Lip Ties in Children: Causes, Symptoms & Treatment

What is a Lip Tie? What Does it Look Like?

A lip tie occurs when a piece of skin behind a baby’s upper lip is too tight or too thick, limiting the upper lip’s movement. The tissue, in this case, is called the superior labial frenulum.1 

The critical function of the labial frenum is to provide support or stability to the upper lip. It also keeps the lips in harmony with the growing bones of the maxilla. 

If you run your tongue between the top of the gum and your upper lip, you can feel your labial frenulum. 

Some infants have a labial frenulum that is very short and tight. The frenulum attaches to the gum at a lower level than is usual. These infants have difficulty moving their upper lips. It may interfere with a baby’s ability to breastfeed in some instances. A lip-tie should be treated to guarantee healthy growth.

What Causes a Lip Tie in Children?

There is no known leading cause of upper lip tie in children.2 However, some kids are born with the condition, while others are not. 

Lip ties can run in families or occur in children who have other problems that affect the face or mouth, such as cleft palate

A cleft palate is a common birth defect where the tissues that form the roof of the mouth do not connect.3 The effect of this is lips that do not develop properly. Surgery can restore a cleft palate to normal function. 

A lip tie may also develop in the mother’s womb while the baby’s mouth is forming. However, many experts also believe that genetics contribute to lip tie formation. 

If your baby is diagnosed with lip tie, look at your upper lip or your spouse’s lip; you might find the same. While many people attribute the condition to genetics, it has never been proven. 

The 4 Types of Lip Ties in Babies & Toddlers

Lip ties can develop on the lower lip, upper lip, or both lips. They are classified into four classes based on severity.6 Class 4 is the most severe, and class 1 is the least troublesome.

  • Class 1
  • Class 2 
  • Class 3 
  • Class 4 

1. Class I

A Class I lip tie is a normal mucosal lip tie that has no significant effect and is rare in kids. It is asymptomatic and no treatment is usually recommended.

2. Class II 

The lip tie is attached to the gum somewhere in the middle above the gum line. It is typically asymptomatic and causes a hygiene issue or tears from trauma if left alone. 

3. Class III 

The lip tie is generally attached to the area where teeth will grow or to the alveolar ridge. It makes it difficult to lift the lip without blanching. This potentially causes a gap between the front teeth and hygiene can be difficult causing an increase in the risk of tooth decay.

4. Class IV

The lip tie extends around the entire alveolar ridge and is the most severe case. Treatment is often recommended to avoid tooth decay and problems with hygiene. 

Can a Lip Tie Affect Breastfeeding?

Issues faced by mothers and babies because of lip ties vary. For example, in some cases, the baby can continue breastfeeding comfortably without pain. The babies get all of the nutrition and gain weight normally. 

In the case of a class four lip tie, breastfeeding might be a challenge. In this case, the baby may not get a good latch or may constantly lose the nipple. 

If you notice that your child is not nursing effectively due to a lip tie, below are some tips to help you feed your child effectively:

  • Bottle feeding: An infant with a lip tie may find it easier to drink from a bottle.4 Milk pumped from your breast, or store-bought formula, is an appropriate source of nourishment. They will keep your kid on track in terms of development while you determine whether or not your youngster needs a lip tie revision.
  • Express regularly: If you want to continue nursing, be sure to pump milk every time your baby takes formula milk to maintain your milk supply.
  • Soften the nipple: Before trying to latch, try softening your breast with your baby’s saliva and practicing the correct latching technique so that your baby can latch more firmly to your breast.
  • Consider professional advice: A lactation consultant may be able to assist you in coming up with additional methods to make breastfeeding more pleasant and efficient for both you and your baby. They will also know when to recommend other options such as frenectomy.5

How to Tell if Your Baby Has a Lip Tie (Common Signs) 

A lip tie is one of the most challenging conditions to diagnose. The main reason for this is because its occurrence is rare and like a tongue tie. 

Common symptoms of a lip tie include:

  • Prolonged feeding time
  • Development of plugged ducts and mastitis on the mother
  • Irritability, or reflux because of swallowing excess air
  • Breast milk leaking from the mouth because of a poor lip seal
  • Poor weight gain
  • Trouble sucking on a pacifier
  • Trouble maintaining a latch
  • Difficult suckling at the breast
  • Biting or chewing the nipple
  • Mothers may experience nipple creasing, nipple abrasions, and nipple pain
  • Choking 
  • Clicking sound when lactating
  • The baby may fall asleep while breastfeeding
  • Grown children may have problems pronouncing letters

How are Lip Ties Diagnosed?

Lip ties, like tongue ties, are diagnosed through physical oral examinations. It is becoming more and more common for newborns to be evaluated for lip ties in the hospital at birth. 

Most pediatricians diagnose lip ties based on their appearance. The upper lip easily flanges. If the lip looks lifted and gently pulled, and the upper jaw where the lip tie gets attached looks pale, that indicates a lip tie. 

In case you suspect the presence of a lip tie in your child, talk to your pediatrician. However, the most recommended person to consult is a lactation specialist. 

Alternatively, you can also consult a pediatric dentist to identify a lip tie and recommend treatment options.

What Treatments are Available for Lip Ties?

Before you think about treatment for lip tie, working with a lactation specialist will go a long way in resolving breastfeeding issues. Some mothers prefer using alternative methods such as feeding the baby with a bottle. 

