Breastfeeding can present unexpected challenges. When difficulties arise, the cause may sometimes be traced to anatomical variations in the infant’s mouth that affect feeding mechanics. A lip tie, a variation in the frenulum’s structure, can interfere with the coordinated movements required for effective milk transfer. Investigating this anatomical restriction is important for families experiencing pain or poor infant weight gain during nursing.
Defining Lip Tie and its Impact on Latch
A lip tie refers to a condition where the maxillary labial frenulum, the tissue connecting the upper lip to the upper gum, is unusually short, thick, or tight. This congenital condition restricts the mobility and function of the upper lip. A typical frenulum allows the upper lip to flange, or curl outward, widely over the breast tissue during feeding.
When the upper lip is restricted, it cannot achieve the wide flanging needed to create a proper seal around the breast. This anatomical limitation prevents the baby from taking a deep, comfortable mouthful of tissue. The resulting shallow latch leads to suction failure and inefficient milk removal.
The reduced range of motion forces the baby to compensate by clamping down or using an altered sucking pattern. This often results in a poor vacuum seal, which is necessary for effective milk extraction. Consequently, the baby may have prolonged and frequent feeding sessions with little actual milk transfer. A lip tie is only considered problematic if it causes functional difficulties with feeding.
Recognizing Symptoms of Impaired Milk Transfer
Observable signs of feeding issues caused by a lip tie manifest in both the infant and the breastfeeding parent. For the baby, common indicators include struggling to latch onto the breast or frequently slipping off during a feed. During nursing, clicking or smacking sounds signal a loss of the vacuum seal necessary for swallowing milk.
Inefficient milk transfer can lead to physical signs in the baby, such as slow weight gain or a failure to thrive. The baby might also exhibit fatigue, falling asleep often during feeds, or acting fussy and frustrated due to insufficient nourishment. Excessive air intake from the poor seal can cause the baby to suffer from gas, colic-like symptoms, or reflux.
For the mother, a baby with restricted lip movement causes significant discomfort, often described as painful nursing. The shallow latch can lead to damaged nipples, resulting in cracked, bruised, or bleeding tissue. Poor milk drainage, a consequence of ineffective feeding, increases the risk of developing blocked milk ducts or mastitis.
Diagnosis and Intervention Options
When feeding difficulties and associated symptoms are present, a professional evaluation determines if a lip tie is the cause. Diagnosis is typically performed through a physical examination by healthcare professionals such as lactation consultants, pediatricians, or specialized dentists. The examination involves a visual assessment of the maxillary labial frenulum and a physical check of the upper lip’s mobility.
The provider physically lifts the baby’s upper lip to check the attachment point and evaluate the restriction. If the restriction is the primary cause of feeding dysfunction, the standard intervention is a minor surgical procedure called a frenotomy, or revision. This procedure releases the tight band of tissue to restore full lip mobility.
Frenotomy can be performed using sterile surgical scissors or a concentrated laser. The scissor method is quick but may lead to bleeding, potentially resulting in undercorrection. Laser procedures, often using a CO2 laser, offer greater precision and control by vaporizing the tissue and cauterizing blood vessels. This technique minimizes bleeding, resulting in less post-procedure discomfort and a lower risk of reattachment during healing.
Re-establishing Effective Breastfeeding
The frenotomy procedure addresses the anatomical restriction, but the baby must learn how to use their newly freed oral structures to feed. Mothers are encouraged to offer the breast immediately after the procedure. This helps with the healing process and allows the baby to quickly practice their new range of motion. Improvements in feeding are often gradual and may take several weeks.
Working with an International Board Certified Lactation Consultant (IBCLC) post-procedure is highly recommended for suck training and support. Both the mother and baby developed compensatory feeding patterns due to the restriction, and they need to learn new ways to latch and suck effectively. The consultant helps adjust feeding positions and ensures the latch is deep and comfortable now that the lip can flange properly.
Parents will also be instructed on gentle oral exercises and stretches to perform multiple times a day following the revision. These stretches prevent the tissue from reattaching and promote healing with maximum flexibility. Consistent follow-up helps monitor the baby’s milk transfer, tracks weight gain, and provides guidance as the baby reorganizes new motor skills.