Lip Tie in Babies: When to Consider Correction

Medically reviewed by William Truswell, MD

A lip tie is a condition in which the lip frenum or frenulum, the piece of tissue that attaches your lip to your gums, is too short, thick, or stiff. It can be present either on the upper or lower lip. It's a concern in babies when it impacts lip mobility and feeding.

Some infants with a lip tie have difficulty getting the tongue in the correct position for breastfeeding or to create a latch needed to get milk from the breast. A healthcare provider can help you identify whether your baby has a lip tie and what, if anything, to do about it.

This article discusses what to look for if you're concerned your baby has a lip tie, potential impacts on feeding, and whether a correction is necessary.

Identifying Lip Tie in Babies: What to Look For

Lip frenums are present at birth and will grow and change as your baby's oral cavity develops. When an infant is born, this piece of tissue is often very prominent and can be misdiagnosed as a lip tie.

Ways in which the frenum can attach the lip to the gum include:

• Mucosal: When the attachment is where the tissue meets the top of your gums

• Gingival: When the attachment is farther down into your gums than a mucosal frenulum

• Papillary: When the attachment is at the gums between your front teeth
  

• Papilla penetrating: When the attachment is between your teeth but goes over the bone and continues into your palate

A lip tie can result depending on where the frenulum is attached, how short and stiff it is, and how much it affects lip mobility. A lip tie can cause symptoms in the infant and the breastfeeding or chest-feeding parent, primarily related to breastfeeding.

Infants may experience difficulty latching onto the breast to feed, have trouble breathing while eating, fall asleep or become very tired during feeding, make a clicking sound while nursing, have excessive fussiness, or have slowed weight gain.

Nursing parents may experience breast engorgement or mastitis despite a regular nursing schedule, fatigue from frequent breastfeeding even though their baby isn't satisfied, or pain during or after nursing.

Lip Tie Correction: Optional or Required?

Lip ties do not always require intervention. Because the frenulum changes as a child gets older, a lip tie may shrink and correct itself over time. Furthermore, an infant may have a lip tie that does not interfere with their ability to feed and obtain adequate nourishment, in which case intervention is unnecessary.

On the other hand, some lip ties may be so severe that they inhibit a child's ability to obtain proper nourishment. They may even be stiff and short enough that they begin to make the gums pull away from the teeth, which should prompt a conversation about treatment options with a healthcare provider.

Some providers may refer you to an international board-certified lactation consultant (IBCLC) for nonsurgical approaches. An IBCLC will provide support and offer noninvasive approaches, such as changing breastfeeding positions or switching to pumping and bottle-feeding.

While lip ties during infancy may interfere with the ease of nursing, untreated lip ties are less likely to cause significant problems later in life. Some pediatricians suspect that having an untreated lip tie may be related to a higher risk for tooth decay due to plaque accumulation, though the evidence is inconclusive. Additionally, lip ties may be the cause of certain speech difficulties and may contribute to sleep disruption in kids.

Takeaway

Overall, there is limited research on surgical lip tie procedures and breastfeeding outcomes and, therefore, there is no standard guidance regarding intervention. Some studies have concluded that correcting a lip tie can significantly and nearly immediately improve breastfeeding, but it's important to note that this is not the only option.

Lip Tie Effect on Baby’s Growth

If a lip tie is present and interfering with breastfeeding, a baby may experience delays in their growth. This can be especially true if the baby also has a tongue tie, which is when the tissue attaching the tongue to the floor of the mouth is too short and limits tongue motility.

If your baby has a lip tie, is having trouble nursing, and is experiencing weight loss or slowed weight gain, a provider may recommend that you supplement with breast milk or infant formula. This can help ensure that they meet their nutrition needs. 

Lip Tie Removal: Will It Hurt My Baby?

The procedure to correct a lip tie is called a frenectomy. It's an outpatient procedure, meaning infants do not need to be admitted to the hospital overnight. Some pediatricians may perform the procedure in their offices.

The frenectomy is often done using a laser or sterilized surgical scissors. Usually, no pain medication is used as the procedure causes little pain, although bleeding may result.

Following a frenectomy, the most crucial aftercare for infants is to keep the area clean. A healthcare provider may prescribe oral antibiotics to help reduce the risk of infection. The site will start to heal within a day or two, and a scar will generally develop within a week.

A baby will not be hurt by undergoing a lip tie correction.

Stretches to Heal Lip Tie After Removal

After you undergo specific surgical procedures, you may be prescribed stretches, movements, or other physical therapy to encourage full recovery and range of motion. The same is true following a lip tie procedure.

Older children and adults recovering from a frenectomy may practice making intentional, gentle movements with their tongues and lips. For example, tracing the lip with the tongue or gently moving the lip in and out, left and right, to discourage reattachment during the healing process and optimize the range of motion. This helps retrain the lips and tongue.

For babies, parents or caregivers can similarly help "stretch" the area after the procedure. Several times a day, place a clean finger into the baby's mouth and massage the area gently as it heals. The healthcare provider performing the frenectomy will give you specific instructions for how to do this and for how long to support the healing process best.

Lip Tie Baby: Tips for Easier Feeding

When an infant has a lip tie that interferes with nursing, this can be frustrating for both the baby and the parent. If you find yourself in this situation, there are some things you can try to help make feeding easier, including:

• Consult a pediatrician: Always talk to a healthcare provider when you have concerns about your baby's health and nutrition. Ask for a referral to a lactation specialist to help identify what is going on and offer guidance for forming a better latch to improve breastfeeding.

• Try a new nursing position: A football hold is commonly used to adjust and improve the baby's latch. Hold your baby in one arm next to your side, with their feet toward your back, like you're carrying a football. This simple change has long-term positive health outcomes for the parent and baby.

• Use a nipple shield: This is a thin piece of silicone placed over your nipple for breastfeeding. While not required for breastfeeding, a nipple shield can help provide a sturdier surface for your baby to latch onto and create a stronger suction.

Finally, if breastfeeding is too challenging and exhausting, and your baby is not getting enough milk this way, try pumping and bottle-feeding or using infant formula instead. Taking milk from a bottle may be easier for your baby, resulting in a fuller stomach and, hopefully, more rest for both parties.

Related: What to Know About Lactation

Summary

A lip tie in infants affect breastfeeding and may involve a corrective procedure called a frenectomy. If your baby is eating and gaining weight, they may not need a frenectomy, since the frenulum can shrink as your baby gets older. Often, changing the breastfeeding position to strengthen the latch, or transitioning to pumping and bottle-feeding can be just as helpful. It's important to understand the root cause and to work with your healthcare team to design a personalized approach together.

Read the original article on Verywell Health.