Table 1

Hazelbaker Assessment Tool for Lingual Frenulum Function (1998 version)

Appearance Items

Appearance of tongue when lifted
     2: Round OR square
     1: Slight cleft in tip apparent
     0: Heart-shaped
Elasticity of frenulum
     2: Very elastic (excellent)
     1: Moderately elastic
     0: Little OR no elasticity
Length of lingual frenulum when tongue lifted
     2: More than 1 cm OR embedded in tongue
     1: 1 cm
     0: Less than 1 cm
Attachment of lingual frenulum to tongue:
     2: Posterior to tip
     1: At tip
     0: Notched tip
Attachment of lingual frenulum to inferior alveolar ridge
     2: Attached to floor of mouth OR well below ridge
     1: Attached just below ridge
     0: Attached at ridge

Function Items

Lateralization
     2: Complete
     1: Body of tongue but not tongue tip
     0: None
Lift of tongue
     2: Tip to mid-mouth
     1: Only edges to mid-mouth
     0: Tip stays at alveolar ridge or rises to mid-mouth only with jaw closure
Extension of tongue:
     2: Tip over lower lip
     1: Tip over lower gum only
     0: Neither of above, OR anterior or mid-tongue humps
Spread of anterior tongue
     2: Complete
     1: Moderate OR partial
     0: Little OR none
Cupping
     2: Entire edge, firm cup
     1: Side edges only, moderate cup
     0: Poor OR no cup
Peristalsis:
     2: Complete, anterior to posterior (originates at the tip)
     1: Partial: originating posterior to tip
     0: None OR reverse peristalsis
Snapback
     2: None
     1: Periodic
     0: Frequent OR with each suck

© Alison K. Hazelbaker, MA, IBCLC July 1 1998

14 = Perfect score (regardless of Appearance Item score)

11 = Acceptable if Appearance Item score is 10

<11 = Function impaired. Frenotomy should be considered if management fails. Frenotomy necessary if Appearance Item score is <8.

Amir et al. International Breastfeeding Journal 2006 1:3   doi:10.1186/1746-4358-1-3