Lip Ties in Children: Causes, Symptoms & Treatment

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

A lip tie occurs when the tissue connecting a baby’s upper lip to the mouth is too short or thick, limiting the upper lip’s movement. It can also interfere with breastfeeding and proper weight gain for babies.

The piece of tissue associated with lip ties, known as the superior labial frenulum, provides stability to the upper lip.¹ If you run your tongue between the top of the gum and your upper lip, you can feel your labial frenulum. 

You can check for a lip tie by inspecting your baby’s labial frenulum. If they have a lip tie, you will see the tissue attached to the gum at a lower level than normal. You should take them to the doctor for diagnosis and treatment, as a lip tie can interfere with healthy growth..

Signs Your Baby Has a Lip Tie

A severe lip tie is often easy to see. A baby’s labial frenulum may attach to the gums or even close to the teeth, causing a gap between the two upper front teeth. 

Other common symptoms of a lip tie include:

• Difficulty latching to a nipple or pacifier
• Lack of healthy weight gain
• Fatigue during or after nursing
• Clicking sound when lactating
• Trouble breathing when feeding
• Colic

Toddlers with an untreated lip tie may also have trouble pronouncing certain words.

Can a Lip Tie Affect Breastfeeding?

A lip tie can interfere with breastfeeding if it’s severe enough. However, not every class of lip tie will cause problems. In milder cases, the baby can continue breastfeeding comfortably and gain weight normally.

Breastfeeding might be a challenge in the case of a Class IV lip tie. Your baby may not be able to or constantly lose the nipple.

How to Nurse a Baby with a Lip Tie

If you notice that your child is not nursing effectively due to a lip tie, here 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 This  will keep your child on track with development while you determine whether they need treatment.
• Express regularly — If you want to continue nursing, 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 can help with additional methods to make breastfeeding more pleasant and efficient for you and your baby. They will also know when to recommend other options, such as a frenectomy.⁵

What Treatments are Available for Lip Ties?

Class I and II lip ties don’t typically require treatment. Treatment is usually recommended for Class III and IV lip ties. 

With a less severe lip tie, you can work with a lactation specialist on any breastfeeding issues. 

For more restrictive lip ties, doctors typically recommend a lip tie release, also called a frenectomy. 

A frenectomy 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 a scalpel or scissors after the baby is given a local anesthetic. 

Lip Tie Reversal Procedure (Frenectomy)

The process of preparing for, performing, and recovering from a frenectomy consists of the following steps:

• Preparation — You’ll lie on a chair while holding your baby. The dentist will apply a topical numbing agent followed by a local anesthetic.
• Revision — The dentist will use a handheld laser or sterilized scissor to cut part of the frenulum.
• Recovery — It usually takes between 2 and 3 weeks for the wound to heal. Your dentist may recommend post-op exercises and check-ups to avoid reattachment.

A frenectomy is painless for your baby and is easy to heal from.

Possible Complications of an Untreated Lip Tie

Severe lip ties in babies typically cause the following complications if left 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 they grow, an untreated lip tie can cause significant impairments to their speech. 
• Abnormal growth patterns — Toddlers with a lip tie may develop abnormalities in skeletal structures. The poor latching during feeding can lead to directional growth of their facial bones.
• Increased risks of dental issues — Lip ties can promote tooth decay because food can become trapped in this area. Due to the proximity of the lip tie to the front teeth, cleaning the trapped food can be challenging.
• Breastfeed more frequently — Since babies with lip ties have difficulties consuming enough breast milk, they may need to breastfeed more frequently to ensure they drink as much as they can.
• Sleep issues — Babies who try to nurse with lip ties can become fatigued with the effort. They may even fall asleep while feeding. Toddlers may develop a severe snoring habit.

What Causes a Lip Tie in Children?

There is no known leading cause of upper lip tie in children.² However, a genetic component seems likely. 

Lip ties can run in families or occur in children with other problems that affect the face or mouth. A common co-occurring birth defect is a cleft palate, where the tissues that form the roof of the mouth do not connect.³ Children with cleft palate often have lips that do not develop properly.

How are Lip Ties Diagnosed?

Your doctor or dentist can diagnose your baby with a lip tie based on a quick physical examination. 

Talk to your pediatrician if you notice your child having difficulty breastfeeding or moving their upper lip. You can also consult with a lactation specialist or a pediatric dentist.

The 4 Types of Lip Ties in Babies and Toddlers

Lip ties can be classified into four classes based on severity:⁶ 

1. Class I

A class I lip tie is a normal frenum attachment that doesn’t require treatment.

2. Class II 

A class II lip tie refers to a frenum that attaches to the gum somewhere above the gum line. It is typically asymptomatic but can cause hygiene issues or tears from trauma if left untreated. 

3. Class III 

A class III lip tie refers to a frenum that attaches to the area where teeth will grow or to the alveolar ridge. It makes it difficult to lift the lip without blanching. 

A class III lip tie may cause a gap between the front teeth. It can also make oral hygiene difficult, resulting in an increased risk of tooth decay.

4. Class IV

The most severe case, a class IV lip tie refers to a frenum that extends to the palate, or roof of the mouth. Your doctor will recommend treatment to prevent tooth decay and problems with oral hygiene. 

How to Prevent Lip Ties in Babies

Since children are born with or without lip ties, there’s no way to prevent it. For severe cases, early diagnosis and treatment are vital to the baby’s successful recovery.⁸

Summary

A lip tie is a condition in which the labial frenulum, or the tissue between the upper lip and gums, is too short or thick. The cause of a lip tie is unknown but may be genetic, as babies are born either with or without one.

Not all lip ties need to be treated. If your baby’s lip tie interferes with breastfeeding or their lip mobility, consult your pediatrician. They can easily diagnose your child by evaluating their upper lip. 

A frenectomy, also known as a lip tie release, is a quick surgical procedure that treats a severe lip tie. Your dentist will numb your baby’s lip and use a laser or a scissor to cut part of the frenulum. Early diagnosis and treatment is essential for your baby’s healthy development.