Lip tie: Revision and complications
A lip tie occurs when the labial frenulum, which is the piece of tissue that attaches the upper lip to the gums, is very tight. This may make it more difficult to move the upper lip.
In babies, a lip tie may cause breastfeeding problems, such as difficulty getting enough milk. It can also cause pain in the breastfeeding woman.
According to the Triological Society, the frequency with which doctors and other healthcare providers diagnose lip tie has increased in recent years.
This article looks at what it is and provides some information on symptoms, complications, treatment, and revision.
What is it?
A baby with a lip tie may have difficulty getting enough milk during breastfeeding.
To breastfeed properly, a baby must be able to seal their lips around the nipple. The nipple must go fully into the baby’s mouth, so the baby must be able to move the upper lip enough to accommodate the nipple and create a secure latch.
Some babies have a labial frenulum that is very short and tight or that connects lower in the gums than is typical. This may make it more difficult for the baby to move their upper lip. In some babies, this interferes with the ability to nurse.
Parents and caregivers may notice that the baby has a more noticeable labial frenulum, or that the baby has difficulty moving their upper lip.
A lip tie is a difference in anatomy. It is not a disease or a symptom of a serious problem. When a baby does not have difficulty breastfeeding and nursing is not painful for the breastfeeding woman, there is no reason to treat a lip tie.
Lip tie affects the upper lip. Look at the center of the lip, then lift it. There is a band of tissue between the upper lip and the gums.
If it is difficult to lift the upper lip, or if the baby seems unable to move the upper lip, there may be a lip tie.
Though a lip tie can affect breastfeeding, lactation experts disagree about what counts as a lip tie and when, or if, a lip tie needs treatment.
Many lactation counselors and other breastfeeding experts use the classification system that Dr. Lawrence Kotlow developed.
However, a 2019 systematic review found that this system did not reliably produce the same diagnosis across different experts. Multiple healthcare providers may disagree about whether or not a baby has a lip tie.
Some babies have symptoms, while others do not. However, the fact that a baby has breastfeeding difficulties does not mean that they have a lip tie. Also, even when a baby does have a lip tie, it may not be causing the feeding difficulties, and correcting the tie does not always fix the breastfeeding issues.
Some symptoms that parents and caregivers may notice in babies with a lip tie include:
a labial frenulum that seems very tight
pain during breastfeeding
poor weight gain in the baby
a baby who seems fussy or frustrated when nursing
a baby who wants to nurse very frequently (because they are not getting enough food)
a baby who appears happier drinking from a bottle
difficulty getting the baby to latch or remain latched on the breast
However, it is important to note that most of these symptoms can also occur due to a range of other breastfeeding difficulties.
These symptoms may also occur with a tongue tie. Many babies who have lip ties also have tongue ties. A doctor will often evaluate these together.
A lip tie should not be a cause for concern, except for possibly in nursing babies. When a baby cannot get a good latch, it can disrupt breastfeeding. Although it is not clear which lip ties interfere with breastfeeding, if they do, some complications can arise. These include:
sore, itchy, or cracked nipples in the breastfeeding woman
pain during nursing, even after the initial adjustment period
an increased risk of breastfeeding-related infections, such as mastitis or yeast infections, in the woman
a baby who does not gain weight quickly enough
dehydration or malnourishment in the baby
a shorter breastfeeding duration
Some health professionals believe that lip tie causes dental health problems. This is because milk and food may pool on top of the teeth, increasing the risk of tooth decay, gum disease, and other oral health issues. However, research has not yet proven this.
Before resorting to a medical procedure, it may be best to start working with a lactation consultant on some ways to resolve any breastfeeding problems. They can help address any issues more generally, including the possible effects of a lip tie.
For women who are breastfeeding a baby with a lip tie and seeking treatment, there are a few options. For example, some may prefer to give the baby breastmilk in a bottle instead.
Others may prefer a lip tie revision. During this procedure, a doctor will cut a small piece of tissue in the labial frenulum to help loosen it. They can do this painlessly with a laser, or they may do it while the baby is under local anesthetic, using scissors or a scalpel.
It is important to note that laser frenectomy can cause burns, and that experts do not recommend this procedure for newborns. Also, although laser treatment for lip tie is becoming more common, it is expensive and not without risk. There is little evidence that it improves breastfeeding outcomes, and the lip tie can sometimes reoccur after treatment.
Older babies who have breastfed for several months with a lip tie may have learned compensatory strategies that no longer work following a revision. Parents and caregivers should work with a pediatrician or lactation consultant to help the baby nurse in an effective, comfortable way.
People who do not seek a lip tie revision or who want to try less invasive methods first may want to make changes to how they breastfeed the baby.
How to breastfeed a baby with a lip tie
Trying different breastfeeding techniques may make it easier for a baby to nurse. For example, women can try the following tips:
Breastfeed the baby more frequently. This ensures that they get enough food. It also prevents the breasts from becoming engorged and hard. It is more difficult for a baby to nurse from hard breasts.
Position the baby’s chin down. This can help them get a deeper latch.
Try squeezing the area around the nipple to make a dent under the areola just before the baby latches. Place their chin in this dent under the nipple.
Express milk by hand or with a pump. This ensures adequate milk supply if the baby cannot nurse effectively. It also offers another option for feeding the baby.
A lactation consultant can offer additional strategies based on the specific needs of the woman and the baby.
Some people also find help from attending support groups. Experienced group members may have advice for managing lip ties or be able to recommend healthcare providers with experience in treating them.
Lip ties are common and not necessarily a problem for all babies who have them. A lip tie does not always need treatment.
Parents and caregivers should assess whether or not the baby is having trouble breastfeeding. If other measures do not help, a lip tie revision may foster longer and healthier breastfeeding. However, further research into these procedures is necessary.
Anyone with breastfeeding concerns can consult a lactation counselor or a pediatrician with breastfeeding knowledge.