A lip tie is a tight or thick band of tissue, called the upper labial frenulum, that connects the inside of the upper lip to the gum, and current evidence that releasing an isolated lip tie improves breastfeeding is limited. Lip ties are very common, and in fact more than 80 percent of newborns can be scored as having a prominent upper frenulum on the grading scales used, which is one reason a lip tie alone is not a reliable explanation for feeding problems. Where there is a feeding difficulty, the first step is usually feeding support rather than a procedure.
Key takeaways
- A lip tie is a band between the upper lip and gum; many babies have a prominent one.
- The Kotlow scale grades lip ties 1 to 4, but it has poor reliability between examiners.
- Good evidence supports treating tongue-tie when it causes feeding problems; evidence for releasing an isolated lip tie is limited.
- Lactation and feeding support is usually the first step, not surgery.
- A combined assessment, often with a tongue-tie check, is more useful than looking at the lip alone.
What a lip tie is
The upper labial frenulum is the small fold of tissue you can feel if you lift a baby's top lip. When it is tight, thick, or attaches low onto the gum, it is described as a lip tie. The most common grading system is the Kotlow scale, which runs from grade 1 (a high attachment with free lip movement) to grade 4 (the band extends over the gum ridge). The trouble with the scale is that different examiners often grade the same baby differently, and a high grade does not reliably predict feeding difficulty.
Can a lip tie affect breastfeeding?
A lip tie has been suggested to make it harder for a baby to flange the top lip and form a good seal, which could affect latch. In practice, the research has not shown a clear link between an isolated lip tie and feeding success. Many babies with a prominent frenulum feed well. Where feeding is difficult, a tongue-tie, positioning, or other factors are often more relevant, which is why a full assessment matters more than the appearance of the lip alone. Our guide to tongue-tie and feeding covers the condition that has stronger evidence behind it.
Signs parents sometimes notice
- Difficulty keeping a deep latch or frequent slipping off the breast
- Clicking sounds or a shallow latch
- Sore nipples for the feeding parent
- A gap behind the upper lip where milk can pool
These signs are not specific to lip tie and can have many causes, so they are best assessed by someone experienced in infant feeding.
What usually helps first
Because the evidence for releasing an isolated lip tie is limited, leading paediatric and breastfeeding bodies generally recommend trying feeding support first. A lactation consultant can review positioning, latch, and milk transfer. If a tongue-tie is also present and causing problems, releasing the tongue-tie may help, sometimes with improvement reported by parents. A procedure on the lip alone is considered only in selected cases and after careful discussion of the limited evidence.
Lip tie and dental health later on
As a child grows, a prominent upper frenulum sometimes contributes to a gap between the front teeth, although many gaps close on their own as the adult teeth come through. A tight frenulum can also make it harder to clean under the lip, so it is worth keeping that area clean once teeth appear. Our guide to cleaning baby and toddler teeth explains a simple routine. If a gap or hygiene issue persists, it can be reviewed at a first dental visit.
Frequently asked questions
Does every lip tie need to be cut?
No. Many babies with a prominent lip frenulum feed and grow well. Treatment is considered only where there is a clear, ongoing problem and after feeding support has been tried.
Is a lip tie the same as a tongue-tie?
No. They are different bands of tissue. Tongue-tie has stronger evidence linking it to feeding difficulty, and the two can occur together.
Will a lip tie cause a gap in my child's teeth?
It can contribute to a gap between the upper front teeth, but many gaps close naturally as more teeth come through. A dentist can advise if it persists.
Who should assess my baby?
A combined assessment by your child health nurse, a lactation consultant, and where needed a dentist or doctor gives a fuller picture than looking at the lip alone.
Can a lip tie affect bottle feeding?
Some parents report latch issues with bottles too, but the evidence is limited. Trying different teats and positions is a reasonable first step.
Speak with the team at Lumi Dental
If you are concerned about your baby's lip tie or feeding, the team at Lumi Dental in Melrose Park can examine the area and help you decide whether a procedure is even worth considering, working alongside your feeding support team. You can read more about our general dental care or view current new-patient offers on the current deals page.
This article is general information only and is not a substitute for personal medical or dental advice. Please see your child health nurse, doctor, or dentist for advice about your baby.
