The components of the tool are relevant for a wide age range of infants and are also sensitive to the subtle changes that are important for improving breast feeding following frenotomy. It is simple to use whilst giving details of positioning and attachment skills. The mother-reported comfort aspects of breast feeding are important, but less consistent results were shown when including them within the midwife-observed breast feeding assessment items of the tool, and we concluded that comfort should be recorded as a separate score linked to pain.