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.
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.
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.
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.
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.
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.
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.
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:
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:
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.
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.
This procedure consists of the following steps:
Lip ties in babies typically cause the following complications if untreated:
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
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.
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.
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.
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.
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.
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.
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.
“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