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lactation-newborn

Lip Tie in Newborns: Does It Affect Breastfeeding?

A lip tie — tight frenulum connecting the upper lip to the gum — can prevent proper lip flanging during breastfeeding, causing a shallow latch or difficulty maintaining suction. Not every lip tie requires treatment; intervention is indicated when nursing is measurably impaired, confirmed by an IBCLC or specialist evaluation [1][2]. The AAP recommends lactation support before any surgical procedure [1].

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Lena Park, PNP — Pediatric Nurse Practitioner

kids & teens — sick visits, checkups. Gale can match you with a licensed clinician for a visit.

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What is a lip tie?

The frenulum labii superioris is the small band of tissue you can see on the inside of the upper lip, connecting the lip to the gum. In some babies this band is thicker, shorter, or extends further toward the gum line than typical. This is called a maxillary labial frenulum attachment variant — commonly called a lip tie.

Lip ties are graded on a spectrum from Class I (thin attachment, unlikely to cause problems) through Class IV (attachment reaching to or beyond the gum ridge, more likely to interfere with lip mobility). The classification matters less than the functional question: is nursing being affected?

How does a lip tie affect breastfeeding?

For a baby to latch and feed effectively, the upper and lower lips should flange outward — like fish lips — around the breast. When the upper lip is restricted by a tight frenulum, the baby may:

  • Have difficulty flanging the upper lip outward
  • Slip off the breast frequently
  • Take a shallower latch than needed
  • Make clicking sounds during nursing (air entering the mouth)
  • Take in more air, leading to extra gassiness and frequent spitting up
  • Tire quickly and fall asleep before feeding adequately

For the nursing parent, a poor latch caused by lip tie can result in nipple pain, cracking, and over time may affect milk transfer and supply 3.

That said, many babies with visible lip ties nurse beautifully with no problems at all. The presence of a structural finding alone does not mean treatment is needed 1.

How do I tell if my baby has a lip tie?

You can gently lift your baby's upper lip and look at the frenulum. A thick, tight, or very short band that makes the lip difficult to raise or that blanches when the lip is lifted may suggest a more restrictive attachment.

However, self-assessment is unreliable for determining whether a frenulum is functionally significant. A certified lactation consultant (IBCLC) is usually the best first evaluator — they can observe a feeding, assess the latch, and determine whether the lip anatomy is actually affecting milk transfer. If the IBCLC or your baby's pediatrician identifies a concern, they may refer you to a dentist or pediatric ENT with experience in oral frenulum assessment for further evaluation.

What is the treatment for a lip tie?

When a lip tie is judged to be causing significant functional problems, the procedure used to release the frenulum is called a frenotomy or frenectomy — cutting or using a laser to release the restrictive tissue, typically performed in a dental or ENT office.

There is active debate in the medical literature about patient selection, whether outcomes are consistently better after the procedure, and how to weigh benefits against small procedural risks. Evidence from randomized controlled trials on lip tie specifically (as distinct from tongue tie, which has a larger evidence base) is limited.

Most pediatric and lactation guidelines recommend a conservative approach 12: first, work with a lactation consultant to optimize positioning and latch. If problems persist despite good technique and the frenulum is judged to be restricting lip mobility, frenotomy can be considered. The decision should involve your baby's clinician, a lactation consultant, and the procedural provider — not anatomical appearance alone.

After any frenotomy, post-procedure stretching exercises and continued lactation support are typically recommended to optimize outcomes 3.

Who should evaluate and treat my baby?

The appropriate specialists for lip tie evaluation and treatment are:

  • Certified lactation consultant (IBCLC): first-line evaluation of feeding function
  • Pediatrician: overall newborn assessment, coordination of care
  • Pediatric dentist or dentist with frenulum experience: evaluation and procedure if indicated
  • Pediatric ENT (otolaryngologist): alternative procedural provider in some settings

Gale's care team can help you get a lactation consultation and coordinate a referral to the right specialist if one is needed.

Common questions

Is a lip tie the same as a tongue tie?

No. A tongue tie (ankyloglossia) involves the frenulum under the tongue and tends to have a stronger evidence base for effects on breastfeeding. A lip tie involves the upper lip frenulum. They can occur together. Tongue tie typically has a larger impact on milk transfer than lip tie alone.

Can a lip tie cause problems beyond breastfeeding?

A high or tight upper frenulum has been associated with a gap between the upper front teeth (diastema) later in childhood. However, many such gaps close on their own as permanent teeth come in, and dental specialists typically evaluate frenulum position at a later age rather than acting on it in infancy.

My baby has a lip tie but nursing seems fine. Do I need to do anything?

Not necessarily. If your baby is feeding well, gaining weight appropriately, and you are comfortable, monitoring is entirely reasonable. A frenotomy is only indicated when there is evidence of functional impairment. Your baby's Gale pediatric clinician can help assess this at a routine visit.

Will a frenotomy cure our breastfeeding problems?

Results are variable. Some families see quick improvement; others find that latch issues persist and require ongoing lactation support. This is one reason the procedure is recommended only when a lactation consultant has worked with you first and the frenulum is specifically judged to be the limiting factor.

Talk to a clinician

Lena Park, PNP — Pediatric Nurse Practitioner

kids & teens — sick visits, checkups. Gale can match you with a licensed clinician for a visit.

Find care →

When to contact your care team

  • —Baby not gaining weight adequately or losing more than expected in the first week
  • —Severe nipple pain, cracking, or bleeding with every feeding
  • —Baby falling asleep at breast after very short feeds and not meeting wet diaper targets
  • —Any signs of newborn dehydration (see dehydration article)

This article is for general education. The decision to pursue frenotomy should involve your baby's clinician, a lactation consultant, and a specialist with frenulum evaluation experience — not anatomical appearance alone.

References

  1. 1.Thomas J, Bunik M, Holmes A, Keels MA, Poindexter B, Meyer A, Gilliland A; American Academy of Pediatrics (2024). Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics. doi:10.1542/peds.2024-067605 ✓AAP 2024 multidisciplinary report: recommends lactation support before frenotomy; evidence for surgical benefit in feeding is inconsistent; anatomy alone should not drive treatment decisions
  2. 2.Berens P, Eglash A, Malloy M, Steube AM (2016). ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeeding Medicine. doi:10.1089/bfm.2016.29002.pjb ✓Evaluation of persistent breastfeeding pain including assessment of oral anatomy including lip anatomy, and guidance on when referral for frenulum evaluation is indicated
  3. 3.Mitchell KB, Johnson HM, Rodriguez JM, Eglash A, Scherzinger C, Zakarija-Grkovic I, Cash KW, Berens P, Miller B; Academy of Breastfeeding Medicine (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine. doi:10.1089/bfm.2022.29207.kbm ✓Nipple pain and damage as risk factors for mastitis; context for why correcting latch problems (including those from lip tie) reduces downstream complications

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.