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Design and development of the "neonatal tongue screening test" website/Elaboracao e desenvolvimento de um website sobre o teste da linguinha.


In Brazil, the federal law 13.002 passed in 2014 [1] states that all newborns in the country must undergo lingual frenulum assessment using the "Neonatal Tongue Screening Test" (NTST) before hospital discharge.

The NTST [2,3]--administered within 48 hours after birth--consists of the anatomo-functional evaluation of the "Lingual Frenulum Protocol for Infants"--LFPI [2,3].

The LFPI is a validated tool that assists with the diagnosis of movement restriction of the tongue due to frenulum alterations.

Although the law 13.002 has been passed, there are still newborns that do not undergo lingual frenulum assessment for several reasons. Educational actions could contribute for demonstrating the society the importance of early assessment to diagnose any tongue movement restriction that may interfere with the oral functions such as breastfeeding, chewing, swallowing, and speech.

Based on this reality, a website with useful information on the consequences of lingual frenulum alterations can be an effective tool to increase the knowledge of the population about the importance of the NTST.

The "World Wide Web"--abbreviated WWW or the Web--is an information space where resources and documents are identified by Uniform Resource Locators (URLs), interlinked by hypertext links, and accessed via the Internet [4].

The use of internet has grown allowing the population to easily access information. The internet has become an important channel of knowledge dissemination. All fields, including health, have implemented technological resources to promote health education; thus, internet is an excellent platform to spread knowledge [5-9].

To provide objectivity, reliability, and credibility of health information, "Health on the Net Code of Conduct" (HONcode) was created. The HONcode is a conduct code to guide web developers on how to design medicine and health websites by establishing principles to be followed [10]. When designing electronic media, ethical standards must be considered so the quality of content is reliable and the patients are not harmed [8].

The "Babies'Portal" was the first website to include guidelines on the NTST. The contents were evaluated by parents/caregivers and speech language pathologists. Concerning readability, both groups considered the content optimum, and there were positive results regarding the ownership, classification of purpose, authorship, author qualification, attribution, interactivity and updates [11,12].

The aim of this study was to design the "Teste da Linguinha" (The Neonatal Tongue Screening Test) website to provide information about assessment and consequences of lingual frenulum alterations.


This is an applied research based on the active development of a website with the purpose of providing information about the NTST. Since the study does not involve human participants, ethical approval was not required.

Designed by a team of Speech Language Pathologists and professionals from the computing field, the website provides reliable scientific-based information that can be accessed using tablet, cellular phones and/or computers, without losing functionality.

The development of this study consisted of 3 stages: conceptualization, development and implementation.

The conceptualization stage included the following definitions: the target audience, the aim, the analysis and the definition of the content based on a literature review on tongue-tie, infants' lingual frenulum assessment, and frenotomy [2,3,13-19]. Subsequently, the website content was defined and organized. Texts and topics were written in plain language to ensure the reader understands as quickly, easily, and completely as possible.

Videos and images--with prior written authorization --were also added to the website for a better understanding of the content.

To guarantee the content quality of the website, the principles proposed by the HONcode were adopted [10]. The eight HONcode principles aimed to respect ethical and transparency criteria are: Authoritative, Complementarity, Privacy, Attribution, Justifiability, Transparency, Financial disclosure, and Advertising policy.

The development stage of the website consisted of the final project for earning a Bachelor's Degree in Computer Engineering at the Computer Systems Department of the Institute of Mathematical and Computer Sciences (ICMC-USP)--Web Development and Software Testing--from the University of Sao Paulo [20].

A computer with a Mac OS operating system was used. A text editor, scanner, and image editor were used for the web page development (text, images and animations).

The text editor used for the construction of the Web pages was Sublime Text. Chrome was the browser used to test the pages.

The implementation phase consisted of publishing the website on the World Wide Web (WWW).

Finally, the domain was registered, a commercial internet service provider was contracted, and the information updated and published on the internet.


The "Teste da Linguinha" website was published and has a registered domain. It is available at the electronic address

The content of the website--designed for parents/ caregivers and health professionals--offers scientific information on tongue-tie and the NTST.

The website has a responsive web design to allow desktop web page to be viewed in response to the size of the screen--tablet, smartphones--or web browser, without losing functionality. Responsive web design has become important as the amount of mobile traffic accounts for more than half of total internet traffic.

The website homepage contains 5 menus: about the test, photos, contact, downloads and FAQ.

It is also provides access to Law 13.002, as well as to the documents provided by the Federal Speech Therapy Council and the Brazilian Society of Speech Therapy (Fig. 1).

The item "About the test" (Sobre o teste) provides tongue-tie definition, possible consequences of tongue-tie and more info. The item "Photos" (Fotos) provides photos. The item "Contact" (Contato) provides an e-mail form to visitors to the website who want to contact. The item "Downloads" contains links to official documents and scientific research. The item "FAQ" lists questions and answers commonly asked. The menu items follow a didactic order in order to assist the understanding of information.

There is a scrollbar on the sides of the pages to help users interact with the content and flags that show the selected tab.


