A lip tie involves the maxillary labial frenulum, the small band of tissue connecting the center of the upper lip to the gum line. While every baby has this tissue, a lip tie occurs when the frenulum is unusually thick, short, or tight, restricting the upper lip’s movement. This restriction can interfere with normal oral function, and the primary concern is typically how this anatomical variation affects the infant’s ability to feed effectively.
What a Lip Tie Is and Why It Matters
The maxillary labial frenulum is a natural structure. When this frenulum limits the range of motion of the upper lip, it is called a restrictive lip tie. This restriction is significant during infancy because creating a proper seal around the breast or bottle nipple requires the upper lip to flange, or curl outward, to create suction.
A tight lip tie prevents this necessary flanging, which often leads to functional problems, especially with breastfeeding. Common signs of this restriction include a shallow latch, clicking sounds during feeding, or the baby taking in excessive air, which can lead to gassiness or colic. The mother may also experience pain, cracked nipples, or symptoms of low milk supply due to ineffective milk transfer.
Specialists often use a classification system, such as the Kotlow classification, to grade the severity of a lip tie from Class I (least restrictive) to Class IV (most restrictive). This grading is based on the frenulum’s attachment point on the gums, with higher classes indicating a deeper attachment. While the grading system describes the anatomy, the true concern is the functional impairment, requiring a full assessment that includes observing the baby’s feeding patterns and symptoms.
The Likelihood of Natural Resolution
The frenulum itself does not typically disappear, so babies do not simply “grow out of” a lip tie. However, the appearance of restriction often lessens as the child grows and their oral anatomy changes. The frenulum undergoes apical migration, meaning its attachment naturally moves higher up the gum line as the jaw and alveolar ridge develop and the baby’s teeth erupt.
This migration and tissue thinning can reduce the functional impact of the frenulum over time. For instance, a tie causing significant breastfeeding issues in a newborn might become less symptomatic once the child transitions to bottle feeding or solid foods, which require less upper lip mobility. This change in symptoms can create the perception that the baby has outgrown the tie.
Mild lip ties (Class I or II) that do not cause significant feeding or oral hygiene problems are the most likely to become less restrictive and noticeable as the child ages. For moderate to severe anatomical restrictions, the frenulum may stretch or thin, but the underlying anatomical tether rarely resolves completely. If a lip tie causes documented functional impairment, such as poor weight gain or significant maternal pain, professionals recommend intervention rather than waiting for natural resolution.
Treatment Options When Resolution Does Not Occur
When a lip tie causes functional issues that do not resolve, intervention is recommended to release the restrictive tissue and improve lip mobility. This procedure, called a frenectomy or frenotomy, is primarily recommended only when the restriction causes a functional problem, such as documented difficulty with feeding. The two main procedural options are a surgical snip or a laser revision.
A frenotomy performed with surgical scissors or a scalpel is a quick procedure that severs the restrictive tissue, but it may require sutures. Laser revision, or laser frenectomy, is increasingly common and uses a focused light beam to release the tie. The laser offers benefits such as minimal bleeding, no need for sutures, and a lower risk of infection because it sterilizes and cauterizes the tissue as it cuts.
Following the procedure, post-operative care is important to prevent the released tissue from reattaching as it heals. This aftercare typically involves specific stretching or massage exercises that parents perform several times a day for a few weeks. These exercises help maintain the mobility gained from the release and encourage proper wound healing, and infants often benefit from follow-up with a lactation consultant to optimize feeding.