A lip tie, medically known as a restrictive labial frenulum, occurs when the band of tissue connecting the upper lip to the gum line is unusually tight, thick, or short. This congenital condition limits the mobility of the upper lip required for effective infant feeding. When the lip cannot move freely, it prevents the baby from achieving a deep and secure latch, which leads to various feeding difficulties. This restriction often prompts parents to seek professional evaluation during the early months of their child’s life.
Anatomy and Types of Lip Ties
The tissue involved in this restriction is the superior labial frenulum, a fold of mucous membrane extending from the inside of the upper lip down to the gum tissue above the front teeth. While everyone has this tissue, it is considered a lip tie only when its attachment is restrictive enough to impair function.
The degree of restriction is often described using a classification system, such as the one developed by Dr. Lawrence Kotlow, which helps practitioners communicate the anatomical finding. This classification typically uses four types or grades to describe the severity and location of the frenulum’s attachment.
A Type 1 attachment is minimal and high on the gumline, generally causing no functional issues. Conversely, a Type 4 is the most restrictive, inserting deep into the gum tissue or extending toward the hard palate.
A restrictive tie, such as a Type 3 or 4, inhibits the lip from flanging out, which is necessary for creating a proper seal around the breast or bottle nipple. The inability to flare the lip outward forces the baby to use a shallow latch, preventing optimal milk transfer.
Identifying the Functional Symptoms
The primary concern stemming from a lip tie is difficulty creating and maintaining a strong oral seal during feeding. This poor seal often results in the baby swallowing excessive air, manifesting as significant gas, fussiness, or colic-like symptoms following a feed.
The inefficient milk transfer can also lead to symptoms in the infant such as prolonged feeding sessions, frequent feedings that still do not satisfy, and, potentially, poor weight gain or failure to thrive.
The restricted upper lip movement often causes the baby to make a characteristic clicking or smacking sound during nursing, indicating a repeated loss of suction. Parents may also notice that the baby’s upper lip is tucked inward rather than being rolled out. Sometimes, a small blister develops on the center of the upper lip from friction.
For the nursing parent, the functional problems often translate into physical discomfort and complications. A shallow latch can cause significant pain, cracking, or bleeding of the nipples because the breast tissue is not properly positioned. Furthermore, the baby’s inability to effectively drain the breast can lead to recurrent issues like plugged milk ducts, breast engorgement, or mastitis.
Diagnosis and Corrective Procedures
Diagnosis of a lip tie typically involves a pediatrician, a lactation consultant, or a specialized pediatric dentist. Evaluation focuses on the functional limitation caused by the frenulum, not solely its visual appearance or anatomical classification. Examination involves a visual inspection of the frenulum’s attachment and digital palpation, where the practitioner gently attempts to lift the lip to gauge the degree of restriction.
If a lip tie is confirmed to be causing feeding difficulties, the primary treatment is a minor surgical procedure called a labial frenectomy, often referred to as a “release.” This procedure severs or alters the restrictive tissue to allow for improved range of motion in the upper lip.
The frenectomy can be performed using either sterile scissors or a soft-tissue laser. The laser method is often preferred for its precision, minimal bleeding, and quick recovery time.
The procedure is swift, often taking only a few minutes, and is typically performed in the office with little to no anesthesia for infants. Immediate post-procedure care involves encouraging the baby to feed right away to utilize the new range of motion and establish a better latch. Parents are also instructed on post-operative stretching exercises to prevent the tissue from reattaching as it heals.
Understanding the Difference Between Lip and Tongue Ties
While lip ties involve the superior labial frenulum connecting the upper lip to the gum, a tongue tie, or ankyloglossia, involves the lingual frenulum connecting the underside of the tongue to the floor of the mouth. Both conditions restrict oral movement and often co-occur, but they affect different aspects of oral function.
The tongue is responsible for creating the suction and peristaltic wave motion necessary to efficiently extract milk from the breast. Therefore, a tongue tie generally has a greater impact on feeding mechanics, swallowing, and later, speech development.
A lip tie primarily impacts the seal and latch, whereas a tongue tie directly impairs the function of the tongue itself. Although both can result in a shallow latch and poor weight gain, an isolated lip tie presents a lesser functional challenge than a moderate to severe tongue tie. When both are present, feeding difficulties are compounded, and providers may recommend releasing both frenula simultaneously.