Since studies report that the internet consists of a relevant source of information on health [21], and an increased number of people have been looking for this kind of information on the internet, we decided to design a website to spread knowledge about the importance of The Neonatal Tongue Screening Test.

Given that the content of the website is designed for parents, caregivers, health professionals, and general audience, the texts are written in plain language for clearly communicating health information and keeping website engagement.

Additionally, the color scheme chosen for the website were: blue, light pink, black and white. The choice of the website colors was based on the literature [22] that reports about the influence of colors on public acceptance and response to the website.

Given the benefits to using video in education and the connection between visual clues, the memory process, and the recall of new knowledge reported in the literature, the website included videos, images and illustrations to facilitate learning [23-25].

The "Teste da Linguinha" website is a relevant tool since it provides basic information on tongue-tie and on the importance of early assessment to diagnose any tongue movement restriction that may interfere with the oral functions such as breastfeeding, chewing, swallowing, and speech.

Future studies aiming to evaluate the content presentation and quality of the "Teste da Linguinha" website as well as possible translations of the content into English and Spanish may contribute for increasing the number of users.


The "Teste da Linguinha" website was developed and can be accessed by entering the web address:

doi: 10.1590/1982-021620171923917


[1.] Martinelli RLC. Relacao entre as caracteristicas anatomicas do frenulo lingual e as funcoes de succao e degluticao em bebes [dissertacao]. Bauru: Faculdade de Odontologia de Bauru, Universidade de Sao Paulo; 2013.

[2.] Martinelli RLC. Validacao do Protocolo de avaliacao do frenulo da lingua em bebes [tese]. Bauru: Faculdade de Odontologia de Bauru, Universidade de Sao Paulo; 2015.

[3.] Brasil. Presidencia da Republica. Lei no. 13.002 de 20 de junho de 2014. Obriga a realizacao do protocolo de avaliacao do frenulo lingual em bebes. Brasilia, DF; 2014 [acesso em: 2015 out. 11]. Disponivel em: ccivil_03/_Ato2011-2014/2014/Lei/L13002.htm.

[4.] Catledge LD, Pitkow JE. Characterizing browsing strategies in the World-Wide Web. Computer Networks and ISDN Systems. 1995; 27(6):1065-73.

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[7.] Correa CC, Pauleto ARC, Ferrari DV, BerretinFelix G. Website Babies Portal: development and evaluation of the contents regarding orofacial functions. J Appl Oral Sci. 2013; 21(6):581-9.

[8.] Chaves JN, Libardi AL, Agostinho-Pesse RS, Morettin M, Alvarenga KF. Telessaude: avaliacao de websites sobre triagem auditiva neonatal na Lingua Portuguesa. CoDAS. 2015; 27(6):526-33.

[9.] Medeiros HEGB, Leite CRM, Santos JF, Ribeiro Neto PF, Martinelli RLC, Cavalcanti RVA. Sistema de apoio a decisao na realizacao e no acompanhamento do teste da linguinha. Rev Bras Comp Aplicada. 2016; 8(1):104-13.

[10.] Health on the Net Foundation. [homepage na internet]. Disponivel em: html. Acesso em: 14 de novembro de 2015.

[11.] Rizatto AJP, Correa CC, Martinelli RLC, BerretinFelix G. Nivel de legibilidade das secoes sobre o teste da linguinha no website portal dos bebes. Anais do XXIII Congresso Brasileiro e IX Congresso Internacional de Fonoaudiologia; 2015.

[12.] Rizatto AJP, Correa CC, Martinelli RLC, BerretinFelix G. Atualizacao e avaliacao da secao de motricidade orofacial do portal dos bebes. Anais do XXIII COFAB; p. 36; 2016.

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Victor Lopes de Castro Martinelli (1)

Roberta Lopes de Castro Martinelli (2)

Irene Queiroz Marchesan (2)

Giedre Berretin-Felix (3)

Simone do Rocio Senger de Souza (4)

(1) Instituto de Ciencias Matematicas e Computacao, Universidade de Sao Paulo, Sao Paulo, SP Brasil.

(2) CEFAC, Consultoria em Fonoaudiologia Clinica, Sao Paulo, SP, Brasil.

(3) Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru, Universidade de Sao Paulo, Bauru, SP, Brasil.

(4) Departamento de Sistemas de Computacao do ICMC Sao Carlos, Universidade de Sao Paulo, Sao Carlos, SP, Brasil.

Conflict of interest: non-existent

Received on: March 15, 2017

Accepted on: March 19, 2017

Mailing address:

Victor Lopes de Castro Martinelli Av. Angelo Piva, 331 Brotas--Sao Paulo CEP: 17380-000


Caption: Figure 1. Homepage of the "Teste da Linguinha" website
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Article Details
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Title Annotation:Original articles
Author:de Castro Martinelli, Victor Lopes; de Castro Martinelli, Roberta Lopes; Marchesan, Irene Queiroz; B
Publication:Revista CEFAC: Atualizacao Cientifica em Fonoaudiologia e Educacao
Article Type:Ensayo
Date:Mar 1, 2017
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