Infant Lip Tie

There are multiple different frenulums in a baby’s mouth. There are some in the cheeks, the upper lip, and under the tongue. All that helps balance and stabilize the cheeks, lips, and tongue in a baby’s mouth. When the frenulum is too short, tight, or connects to the gums lower than they should, it is called a lip tie, tongue tie, or cheek tie. A lip tie is when the skin that is attached from the upper lip to the gums is too short, too tight, or connects too low. This lip tie can prevent lip movement which can cause breastfeeding trouble in infants. If the skin that is attached under a baby’s tongue is too tight it is called a tongue tie.

The cause of lip ties is unknown. It seems to run in families more often than not, so there could be something genetic that causes them. And different types of ties tend to occur together. It is more common for a baby to have both a tongue tie and lip tie instead of just one or the other. Tongue ties are more common than lip ties. There is no exact test to deem if a child has a tongue tie or lip tie. What one doctor may think is a lip tie, may not be to another doctor.

There are four levels of severity of lip ties. One being the least extreme to four being the most extreme. Level one is called mucosal, level two gingival, level three papillary, and level four papilla penetrating.

Symptoms

One of the first signs your baby may be struggling from a lip tie is that you have trouble breastfeeding. A lip tie can cause a baby to not be able to move their top lip enough to get a good deep latch. This can lead to your baby wanting to feed constantly since they may not be getting adequate feeds each time. Your baby may experience difficulty breathing while feeding. They may also seem very worn out after feeding because they are working extra hard to feed. Your baby may have slow or no weight gain. Your baby may also experience gassiness, fussiness, or colic. Mothers may have a more painful breastfeeding experience. Inadequate feeds may leave a mother feeling engorged.

Complications

A poor latch in an infant can lead to complications for both the mother and baby. The mother may have sore, itchy, and cracked nipples. Mastitis or yeast infections are more likely to occur. A shorter breastfeeding experience can also happen. For a baby with a poor latch it can cause poor weight gain. It can also lead to dehydration and malnutrition. In older children a lip tie can cause dental complications. A lip tie can cause milk to pool on top of the top teeth which can lead to teeth problems as well as trouble with your child’s gums. A lip tie can also cause feeding problems in older babies or children. They may not have the ability to clean off a spoon fully in one bite.

Diagnosis

A pediatrician or a lactation consultant can help you diagnose if your baby is suffering from a lip tie. You can sometimes tell by trying to lift up your baby’s top lip. If it is too tight or you are unable to lift it, that can be a sign of a lip tie. After a physical examination there are a few things your doctor or lactation consultant will check for to decide if a lip tie is present. One they will check your baby’s ability, or inability to latch while breastfeeding. They will listen for a clicking sound while your baby is feeding. This clicking sound can be an indicator of a poor latch. If your baby is spitting on milk or choking on milk while feeding. If your baby is wanting to feed constantly, or cluster feed. They will check your baby’s weight gain over a period of time. If your baby is developing jaundice, it can also be a sign of a lip tie or poor feeding. There are other things that can cause your baby to have a poor latch, so checking with a doctor or lactation consultant before you assume your baby has a lip tie can help you navigate your breastfeeding journey the best way to make sure your baby is getting fed appropriately.

Treatment

Not all lip ties need to be treated. Sometimes they resolve on their own. Some babies will grow out of a lip tie. Other babies will find ways to feed with the lip tie where they are getting sufficient nutrition. Bottle feeding can be easier for babies with a lip tie. If you don’t want to switch to formula, you can pump and give your baby your breast milk from a bottle that way. You can try working with a lactation consultant to help you nurse in an effective and comfortable way for both mom and baby. They may suggest you feed more often. They also may have tips on how best to position your baby, such as positioning their chin downwards while feeding. If none of that works you can have a lip tie revision done. This is when the skin that connects the top lip is cut just slightly to help loosen up the hold. This can be done with a laser, scissors, or scalpel. Usually a laser is not used on an infant. This procedure can be done on a baby of any age.

Takeaway

Lip ties are when the skin that connects the upper lip to the gums is too tight, short, or connected too low on the gums. This happens in infants and can cause breastfeeding to be hard. In some cases a baby will grow out of it or learn other ways to effectively eat around the lip tie. With any breastfeeding concerns you should talk with your pediatrician or lactation consultant.