A lip tie (tethered maxillary labial frenulum) and a tongue tie (ankyloglossia) are conditions involving connective tissue in the mouth that restricts movement. These tissues, called frenula, are present in everyone. When they are too short, thick, or tight, they can interfere with normal oral function, particularly in infants. Identifying a potential tie involves observing both the visual anatomy and the functional symptoms an infant exhibits.
Identifying a Tongue Tie Visually
A tongue tie involves the lingual frenulum, the band of tissue connecting the underside of the tongue to the floor of the mouth. In a baby with ankyloglossia, this tissue may appear thick, tight, or inelastic, attaching closer to the tip of the tongue than is typical. This abnormal attachment restricts the tongue’s ability to lift, extend, or move side-to-side, which is necessary for proper feeding.
One of the most frequently observed visual signs is the “heart-shaped” or notched appearance of the tongue tip when the infant cries or attempts to lift their tongue. The frenulum pulls the center of the tongue down, creating an indentation or a “W” shape at the tip. In some cases, the tissue may be attached further back under the tongue, known as a posterior tie, which can limit the upward and forward motion of the tongue.
Identifying a Lip Tie Visually
A lip tie is a restriction of the labial frenulum, the tissue that connects the center of the upper lip to the gum line, often located just above the two front teeth. When this frenulum is too tight or thick, it prevents the upper lip from flanging outward or lifting freely, which is necessary for creating a seal during feeding. Parents can gently lift the baby’s upper lip to examine the frenulum, which may appear white, thick, or tight.
A restricted frenulum may attach high up on the gum tissue or even extend onto the palate, restricting the lip’s movement. Lip ties are sometimes classified based on the attachment location, ranging from a mucosal attachment to an attachment that reaches the gum line. Visual confirmation involves observing the limited mobility of the upper lip when the baby attempts to open wide or cry.
Observable Feeding and Functional Symptoms
While the visual appearance of the frenulum is a structural observation, the functional symptoms often lead parents to suspect a problem. A baby with a tie may struggle to achieve or maintain a deep latch, resulting in a shallow latch that causes the nipple to slip back to the front of the mouth. This can lead to a clicking or popping sound during feeding when the baby loses the suction seal due to limited tongue or lip mobility.
The infant may exhibit frustration at the breast or bottle, have excessively long or frequent feeding sessions, and may not gain weight efficiently because of ineffective milk transfer. Because the baby is unable to create a proper seal, they may swallow excessive air, leading to symptoms like gassiness, hiccups, or reflux. These challenges can cause them to fall asleep quickly during a feed without getting enough milk.
The restricted oral function also affects the breastfeeding parent, who may experience pain or discomfort during nursing. Symptoms can include cracked, bruised, or damaged nipples, often appearing flattened, ridged, or lipstick-shaped after a feed. When the baby cannot effectively drain the breast, the parent can develop complications such as blocked ducts, engorgement, or recurrent mastitis, which can affect milk supply over time.
Next Steps for Assessment
Observing visual or functional signs of a tie only provides an indication that a restriction may be present. Accurate diagnosis requires a comprehensive functional assessment by a qualified professional. Parents should consult with their pediatrician, a board-certified lactation consultant (IBCLC), or a pediatric dentist with specialized training in oral ties.
These professionals will evaluate the appearance and, more importantly, the movement and function of the tongue and lip in relation to feeding. A thorough assessment ensures that the feeding difficulties are not caused by other factors and determines the degree to which the frenulum is restricting mobility. Consulting with experts provides guidance on the next steps.