A lip tie in a baby looks like a thick, tight band of tissue connecting the inside of the upper lip to the upper gum. Every baby has this tissue (called the frenulum), but in a lip tie, it appears shorter, thicker, or attaches lower on the gum, closer to where the front teeth will come in or even onto the roof of the mouth. The key visual clue is how restricted the upper lip looks when you try to gently lift it.
How to Check Your Baby’s Upper Lip
The simplest way to see what’s going on is to gently flip your baby’s upper lip upward toward the nose. In a baby with a normal, flexible frenulum, the lip lifts easily with little resistance. You’ll see a thin, stretchy strip of tissue in the center connecting the lip to the gum, but it won’t pull tight or limit movement.
If your baby has a restrictive lip tie, you’ll notice a few things when you do this. The tissue connecting the lip to the gum will look noticeably thick or taut, almost like a short rope holding the lip down. The tissue immediately around the frenulum may blanch, turning whiter than the surrounding tissue, when you lift the lip. You might also feel resistance as you try to flip the lip outward. In more pronounced cases, the band of tissue extends all the way down to the ridge where the front teeth will emerge, or even wraps back onto the hard palate behind the gum line.
What Different Severities Look Like
Lip ties are sometimes described using a grading system developed by a pediatric dentist named Kotlow, which ranks them from least to most restrictive based on where the tissue attaches to the gum:
- Grade I: The frenulum attaches high up on the gum, well above the teeth line. This is the least restrictive and often looks like a normal frenulum.
- Grade II: The attachment point sits lower, right at or just above the gum margin where the front teeth will come through.
- Grade III: The tissue inserts into the small triangle of gum tissue (the papilla) between where the two front teeth will be.
- Grade IV: The frenulum extends into that papilla or wraps onto the hard palate. This is the most visually obvious type, and you can often see it without even lifting the lip.
Here’s something important, though: when researchers tested this grading system by having multiple examiners look at the same babies, they found poor agreement between examiners. More than 80% of all newborns were scored as having the highest grade. That suggests most babies have prominent-looking frenula, and appearance alone isn’t a reliable way to determine whether the tissue is actually causing problems.
What’s Normal vs. What’s Restrictive
This is where things get tricky for parents. The majority of newborns have frenulum tissue that extends roughly halfway down the upper gum, which would technically fall into the middle grades of the classification system. That means what looks like a lip tie to a worried parent (or even to some providers) is often just normal newborn anatomy.
A few visual features sometimes get flagged as signs of a restrictive tie: a dimple or notch in the upper lip when the baby cries, the blanching mentioned earlier, or a visible indent in the bony ridge of the gum where the tissue pulls. But the American Academy of Pediatrics noted in a 2024 clinical report that none of these visual signs have supporting evidence linking them to actual feeding problems. The AAP’s position is straightforward: the labial frenulum is a normal structure present in all infants, and its appearance alone doesn’t indicate a problem.
Functional Signs That Matter More Than Appearance
Because the look of the frenulum is so variable in normal babies, what matters more is whether it’s causing functional difficulty. During breastfeeding, a baby needs to flange (curl outward) both lips to create a seal around the areola and maintain suction. If the upper lip can’t flange because the frenulum holds it tight against the gum, the baby may only latch onto the nipple rather than taking in enough surrounding tissue.
Signs that suggest the lip tie is actually restrictive during feeding include:
- Upper lip tucks inward during feeding instead of curling out like a fish lip
- Clicking sounds while nursing, which indicate the baby is repeatedly breaking and re-forming suction
- Painful latch for the breastfeeding parent, often because the baby compensates by clamping down harder with the gums
- Prolonged or inefficient feeds where the baby seems to work hard but doesn’t transfer enough milk
A tight upper lip that shows very little gum tissue when the baby smiles or cries can also be a visual hint. Children with a significant lip tie sometimes look like their upper lip is held flat against their teeth rather than lifting freely.
The Gap Between Front Teeth
Parents of older babies and toddlers sometimes notice a gap between the upper front teeth and wonder if a lip tie caused it. There is an association: when the frenulum inserts into or through the gum papilla (the higher grades), it can contribute to a space between the central incisors. But many other things cause gaps in baby teeth, including thumb sucking and missing teeth, and a gap in baby teeth often closes on its own as the permanent teeth come in.
Dental guidelines recommend against surgically releasing the frenulum to fix a tooth gap until after the permanent lateral incisors (the teeth next to the front two) have erupted, because the gap frequently closes spontaneously at that point. If the gap persists, orthodontic treatment is typically recommended before or alongside any frenulum release, not the other way around.
What Medical Organizations Say About Treatment
The rise in lip tie diagnoses over the past decade has significantly outpaced the evidence supporting treatment. Both the American Academy of Pediatrics and the Academy of Breastfeeding Medicine state that there is no evidence supporting surgical release of the upper lip frenulum to improve breastfeeding. The AAP’s 2024 clinical report is direct: labial frenula are normal oral structures unrelated to breastfeeding mechanics and do not require surgical intervention for feeding purposes.
This doesn’t mean feeding difficulties aren’t real. It means that if your baby is struggling to latch, the lip frenulum may not be the cause, even if it looks prominent. A lactation consultant can evaluate latch mechanics and positioning, which resolves many feeding challenges without any procedure. If a provider recommends releasing a lip tie, it’s reasonable to ask what specific functional problem they expect it to solve and whether less invasive options have been tried first.