{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:43:02Z","timestamp":1779165782854,"version":"3.51.4"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004212","name":"P\u00e4ivikki ja Sakari Sohlbergin S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100004212","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018862","name":"Korvatautien Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100018862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008488","name":"Stiftelsen Alma och K. A. Snellman S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100008488","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008488","name":"Stiftelsen Alma och K. A. Snellman S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100008488","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008723","name":"Suomen L\u00e4\u00e4ketieteen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100008723","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007417","name":"Paulon S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100007417","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005744","name":"Lastentautien Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100005744","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ankyloglossia may restrict newborn infant\u2019s tongue movements, complicating breastfeeding. However, due to lacking evidence-based guidelines, patient selection for early frenotomy has remained a challenge. The present prospective, observation study validated a scoring aimed to detect infants who required early tongue-tie treatment. It is a part of the Lingual Frenulum in Newborn Infants (LINNE) project, investigating tongue-tie epidemiology along with a randomized treatment trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Healthy mother-infant-dyads were assessed by independent and mutually blinded study physicians and midwives. They used the LINNE scoring, including: 1. Infant examination using a picture assessment tool for tongue-tie in breastfed babies (TABBY); 2. Maternal breastfeeding experience scoring (MBES), a psychometric testing on acute breastfeeding symptoms; 3. Three anamnestic factors associated with tongue-ties and breastfeeding problems. Validation tests were conducted using the Cronbach alpha for the whole LINNE scoring, and for the subscorings: 1. TABBY: areas under the curve (AUC), multi-rater Fleiss kappa; 2. MBES: content and construct validity and responsiveness tests; 3. Anamnesis: accuracy studies for diagnostic tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the studied 556 mother-infant-dyads, 72 (12.9%) infants fulfilled the early tongue-tie treatment criteria. The overall LINNE scoring\u2019s internal consistency was acceptable (alpha\u2009=\u20090.723). The pooled TABBY scoring (n\u2009=\u20091094) accurately detected the need for treatment (AUC\u2009=\u20090.914, 95%CI 0.891\u20130.938) with moderate inter-rater agreement (kappa\u2009=\u20090.441, 95%CI 0.406\u20130.477). MBES responsiveness, content, and construct validities reached the required levels. Anamnestic factors had high specificity but fair sensibility for the tongue-tie causing breastfeeding symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The LINNE scoring demonstrated moderate inter-rater agreement; however, the accuracy of the TABBY tool was very good with AUC 0.9 for ankyloglossia needing early treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338491","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T18:29:46Z","timestamp":1765304986000},"page":"e0338491","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tongue-tie diagnosis using the Lingual frenulum in newborn infants (LINNE) -scoring: A validation study"],"prefix":"10.1371","volume":"20","author":[{"given":"Anu","family":"Lehtinen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venla","family":"Lohi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stiina","family":"Aitamurto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8267-8621","authenticated-orcid":true,"given":"Outi","family":"Aikio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"pone.0338491.ref001","unstructured":"World Health Organization. Guidelines on Infant Feeding 2020; Principles and recommendations for infant feeding in the global context and a summary of evidence. 2023 Dec 20."},{"issue":"10","key":"pone.0338491.ref002","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1016\/j.ijporl.2015.07.033","article-title":"Breastfeeding difficulties and oral cavity anomalies: The influence of posterior ankyloglossia and upper-lip ties","volume":"79","author":"SM Pransky","year":"2015","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"5","key":"pone.0338491.ref003","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1111\/apa.16289","article-title":"Systematic review of the evidence for resolution of common breastfeeding problems-Ankyloglossia (Tongue Tie)","volume":"111","author":"TL Bruney","year":"2022","journal-title":"Acta Paediatr"},{"issue":"12","key":"pone.0338491.ref004","doi-asserted-by":"crossref","first-page":"2502","DOI":"10.1111\/apa.15473","article-title":"Symptoms of problematic feeding in infants under 1 year of age undergoing frenotomy: A review article","volume":"109","author":"RR Hill","year":"2020","journal-title":"Acta Paediatr"},{"issue":"3","key":"pone.0338491.ref005","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.jped.2018.12.013","article-title":"Evaluation of the lingual frenulum in newborns using two protocols and its association with breastfeeding","volume":"96","author":"CM Araujo M da","year":"2020","journal-title":"J Pediatr (Rio J)"},{"issue":"2","key":"pone.0338491.ref006","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2024-067605","article-title":"Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report","volume":"154","author":"J Thomas","year":"2024","journal-title":"Pediatrics"},{"issue":"10017","key":"pone.0338491.ref007","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S0140-6736(15)01024-7","article-title":"Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect","volume":"387","author":"CG Victora","year":"2016","journal-title":"Lancet"},{"issue":"11","key":"pone.0338491.ref008","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.adaj.2022.07.011","article-title":"Prevalence of ankyloglossia according to different assessment tools: A meta-analysis","volume":"153","author":"PV Cruz","year":"2022","journal-title":"J Am Dent Assoc"},{"issue":"1","key":"pone.0338491.ref009","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1002\/ped4.12416","article-title":"A cross-sectional study of breastfed infants referred for tongue tie assessment and frenotomy in one Canadian health region","volume":"8","author":"TA Lee","year":"2024","journal-title":"Pediatr