There were three objectives to performing a study on Frenotomy for Tongue-tie or ankyloglossia.

  • Determine the incidence rate of ankyloglossia.
  • Evaluate the Hazelbaker score and its usefulness. The Hazelbaker score is an assessment tool for lingual frenulum function. It is used to determine the degree of ankyloglossia and the need for treatment.
  • Measure the effectiveness of frenotomy for improved breast feeding.


Methods of the study included examinations of breast feeding babies, Hazelbaker assessments, treatment and follow-up.

Study Group:

The study group comprised of inborn breastfeeding infants as well as outpatients with breastfeeding problems.

Indications for Frenotomy:

A low Hazelbaker score in conjunction with breastfeeding problems are indications for Frenotomy. A hazelbaker score of < 11 for function and < 8 for appearance would be considered low. Breast feeding problems include ineffective latch, infant frustration at breast, low weight gain, and nipple pain.

Hazelbaker Scores:

The total Hazelbaker scores for appearance and function are the sums of several characteristic scores.

  • For Ineffective Latch
    • Function: 7.8 +/-1.8
    • Appearance: 4.8 +/- 1.8
  • For Nipple Pain
    • Function: 8.0 +/- 1.9
    • Appearance: 5.0 +/- 1.8

Ages for Frenotomy:

  • For poor latch - median age: 1.2 days (range 0.1-12)
  • For nipple pain - median age: 2.0 days (range 0.1-60)
  • P=0.0001

The results of the study indicate breastfeeding improvement and a decrease in pain following the procedure.

Anecdotal findings at 3-day follow-up:

Babies once failing to thrive are growing, some gaining 2 to 3 oz. per day. The mothers nipples showed signs of healing. Breast feeding time decreased from over 45 minutes on average to less than 20 minutes. Formula supplementations were no longer necessary in most cases.


Ankyloglossia accounts for a significant proportion of breastfeeding problems. Hazelbaker?s lingual assessment tool is useful for evaluating the severity of ankyloglossia and for selecting appropriate candidates for frenotomy. Frenotomy results in improved infant latch and decreased maternal nipple pain, thus facilitating breastfeeding success.

References :

References :
Jeanne L. Ballard, Christine E. Auer and Jane C. Khoury
Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the
Breastfeeding Dyad J Pediatrics 2002;110;63-DOI: 10.1542/peds.110.5.e63

About Dr. Ballard

Dr. Ballard is an associate professor of Pediatrics, Obstetrics and Gynecology at the University of Cincinnati College of Medicine. More ...