What is a lip-tie?

To put it simply it is a condition that restricts the upper lip.

You are born with it. You either have it or you don’t. A lip tie is when the band of tissue under the baby’s upper lip is too short or tight and is tethered, limiting the upper lip’s movement. That band of tissue is called the maxillary labial frenum (you can feel yours if you run your tongue between your upper lip and your front teeth right under your nose and the top of the gum).

 If the tissue is too tight it can interfere with breastfeeding. Babies who are having difficulty latching should be evaluated for lip and tongue ties.

Similar to lip-ties tongue-tie can cause feeding difficulties as well if a baby can’t get his/her lips around the nipple and areola. (The baby’s Lips should be able to form a proper seal around them.)


What does a lip-tie look like?

Lip-ties look different depending on the severity of the tie: a small, string-like appearance on one end of the spectrum, a wide, fanlike band of connective tissue on the other. Sometimes, babies with a lip tie also develop a callus on their upper lip.

The Kotlow classification system uses four grades to rate the frenulum based on appearance. With this system, the higher the grade, the higher the ‘severity’ of lip-tie, and the greater the likelihood of breastfeeding problems. (However, it should be noted that the utility of the Kotlow classification system has been recently questioned by some experts.)


Image from: The National Center for Biotechnology

From a medical standpoint, the key is really understanding if the upper lip’s movement is restricted. No symptoms, no problem. But any feeding problems in a growing baby are always a cause for concern.

Lip tie symptoms

Difficulty breastfeeding is one of the most common clues that your child may have a lip tie or tongue tie. The symptoms include:

  • Colic
  • struggling to latch onto the breast
  • slow or lack of weight gain
  • making a clicking sound or other noises while nursing
  • difficulty breathing during feeding
  • your child never seems to be full
  • falling asleep frequently during nursing
  • acting extremely fatigued from nursing

If you’re a breastfeeding mother of a child with a lip tie….you may experience:

  • pain during or after breastfeeding
  • breasts that feel engorged even right after nursing
  • blocked milk ducts or mastitis


Complications of Lip Ties

Babies who have a severe lip tie or tongue tie may have trouble gaining weight. You may need to supplement breastfeeding with formula or breast milk-fed from a bottle if that makes it easier for your baby to get nourishment.

Babies who have a severe lip or tongue tie may grow to have difficulty eating from a spoon or finger foods.

Lip ties don’t have as many complications later in life. Some pediatricians believe that an untreated lip tie can lead to a higher likelihood of cavities for toddlers because their tongue can not sweep away food from the back of the mouth and teeth.

What is the treatment for lip-tie?

Treatment for lip-tie will vary depending on the professional opinion of who where you seek treatment. Like most medical procedures it depends on the education and experience of the Dr. you choose. 

Given the lack of knowledge surrounding its presence, function, and level of attachment of the upper frenum in most infants, the release of the frenulum is not based on appearance alone.

Some lip-ties are left alone and do not require surgical treatment, while some doctors may recommend a frenectomy, a surgical treatment for lip-tie that loosens the tissue connecting the lip to the gums.

It is common for a baby to have a lip-lie and tongue-tie at the same time it may recommend releasing both. Research suggests that frenectomies improve breastfeeding outcomes.

If the frenum attachment wraps around the gums between the teeth, it can cause a noticeably large gap between the front teeth. Not every gap is the result of a lip tie, nonetheless closing a gap where a lip tie is present can be difficult to accomplish with orthodontic treatment alone and may result in relapse and the teeth moving back.

Can you continue breastfeeding if your baby has a lip-tie?

Anything is possible, If your baby is having trouble latching, talk with a lactation consultant and your baby’s pediatrician to see if lip-tie is really the problem. You can also try:

  • Strategic positioning. Holding your baby in a different position may improve feeding and allow your baby to connect more fully to your breast. Chat with a lactation consultant for ideas.
  • Therapy techniques. Sliding your finger along the top of your baby’s lip — trying to loosen the gap between the lip and gum line — to gradually improve the mobility of the lip.
  • Softening breasts before feeding. Spreading your baby’s saliva on your breast before having them latch on. (Creating lubrication!) is another technique recommended by lactation consultants. 
  • Special nipple shields. Find one made specifically for moms of babies with nursing challenges. Always work with a lactation consultant when using a nipple shield.

A baby with a lip-tie may have an easier time drinking from a bottle. That bottle can include formula or milk pumped from your breast.

No matter what you choose whether you pump breast milk, supplement with formula or use formula exclusively, rest assured that every option will give your baby the nutrition he/she needs to thrive.

What do I tell parents? 

As a breastfeeding supporter parents first and foremost should understand how a baby latches effectively to the breast, the role of the lip, tongue, and how to achieve a good latch. We need to acknowledge that there is a lot of information on this subject on the internet and experts are divided. 

What we do know about how babies latch is that lip ties do affect feeding;  in a small number of babies. 

Our focus is supporting mothers in understanding and overcoming the challenges they face with nursing simply cutting the frenulum may not totally solve the issue. 

Talk it through with your dentist, pediatrician, or lactation consultant. to learn what is best for you and your baby. Remember, a latching baby is a happier baby.