Investig"},{"issue":"5","key":"pone.0338491.ref010","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1002\/lary.26306","article-title":"Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study","volume":"127","author":"BA Ghaheri","year":"2017","journal-title":"Laryngoscope"},{"issue":"2","key":"pone.0338491.ref011","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jpedsurg.2017.11.014","article-title":"Long-term efficacy of a tongue tie service in improving breast feeding rates: A prospective study","volume":"53","author":"J Billington","year":"2018","journal-title":"J Pediatr Surg"},{"key":"pone.0338491.ref012","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/j.1440-1754.2005.00604.x","article-title":"Randomized, controlled trial of division of tongue-tie in infants with feeding problems","volume":"41","author":"M Hogan","year":"2005","journal-title":"J Paediatr Child Health"},{"issue":"2","key":"pone.0338491.ref013","doi-asserted-by":"crossref","first-page":"88","DOI":"10.5694\/mja17.00438","article-title":"Frenotomy for tongue-tie in Australian children, 2006-2016: an increasing problem","volume":"208","author":"V Kapoor","year":"2018","journal-title":"Med J Aust"},{"issue":"5","key":"pone.0338491.ref014","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1136\/archdischild-2014-306211","article-title":"Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance","volume":"100","author":"RF Power","year":"2015","journal-title":"Arch Dis Child"},{"issue":"10","key":"pone.0338491.ref015","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1001\/jamaoto.2017.0948","article-title":"Diagnosis and Treatment of Ankyloglossia in Newborns and Infants: A Review","volume":"143","author":"J Walsh","year":"2017","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"5","key":"pone.0338491.ref016","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1177\/0194599820915457","article-title":"Clinical Consensus Statement: Ankyloglossia in Children","volume":"162","author":"AH Messner","year":"2020","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"6","key":"pone.0338491.ref017","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-0660","article-title":"Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review","volume":"135","author":"S Chinnadurai","year":"2015","journal-title":"Pediatrics"},{"issue":"12","key":"pone.0338491.ref018","first-page":"1902","article-title":"Ankyloglossia as a Barrier to Breastfeeding: A Literature Review","volume":"10","author":"E Tomara","year":"2023","journal-title":"Children (Basel)"},{"key":"pone.0338491.ref019","unstructured":"Hazelbaker A. The Assessment Tool for Lingual Frenulum Function (ATLFF):Use in a lactation consultant private practice. 1993."},{"issue":"1","key":"pone.0338491.ref020","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1746-4358-1-3","article-title":"Reliability of the hazelbaker assessment tool for lingual frenulum function","volume":"1","author":"LH Amir","year":"2006","journal-title":"Int Breastfeed J"},{"issue":"4","key":"pone.0338491.ref021","first-page":"259","article-title":"Ankyloglossia (tongue-tie): a diagnostic and treatment quandary","volume":"30","author":"LA Kotlow","year":"1999","journal-title":"Quintessence Int"},{"issue":"4","key":"pone.0338491.ref022","doi-asserted-by":"crossref","DOI":"10.1136\/archdischild-2014-307503","article-title":"The development of a tongue assessment tool to assist with tongue-tie identification","volume":"100","author":"J Ingram","year":"2015","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"pone.0338491.ref023","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13006-019-0224-y","article-title":"The development and evaluation of a picture tongue assessment tool for tongue-tie in breastfed babies (TABBY)","volume":"14","author":"J Ingram","year":"2019","journal-title":"Int Breastfeed J"},{"key":"pone.0338491.ref024","article-title":"Congenital tongue-tie and its impact on breastfeeding","author":"E Coryllos","year":"2004","journal-title":"Am Acad Pediatr"},{"key":"pone.0338491.ref025","doi-asserted-by":"crossref","first-page":"103843","DOI":"10.1016\/j.midw.2023.103843","article-title":"The German version of the Bristol breastfeeding assessment tool: A validation study","volume":"127","author":"M Pujos","year":"2023","journal-title":"Midwifery"},{"issue":"7","key":"pone.0338491.ref026","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1093\/pch\/pxx112","article-title":"Changes in the incidence and surgical treatment of ankyloglossia in Canada","volume":"22","author":"Canadian Perinatal Surveillance System (Public Health Agency of Canada)","year":"2017","journal-title":"Paediatr Child Health"},{"issue":"10","key":"pone.0338491.ref027","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1001\/jamaoto.2017.0948","article-title":"Diagnosis and Treatment of Ankyloglossia in Newborns and Infants: A Review","volume":"143","author":"J Walsh","year":"2017","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"pone.0338491.ref028","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ijporl.2018.07.045","article-title":"A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study","volume":"113","author":"B Dixon","year":"2018","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"pone.0338491.ref029","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1038\/s41390-023-02784-y","article-title":"Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis","volume":"95","author":"H Cordray","year":"2024","journal-title":"Pediatr Res"},{"issue":"3","key":"pone.0338491.ref030","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/apa.16609","article-title":"Severity and prevalence of ankyloglossia-associated breastfeeding symptoms: A systematic review and meta-analysis","volume":"112","author":"H Cordray","year":"2023","journal-title":"Acta Paediatr"},{"key":"pone.0338491.ref031","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988","edition":"2"},{"key":"pone.0338491.ref032","doi-asserted-by":"crossref","DOI":"10.1002\/0471445428","volume-title":"Statistical methods for rates and proportions","author":"J Fleiss","year":"2003","edition":"3"},{"key":"pone.0338491.ref033","unstructured":"Laerd Statistics. Fleiss\u2019 kappa in SPSS Statistics. In: Laerd Statistics. Fleiss\u2019 kappa using SPSS Statistics. Statistical tutorials and software guides. 2019."}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T18:29:53Z","timestamp":1765304993000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338491"}},"subtitle":[],"editor":[{"given":"Prita Abhay","family":"Dhaimade","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,9]]},"references-count":33,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0338491","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,9]]}}}