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Table 1 Guidance on the use of the TABBY (Tongue-tie and Breastfed Babies) assessment tool

From: The development and evaluation of a picture tongue assessment tool for tongue-tie in breastfed babies (TABBY)

TABBY category Guidance on use of TABBY
What does the tongue-tip look like This is usually the most obvious and most likely to be noted by parents. A notch in the tip of the tongue may only be noticed when the baby lifts the tongue.
Where it is fixed to the gum? With some training and experience this can be assessed visually. If it is difficult to see, then the assessor can [with parental consent] gently use their index finger to feel where the frenulum is attached.
How high can it lift (wide open mouth)? This can be the most difficult to teach. The assessor needs awareness of normal tongue lift in infants.
The tongue may curl back when restricted and so appear to lift. The lift is most easily viewed if the infant is awake and crying. If the baby is not awake, then the assessor can digitally lift the tongue to assess.
How far can it stick out? This is not always easy to assess in newborn infants. It can be helpful to ask parents what they have noticed, and the pictures can be helpful in discussing this. The easiest way to assess protrusion is to watch the baby as they latch to the breast; are they able to bring the tongue out to latch?