A lip tie, or a restrictive superior labial frenulum, occurs when the thin piece of tissue connecting the center of the upper lip to the gum line is too tight, thick, or short. This anatomical structure, known as the maxillary labial frenulum, is present in everyone, but in a lip tie, it limits the upper lip’s necessary range of motion. When the lip cannot move freely, it can interfere with the baby’s ability to create a proper seal while feeding, potentially impacting the transfer of milk and causing discomfort.
Identifying Common Symptoms
The most noticeable indicators of a lip tie are often functional problems experienced during feeding, which can affect both the baby and the mother. For the baby, a restrictive frenulum can prevent the upper lip from flanging out over the breast or bottle, leading to a shallow or poor latch. This compromised seal frequently results in a characteristic clicking or popping sound as the baby loses suction during a feed.
The baby may also exhibit signs of frustration, such as repeatedly slipping off the nipple or falling asleep quickly due to the effort required to feed effectively. Swallowing excessive air because of the poor seal can cause increased gassiness, fussiness, and symptoms that mimic reflux or colic. Ineffective milk transfer can lead to slow weight gain or failure to thrive, which requires immediate professional evaluation.
Mothers often experience their own set of symptoms when their baby has a lip tie, particularly during breastfeeding. Significant pain, soreness, or blistering of the nipple can result from the baby compensating with a stronger, shallower bite. The incomplete emptying of the breast, due to the baby’s inefficient suck, can lead to recurrent issues. These include painful breast engorgement, blocked milk ducts, or repeated episodes of mastitis.
Visual Assessment and Classification
Once functional symptoms are noticed, a parent can perform a simple visual check, although this is only an observation, not a formal diagnosis. Gently lift the baby’s upper lip toward their nose to expose the frenulum and observe where the tissue connects to the gum line. A lip tie often appears as a band of tissue that causes the gum tissue to blanch, or turn white, when the lip is lifted, indicating tension.
Professionals often use a classification system, such as the Kotlow classification, to describe the anatomical severity of the frenulum’s attachment. This system categorizes the tie based on where the frenulum inserts onto the gum. A type 1 attachment is the least restrictive, inserting high into the gum tissue closest to the lip.
The severity increases as the attachment point moves lower down the gum line. A type 2 tie attaches to the gums, while a type 3 tie extends down to the tissue between the two front teeth. The most restricted, a type 4 tie, penetrates the papilla and may extend onto the hard palate behind the teeth.
Professional Diagnosis and Management Options
If symptoms suggest a lip tie is present, the next step is a comprehensive evaluation by healthcare professionals who specialize in infant oral function. These providers include Lactation Consultants, Pediatric Dentists, Otolaryngologists (ENTs), and some Pediatricians. The diagnostic process involves both a structural assessment, which confirms the physical appearance of the frenulum, and a functional assessment. The functional assessment involves observing the baby feeding to assess the quality of the latch, suck pattern, and milk transfer efficiency.
Management options depend entirely on whether the lip tie is causing functional difficulty. For mild ties or those causing minimal symptoms, the initial approach may involve observation and compensatory strategies. This includes working with a lactation consultant to improve positioning and latch techniques. When the tie significantly restricts function and causes issues like poor weight gain or maternal pain, an intervention known as a frenotomy may be recommended. This minor procedure involves releasing the tight frenulum tissue to restore full mobility to the upper lip. A pediatric dentist or an ENT specialist typically performs the frenotomy to eliminate the physical restriction, allowing the baby to achieve a deeper, more effective latch and resolve feeding difficulties.