However, some parents prefer lip tie revision (frenectomy) which involves cutting off a piece of tissue from the labial frenulum to help loosen it.7 This may be accomplished through painless laser surgery or using a scalpel or scissors while the baby is put under a local anesthetic. 

Lip-Tie Reversal Procedure

This procedure consists of the following steps:

  1. The mother lays on the dental chair while holding the baby
  2. The pediatric dentist applies a topical numbering agent (local anesthetic)
  3. With the use of handheld lasers, the dentist precisely cuts a part of the frenulum to remove the lip tie. The laser helps immediately cauterize the wound
  4. The baby begins the recovery process
  5. The dentist provides post-operation instructions such as post-procedure exercises
  6. You may have to return the baby for continued check-up through the process of recovery to avoid reattachment of the lip tie

Possible Complications of an Untreated Lip Tie

Lip ties in babies typically cause the following complications if untreated:

  • Difficulty nursing and eating: A lip tie can impact a baby’s feeding abilities, from being unable to latch correctly to having difficulties shaping their lips around a spoon.
  • Impaired speech: Your toddler’s early babble may sound ordinary, but as the baby grows to preschool, untreated lip ties can cause significant challenges to the baby’s speech. 
  • Abnormal growth patterns: Toddlers with a lip tie may develop different skeletal structures. The poor latching during feeding can lead to directional growth of their facial bones.
  • Increased risks of dental issues: Tooth decay may lead to severe dental problems because the food becomes trapped. Due to the proximity of the  lip tie to the front teeth, it can be a challenge brushing off trapped food.
  • Breastfeed more frequently: Since babies with lip ties have difficulties consuming enough breast milk, it’s important to do it frequently to ensure they drink as much as they can.

How to Prevent Lip Ties in Babies

There is no way to prevent a lip tie. The main reason is that there is no known cause of lip tie in children. 

The condition may run in the family or occur in children who have other problems that affect the face or mouth, such as a cleft palate. 

For severe cases of a lip tie, early diagnosis and treatment are vital to the baby’s successful recovery.8

Lip Tie: Common Questions & Answers

Are lip ties painful for babies?

A lip tie is not painful for babies but may cause difficulties in breastfeeding. This can have severe consequences on health (like malnutrition). 

However, not being able to breastfeed properly may cause painful breasts in mothers.

Does a lip tie need to be corrected?

A lip tie does not always need to be corrected. Caregivers, parents, and lactation specialists can effectively determine whether a baby is having problems with breastfeeding. If all other treatment measures don’t work, lip tie revision would be necessary.

What are the serious risks of a lip tie?

Most people think a lip tie only affects an infant’s feeding, but severe lip ties can affect your child as they grow older as well. 

The risks of a lip tie include difficulty breathing during feeding, biting or chewing the nipple, inability to latch deeply, and cluster feeding.

Can a lip tie affect speech?

Yes, lip ties can impact speech. A lip tie may impede a child’s speech, alter dental alignment, and cause cavities if left untreated. 

Impaired speech becomes noticeable around the age of three. While there is no way to predict whether or not your kid may have speech difficulties, there are signs to look for. 

These include the inability to touch the roof of the mouth, significant gaps between affected front teeth, and/or difficulty moving the tongue side to side.

Can a lip tie affect sleep?

Yes, a lip tie can impact sleep. Children with a lip tie sleep more often during nursing. The physically exhaustive effort of the babies trying to reset their lips for a proper suction makes them sleep.

How do you feed a child with a lip tie?

To nurse a baby while wearing a lip tie, you may need to be a bit more strategic. Before trying to latch, try softening your breast with your baby’s saliva and practicing the correct latching technique so that your baby can latch more completely to your breast. 

You can also express milk into a feeding bottle if that makes it easy for your baby. Otherwise, a lactation consultant may be able to assist you. They can come up with additional ways to make breastfeeding more pleasant and efficient for both you and your baby.

How long does a lip tie take to heal? 

The majority of lip tie wounds heal on the surface in 10 to 14 days. It may take 2 to 3 weeks to heal, depending on the extent of the wound. The wound continues to heal underneath the mucosa (the moist inner lining) over several weeks until full recovery.

Resources

The Superior Labial Frenulum in Newborns: What Is Normal?,” National Center for Biotechnology Information (NCBI), 12 July 2017

"Tongue-tie,” Department of Health, State Government of Victoria, Australia

Facts about Cleft Lip and Cleft Palate,” Center for Disease Control and Prevention (CDC)

Just Flip the Lip! The Upper Lip-tie and Feeding Challenges,” American Speech-Language-Hearing Association (ASHA), 9 March 2015

Breastfeeding improvement following tongue‐tie and lip‐tie release: A prospective cohort study,” National Center for Biotechnology Information (NCBI), 19 September 2016

Frenectomy: A Review with the Reports of Surgical Techniques,” National Center for Biotechnology Information (NCBI), 15 November 2012

Speech and Feeding Improvements in Children After Posterior Tongue-Tie Release: A Case Series,” International Journal of Clinical Pediatrics, 3 September 2018

Tongue-tie in the newborn: early diagnosis and division prevents poor breastfeeding outcomes,” National Center for Biotechnology Information (NCBI), 23 march 2015

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