OBJECTIVE: To describe the importance of a speech pathology intervention in a neonate with a short lingual frenulum in the pediatric intensive care unit (ICU). CASE REPORT: The child was hospitalized in the pediatric ICU due to a congenital heart disease termed as Tetralogy of Fallot. A speech pathology clinical evaluation was performed on the second day of hospitalization, when the child was 13 days old. This evaluation was requested for by the medical staff due to breastfeeding complaints. In the oral sensory-motor assessment, suction, search, bite, and gag reflexes were present and were found to be adequate. In the nutritive sucking evaluation, the child presented with proper oral opening but showed difficulty gripping the mother's breast. When the bottle was presented, the child showed good acceptance with adequate sucking and coordination of sucking, breathing, and swallowing. The structural evaluation of the speech organs showed anterior fixation of the lingual frenulum. The neonate had decreased tongue mobility and difficulty sucking on the mother's breast. The feeding of the child was observed during 13 speech pathology interventions, primarily without the use of a silicon intermediate nozzle and using this instrument. CONCLUSION: One of the tools available for speech pathology therapy is the silicon intermediate nozzle. Even though its use is restricted in some hospitals, this device proved to be essential. It is important to highlight the importance of speech pathology evaluations and orientation in the pediatric ICU, as in the present case. After the intervention with specific instruments, the child presented with a good grip and effective sucking; thus, providing all the benefits of breastfeeding to the mother and her child.