Lip-tie, which varies in severity, has gained more awareness in recent years in relation to breastfeeding problems — a simple Google search for "lip-tie and babies" yields millions of results. But is lip-tie the only thing to blame for your sore nipples? Is treatment necessary to "flip that lip?"
It's all a bit tricky. Here's what you need to know if you think your baby might have a lip-tie.
What is lip-tie?
Lip-ties occur when the piece of tissue behind your baby's upper lip is too short and tight, limiting the upper lip's movement. This tissue is called the maxillary labial frenum, and you can feel yours if you run your tongue between your upper lip and the top of the gum).
Similar to tongue-tie, lip-ties can cause feeding difficulties when a baby can't get her lips around the nipple and upper portion of the areola. (Her lips should be able to form a proper seal around them.)
What does a lip-tie look like?
Lip-ties look different depending on the severity of the tie: a small, string-like appearance on one end of the spectrum and a wide, fanlike band of connective tissue on the other.
The Kotlow classification system uses four grades to rate the frenulum based on appearance.[1] With this system, the higher the grade, the higher the severity of lip-tie. This rating system does not look necessarily at the lip-tie's impact on function, so follow-up is necessary to decide on next steps.
From a medical standpoint, the key is really understanding if the upper lip's movement is restricted. No symptoms, no problem. But any feeding problems in a growing baby are always a cause for concern.
How does lip-tie affect breastfeeding?
In the same way that not all babies with tongue-tie have problems breastfeeding, not all babies with lip-tie will have trouble either. It is also not clear that a lip-tie can definitely cause difficulties latching or feeding.
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Lip-tie-related symptoms in babies may include:
- Poor latch. If you notice a clicking or smacking sound while your baby is nursing, it may be an indication that she can't get a good latch or is constantly losing the nipple.
- Failure to thrive, meaning slow or poor weight gain.
- Prolonged feeding time.
- Reflux and irritability — often from swallowing excessive air.
- Breast milk leaking from the mouth — a result of a poor seal.
- A callus on the upper lip.
Lip-tie-related symptoms in mothers may include:
- Nipple pain
- Decreased milk supply
Experts say more research is needed to further evaluate lip-tie's effect on breastfeeding.
What is the treatment for lip-tie?
Treatment for lip-tie is a bit of a mixed bag with varying professional opinions.
Some lip-ties do not impact function and do not require surgical treatment. Other times, doctors may recommend a frenectomy, a surgical treatment for lip-tie that severs the tissue connecting the lip to the gums.
It is possible for a baby to have both tongue-tie and lip-lie at the same time. In this case, a pediatrician may recommend releasing both.
While more research on the surgical treatment of lip-tie is needed, some research suggests that frenectomies improve breastfeeding outcomes.[2]
Talk it through with your pediatrician, lactation consultant, ENT or pediatric dentist to learn what is best for you and your baby. Remember, a fed baby is a happier baby.
How can you continue breastfeeding if your baby has lip-tie?
If your baby is having trouble latching on, talk with a lactation consultant and your baby's pediatrician to see if lip-tie is really the problem. You can also try:
- Special nipple shields. There are ones made specifically for moms of babies with nursing challenges. Always work with a lactation consultant when using a nipple shield.
- Strategic positioning. Holding your baby in a less-traditional way may improve feeding and allow your baby to connect more fully to your breast. Talk with your lactation consultant (or a pediatric physical therapist familiar with tie issues) for ideas.
- Therapy techniques. Sliding your finger along the top of your baby's lip — trying to loosen the gap between the lip and gum line — may gradually improve the mobility of the lip and make it easier to breastfeed.
- Softening breasts before feeding. Lactation consultants recommend spreading your baby's saliva on your breast before having them latch on. (A bit weird, but worth a try!)
A baby with a lip-tie may have an easier time drinking from a bottle. That bottle can include formula or milk pumped from your breast. You can also experiment with different nipples and flow rates.
Whether you pump breast milk, supplement with formula or use formula exclusively, rest assured that every option gives your baby the nutrition she needs to continue to thrive.
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