A lip tie, formally known as a restricted maxillary labial frenulum, is an anatomical variation where the band of tissue connecting the upper lip to the gum line is unusually short, thick, or tight. This restriction limits the lip’s ability to move freely and fully outward, a movement called flanging. While everyone has a frenulum, a lip tie is diagnosed only when this tissue significantly impairs function, most often related to feeding in infants.
Identifying the Potential Signs
Parents are often the first to notice signs of a potential lip tie, particularly when issues arise during feeding. A restricted upper lip makes it difficult for a baby to create a wide, deep latch, which is necessary for efficient milk transfer. Observable signs include a distinct clicking sound during feeding, which indicates a loss of suction, and frequent detachment from the nipple. This shallow latching can also lead to the baby swallowing excessive air, resulting in increased gassiness, colic-like symptoms, or spitting up.
A baby with a lip tie may feed for unusually long periods or, conversely, have very short, frequent sessions because they are not transferring milk effectively. Slow weight gain or a failure to thrive suggests a compromise in milk intake and warrants professional attention. Parents might also observe milk dribbling out the sides of the baby’s mouth due to the inability to maintain a proper seal.
The nursing parent often experiences painful symptoms due to the baby’s compensatory sucking patterns. The baby may chew or gum the nipple to extract milk, leading to nipple pain, cracking, or blistering. Incomplete milk drainage from the breast can also cause complications for the parent. These complications include blocked milk ducts, breast engorgement, or recurrent infections like mastitis. The presence of these combined signs indicates that a professional evaluation of oral function is warranted.
Professional Diagnosis and Classification
Diagnosing a lip tie involves a functional assessment by a trained healthcare professional, such as a pediatric dentist, lactation consultant, or pediatrician. The assessment begins with a visual examination of the maxillary labial frenulum to check for thickness and its attachment point on the gum line. The professional gently lifts the upper lip to determine the degree of restriction and how much the tissue tethers the lip’s movement.
A functional assessment is performed by observing the baby’s oral motor skills and feeding mechanics. This includes evaluating the baby’s ability to flange the upper lip outward and sustain a proper seal during sucking. The professional also considers the severity of the symptoms reported by the parents, such as feeding duration and parental pain.
Healthcare providers often use a grading system, like the Kotlow Classification, to categorize the anatomical severity of the lip tie. This system ranges from Class I (least restrictive) to Class IV (most restrictive), based on where the frenulum inserts into the gum tissue. While a high-grade attachment may suggest a greater likelihood of functional issues, the final diagnosis is determined by the presence and severity of feeding difficulties, not just the appearance of the frenulum.
Treatment Procedures and Post-Care
The decision to treat a lip tie is made only when the restriction is causing functional problems, such as feeding pain, poor milk transfer, or insufficient weight gain. Not all visually identified lip ties require intervention; conservative management with a lactation consultant is often the first step. If functional issues persist, the common intervention is a frenotomy, a simple procedure to release the restrictive tissue.
The frenotomy is a quick procedure performed by a specialist, often using sterile scissors or a soft-tissue laser. The laser method offers a minimally invasive approach, involving little to no bleeding and requiring only a topical anesthetic, if any, for pain management. The entire release takes only a few seconds, and the baby is encouraged to feed immediately afterward to help establish a new, deeper latch.
Post-procedure care is a component of treatment success and focuses on preventing the released tissue from reattaching. This involves performing specific stretching exercises, often called “wound management,” multiple times a day for several weeks. For a lip tie, the parent gently lifts the baby’s upper lip high toward the nose to stretch the healing site and keep the wound open.
Parents are instructed to perform these stretches with clean hands to prevent the formation of a tight scar and ensure the tissue heals with increased flexibility. Immediately following the procedure, the baby should work with a lactation consultant or feeding specialist. This professional guidance helps the baby retrain their muscles and learn how to use their newly freed upper lip to achieve an effective, pain-free latch.