Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Diane Saleska


Diane Saleska

Cathy Koetting

Laura Kuensting


Problem Ankyloglossia occurs when the tongue cannot extend past the gums or lips due to frenulum restriction. In breast feeding, proper movement of the tongue around the nipple is hindered causing difficulty for the infant to obtain a proper latch. This may result in slow weight gain (SWG), failure to thrive (FTT), and dehydration due to poor milk production. Evaluating for ankyloglossia is difficult, however, the Hazelbaker Ankyloglossia Tool for Lingual Frenulum Function (HATLFF) may be of benefit.

Method Observational descriptive design utilizing a retrospective medical record review. The HATLFF was utilized in full term neonates suspected of ankyloglossia in a mid-western suburban primary care practice from February 28-April 8, 2022. Birth weights and one-month weights were recorded.

Results Total sample size was nine (N=9). Ankyloglossia was not impacted by gender or race (χ2(1) = 0.32, p = .571). The mean appearance score was 5.44 (SD=1.59), mean function score was 3.44 (SD=1.01), and mean total score was 8.89 (SD=2.09). The mean weight gain for infants who underwent a frenotomy was 4.5 kg (SD=0.48 kg) at the one-month visit. The relationship between birth weight and one-month weight was weak (r=-.06).

Conclusion The HATLFF assisted providers in determining need for frenotomy. All infants who underwent frenotomy demonstrated adequate weight gain by one-month of age. The HATLFF instrument may be a useful tool for determining the need for frenotomy, however, maternal comfort may also need to be considered.