TABBY: Is Easier Better?

At what point does easy become complex? I recall, from my consultations with Ingram and colleagues when they were formulating the BTAT, that they were looking for a tongue-tie screening process that would take less time for the midwives to perform in the clinic. They then extracted certain elements from the ATLFF™© to make the process easier. Evidently, the BTAT was not enough to enable clinicians to diagnose tongue-tie easily and accurately because they have now augmented their BTAT with the TABBY, the pictorial tongue-tie assessment tool for tongue-tie in breastfed babies.

The TABBY must be used in conjunction with a structured breastfeeding assessment to serve as a frenotomy decision rule. Does it accomplish this task with objectivity and reliability? The authors claim that it does. They suggest that its strengths are “…it is easy to use, and it provides a visual aid to help the assessor be clear about crucial features of the tongue tie…” (Ingram et al., 2019).

Its weakness: “…it cannot be used alone to select infants for frenotomy as it does not include any assessment of feeding, for which a separate evaluation is needed using a structured tool…” (Ingram et al., 2019). So what was intended to be easy has, in fact, become quite complex. Now two or more tools and processes are needed instead of the one process of screening with the ATLFF™©. The ATLFF™© has always accurately screened tongue-tie in infants under six months regardless of feeding method. The ATLFF™© is a stand-alone tool that accurately identifies tongue-tie without having to include other structured assessments. Its scoring rules serve as a built-in frenotomy decision rule. Ingram et al. are reinventing the wheel.

Ingram, J., Copeland, M., Johnson, D. & Emond, A. (2019). The development and evaluation of a picture tongue assessment tool for tongue-tie in breastfed babies (TABBY). International Breastfeeding Journal. 14:31,

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