
LATCH scale_
| 0 | 1 | 2 | Example questions | |
|---|---|---|---|---|
| L– latch | Too sleepy or reluctant No latch obtained | Repeated attempts Must hold nipple in mouth Must stimulate to suck | Grasps breast Tongue down and forward Lips flanged Rhythmic suckling | How did your baby grasp your breast? Did you baby suckle on his own or did you have to work with him? |
| A–audible swallow | None | A few with stimulation | Spontaneous | Did your you baby hear swallow? How frequently? |
| T– type of nipple | Inverted | Flat | Everted (after stimulation) | Do your nipples stand out or do they flatten easily? |
| C– comfort | Engorged Cracked, bleeding, large blisters or bruises Severe discomfort | Filling Small or bruises blisters Mother complains of pinching Mild/moderate discomfort | Soft Tender Intact nipples (no damage) | Are your nipples tender? Are your breasts becoming full and heavy? |
| H– hold | Full assist (Staff holds infant at breast) | Minimal assist (i.e. elevate head of bed, place pillows) Teach one side mother does other Staff help, mother takes over feeding | No assist from staff Mother able to position/ /hold infant | Did someone help you put your baby to breast? Do you need help with the next feeding? |