Author’s Reply

To the Editor: We appreciate the opportunity to reply to Alison Hazelbaker’s letter regarding our article, “Newborn Tongue-tie: Prevalence and Effect on Breast-Feeding” in the January–February issue of JABFP.

1. Four of the 5 appearance items in the ATLFF involve scoring the lingual frenulum. Many newborns have no visible lingual frenulum. We concluded, therefore, apparently incorrectly, that the ATLFF was designed to be used only on infants with the appearance of tongue-tie. We apologize for our error.

2. Because we knew our training time with Ms. Hazelbaker was limited, we videotaped her examining 4 babies (not 2 as stated in her letter.) We reviewed the videotape on later occasions and also contacted Ms. Hazelbaker with scoring questions.

3. The scoring information included in our article is correct but incomplete. Because our study did not include treatment decisions (ie, frenotomy), we did not include the portions of the scoring system related to management in our article. In our study, infants were identified as tongue-tied based on appearance only, as stated under Methods.

4. Ms. Hazelbaker had a copy of our study protocol. One of our study goals clearly was to test the usefulness of the ATLFF in identifying which tongue-tied infants were at risk for breast-feeding problems. She indicated support of our study by spending a day at our hospital educating our nursery nurses, training us, and corresponding with us when we had questions about the ATLFF. We were unaware of any objections to the study goals or methods.

   We were surprised and disappointed that the ATLFF did not turn out to be a useful tool. We greatly respect Ms Hazelbaker and her work on tongue-tie. However, we also stand by the integrity of our study.