A lip tie describes a condition where the frenulum, a piece of tissue connecting the upper lip to the gum, is unusually short, thick, or tight. This can restrict the lip’s movement. While various factors can contribute to breastfeeding challenges, a restrictive lip tie is one potential concern for infants and nursing parents.
Understanding a Lip Tie
The labial frenulum is a band of tissue attaching the center of the upper lip to the gum area just above the two front teeth. In some infants, this frenulum may be unusually taut or thick, limiting the full range of motion of the upper lip. This restriction can prevent the lip from flanging outward properly, which is important for a secure and effective latch during feeding. The degree of restriction can vary, from minor limitations to significant immobility.
How Lip Tie Impacts Breastfeeding
A restrictive lip tie can interfere with an infant’s ability to achieve a proper latch on the breast. When the upper lip cannot flange out and create a seal, the baby may struggle to maintain suction. This leads to a shallow latch, where the infant can only grasp the nipple, not enough of the areola. A shallow latch prevents the baby from compressing the milk ducts effectively, resulting in inefficient milk transfer.
For the infant, this inefficiency can manifest as prolonged feeding times, lasting longer than 15-20 minutes per side. Babies may also exhibit clicking sounds during feeding, indicating a loss of suction, or they might frequently fall off the breast. Inefficient milk transfer can lead to poor weight gain despite frequent feedings. Additionally, infants may swallow excessive air due to the compromised seal, contributing to gas, fussiness, and colic.
The impact of a lip tie extends to the nursing parent, causing discomfort. A shallow latch can result in nipple pain, leading to cracked, blistered, or flattened nipples after feeding. This constant trauma can make breastfeeding a difficult experience, discouraging continuation. Inadequate breast drainage due to the baby’s poor suction can also increase the risk of engorgement, plugged milk ducts, and mastitis.
Over time, if breasts are not emptied, the parent’s milk supply may decrease. Incomplete drainage signals the body to produce less milk, creating a cycle of insufficient supply and feeding difficulties. This combination of physical pain, supply concerns, and an unsatisfied baby can lead to frustration and may contribute to premature weaning from breastfeeding.
Identifying Signs of Lip Tie Affecting Feeding
Signs of a lip tie can be observed in an infant’s feeding behavior and physical cues. These may include:
Struggling to lift or curl the upper lip outward, appearing to suck with the lip tucked in.
Milk dribbling from the mouth during feeds.
Noisy swallowing or frequent clicking sounds.
Poor weight gain despite frequent and lengthy feeding sessions.
Persistent fussiness at the breast.
Excessive gas and spitting up.
For the nursing parent, signs that may indicate a lip tie impacting effective milk transfer include:
Persistent nipple pain that does not resolve after the initial weeks of breastfeeding.
Nipples appearing flattened, creased, or lipstick-shaped after a feeding.
Recurrent plugged milk ducts or episodes of mastitis.
A feeling of incomplete breast drainage after feeds.
A noticeable decrease in milk supply despite efforts to increase it.
Diagnosis and Treatment Options
Diagnosing a lip tie involves a comprehensive oral assessment. Healthcare professionals, such as lactation consultants, pediatricians, pediatric dentists, or ear, nose, and throat (ENT) specialists, evaluate the function and appearance of the frenulum. They assess the range of motion of the upper lip and observe a feeding session to understand the impact on latch and milk transfer. Intervention is based on the functional impairment it causes, rather than merely the presence of a tight frenulum.
The treatment for a restrictive lip tie is a procedure called a frenectomy, also known as a frenotomy. This minor procedure releases or revises the frenulum. It can be performed using sterile scissors or a soft-tissue laser. Both methods aim to free the lip, allowing greater range of motion and improved flanging during feeding. The procedure is quick, taking only a few minutes, and can provide immediate functional improvement for infant lip mobility.
Supporting Breastfeeding After Intervention
Following a frenectomy, continued support from a qualified lactation consultant (IBCLC) is important to optimize breastfeeding outcomes. The procedure provides anatomical freedom, but infants may need guidance to relearn how to use their newly mobile lip for a deep latch. A lactation consultant can assist with latching techniques, positioning, and strategies to encourage proper lip flanging. They can also help the parent monitor milk transfer and the infant’s weight gain to ensure nourishment.
Parents are advised to perform specific “wound care” or gentle stretching exercises, as recommended by the practitioner. These exercises help prevent reattachment of the frenulum and to maintain the new range of motion. Improvement in breastfeeding may be gradual, and patience is required as the infant adapts to improved oral mobility. The frenectomy facilitates better feeding, but consistent support and practice contribute to successful, comfortable breastfeeding.