A lip tie is a congenital condition where the tissue connecting the upper lip to the gum line, known as the maxillary labial frenulum, is unusually tight, thick, or short. While this structure is present in everyone, a restrictive frenulum limits the necessary mobility of the upper lip. This restriction can interfere with the proper function of the mouth, particularly an infant’s ability to form a seal during feeding. A lip tie is a relatively common finding in newborns, but its presence becomes a concern only when it causes observable functional difficulties.
Anatomical Structure and Classification
The maxillary labial frenulum is a thin band of connective tissue situated centrally beneath the upper lip, anchoring it to the gum ridge. A lip tie is diagnosed when this tissue tethers the lip too tightly, preventing it from curling outward or “flanging” over the breast or bottle nipple. This limited mobility can compromise the vacuum seal needed for effective suction and milk transfer.
Lip ties are commonly classified into four types, often using a system such as the Kotlow classification, which is based on the frenulum’s point of attachment to the gum ridge. A Class 1 attachment, for example, is minimal and attaches high on the gum, near the lip, while a Class 4 is the most restrictive, inserting directly into the alveolar ridge and sometimes extending into the palate. Class 2 and 3 attachments fall in between, with the frenulum inserting further down onto the gum tissue. It is the functional limitation, rather than the visual grade alone, that dictates whether intervention is needed.
The severity of the tie relates directly to the physical restriction imposed on the upper lip’s movement. For effective feeding, the upper lip must be able to flare out, which is often called flanging, to create a wide, secure latch. A tight frenulum pulls the lip inward and downward, which forces the baby to use improper mouth mechanics to compensate, leading to a shallow or weak latch.
Recognizing Functional Impact and Symptoms
The restriction caused by a lip tie manifests as a range of observable difficulties, primarily impacting a baby’s ability to feed efficiently. Infants with a functional lip tie often exhibit a poor or shallow latch, as the lip cannot fully cup the breast or bottle. This compromised seal results in the baby swallowing excessive air, which contributes to increased gassiness, discomfort, or symptoms often associated with colic or reflux.
During feeding, a clicking or smacking sound can often be heard, which is a direct sign that the baby is repeatedly losing the vacuum seal necessary for suction. Due to the effort required to compensate for the restricted lip movement, babies may tire quickly and fall asleep shortly after starting a feed, leading to prolonged feeding sessions and sometimes inadequate weight gain. An infant might also develop a callus or blister on the center of their upper lip from the friction of struggling to maintain a hold.
When a mother is breastfeeding, the functional impact of a lip tie is equally significant. The baby’s shallow latch can cause substantial pain for the mother, often described as a pinching, biting, or scraping sensation. This ineffective milk removal can lead to physical damage, such as cracked, bruised, or bleeding nipples. Furthermore, poor milk drainage can predispose the mother to complications like:
- Painful breast engorgement.
- Blocked milk ducts.
- Recurrent episodes of mastitis.
- A perceived or actual low milk supply over time.
Diagnosis and Corrective Procedures
Diagnosis of a lip tie is based on a comprehensive functional assessment rather than merely a visual inspection of the tissue. Healthcare professionals such as a pediatrician, a lactation consultant, a pediatric dentist, or an Ear, Nose, and Throat (ENT) specialist perform a physical examination to check the range of motion of the upper lip. The evaluation includes observing the infant’s ability to lift and evert the lip and feeling the frenulum’s thickness and tension.
The ultimate determination of a lip tie requiring treatment hinges on the presence of feeding symptoms and functional limitation. If the tie is causing difficulty with latching, pain, or poor weight gain, a corrective procedure may be recommended to restore full lip mobility. The most common treatment is a frenotomy, which is a simple procedure to release the frenulum.
The frenotomy is a swift, minor procedure that can be performed using sterile surgical scissors or, increasingly, a soft-tissue laser. Laser procedures offer the benefit of minimal bleeding and discomfort due to the cauterizing effect of the laser energy. The goal of the release is to allow the upper lip to move freely, improving the baby’s ability to achieve a deep, effective latch.
Following the procedure, parents are typically instructed to perform simple, gentle stretches or exercises on the treated area. This aftercare is important to prevent the tissue from reattaching as it heals, ensuring the full range of motion is maintained. Follow-up support from a lactation consultant or feeding specialist is highly recommended to help the infant learn how to utilize their newly freed lip for more efficient feeding.