Tongue and upper lip tie in babies and toddlers is being discussed, ad nauseam, everywhere from breastfeeding support groups to online parent forums.
Tongue ties and lip ties are increasingly blamed for almost every sort of breastfeeding or parenting worry.
Baby isn’t putting on enough weight, or won’t sleep?
Baby has reflux, or takes forever to finish a bottle?
Breastfeeding isn’t working out in the way you’d hoped?
Solution: check for a tie.
Some families jump straight to the idea that having a tongue tie and lip tie treatment will ‘fix’ feeding difficulties for their baby.
You can read more about tongue-tie (ankyloglossia) in Tongue Tie – 9 facts You need To Know.
Let’s explore ‘lip ties’ a little further, and answer many of the questions you are all asking.
What is an upper lip tie?
Under the top lip, we have a strip of skin that connects the top lip to the upper gum tissue.
It’s called the maxillary labial frenulum.
It is normal to have this piece of tissue tethering the top lip to the gums. In fact, I’ve never seen a baby without one.
If the tissue happens to be short and tight, many people believe the lip tie will affect a baby’s latch or the function of the upper lip. Tongue ties are often present when there’s a lip tie.
Lip ties are often blamed when mothers experience trouble breastfeeding. They are also claimed to affect breast milk supply and cause poor weight gain in babies.
What evidence supports upper lip tie revision?
To date, research hasn’t shown whether or not an upper lip tie has any effect on breastfeeding.
The studies available use a classification tool for health professionals to assess the function of the tongue.
This tool is called the Kotlow and Hazelbaker Assessment Tool, as it was designed by US pediatric dentist Lawrence Kotlow.
If used without a proper clinical assessment of both mother and baby, the Kotlow tool isn’t reliable when diagnosing lip tie.
Health professionals also vary in their opinions about detecting and treating tongue and lip ties.
Research shows an epidemic of oral ties in countries like Australia and the US.
The evidence available to us shows the impact of breastfeeding support, and how that can overcome many of the problems that are being linked to lip ties.
If you’re told lip tie surgery will fix your baby and any problems with breastfeeding, it’s very important you first seek the guidance and advice of an IBCLC (International Board Certified Lactation Consultant).
Lactation consultants are breastfeeding experts and can help you work with your baby to figure out what the problems are and how to solve them.
Do your research, and find an experienced provider such as a pediatric ear, nose, and throat specialist (ENT), and also work with your IBCLC for a thorough assessment of the full clinical picture.
How do you fix an upper lip tie?
First, it’s important to consider why you want to fix an upper lip tie on your baby or toddler.
Have you been told your baby’s breast or bottle feeding problems will be resolved by a lip tie release?
Or perhaps your toddler is struggling with eating solids and it’s been suggested a tight frenulum is responsible.
It’s important to connect with the best health professional for your individual situation.
If there are problems with eating solid food, for example, a speech therapist can work with your baby or child, and make suggestions for alternative treatments before considering surgery.
Often there are other factors that are causing breastfeeding problems, such as changes to positioning or attachment.
An IBCLC is an expert in breastfeeding latch and positioning, and can assess your situation and see whether changes are affecting breastfeeding and whether a lip tie is the cause.
Rather than oral surgery to release a labial frenulum that actually doesn’t need fixing, your IBCLC might suggest treatment from an osteotherapist.
Cranialsacral therapy can release tension in your baby’s jaw and body might be mimicking a restricted lip tie.
What are the risks of revising an upper lip tie?
Parents are often warned there are dire consequences of not getting a diagnosis and having treatment for lip tie, such as:
- Speech problems
- Swallowing problems
- Sleep disorders
- Need for braces
- Other developmental difficulties in the future.
All these potential concerns are about the future. They do not address the immediate reasons relating to the lip tie – not to mention the lack of evidence supporting these claims.
In many cases, revision on babies with tongue and lip tie might go smoothly, without concern.
Surgery of any type, however, comes with risks.
The mouth has an extensive blood supply. Cutting or lasering procedures can cause blood loss and possible hemorrhaging.
There are lots of pain receptors in the mouth, and cutting the upper lip skin on a baby will cause pain. This can be traumatic for the baby and can cause aversion.
Aftercare procedures, such as manual stretching and rubbing exercises several times a day, can also cause pain, and they are stressful for mother and baby.
Any open wound is vulnerable to bacteria entering, creating a risk of infection.
Finally, the lip tie may not have been the problem and revision will not fix whatever was causing difficulties.
There are many anecdotal cases where tongue tie or lip tie surgery done on babies resulted in no functional change.
Can a dentist fix a lip tie?
If you’re considering oral surgery for your baby or toddler, first seek the support of an IBCLC and ENT specialist to assess whether or not a revision is the best option for your child.
It’s also important to consult with a pediatric surgeon to discuss any oral surgery. Your regular dentist might not have the training or experience to work with your baby.
Some GPs are also known to perform tongue tie and lip tie release.
The health professional you’re considering should have experience with infants, toddlers, or small children.
The most important thing is to do your research and be as informed as possible before making your decision.
How much does lip tie surgery cost?
The range of costs for oral surgery is very broad and depends on each specialized practice.
Generally, the cost of surgery ranges from AUD$110-$1000. It can also depend on the type of treatment. Laser tends to be much more costly than using scissors or a scalpel.
Some places might offer Medicare rebates. If you have private health insurance you can contact the provider to find out if your level of cover includes oral surgery for your baby.
What happens after lip tie release?
The type of aftercare treatment recommended will depend on where you have the procedure done.
Often therapy techniques, such as stretches, are suggested to make sure the released piece of tissue doesn’t re-attach after the surgery.
There’s good evidence from The American Academy of Pediatrics that show stretches are painful and can cause oral aversions.
Simply breastfeeding or bottle feeding after oral surgery can stretch the skin naturally and help it heal.
Can an upper lip tie affect speech?
There are no studies that strongly support the suggestion that having a lip tie can affect speech.
It’s impossible to look into the future and predict whether or not speech will be affected by having skin tethering the top lip to the gums.
Performing lip tie revision on newborn babies or toddlers isn’t something to take lightly or do ‘just in case’ a problem might arise later.
If you have concerns about your child’s speech when he begins to talk, a speech therapist is the best person to discuss them with you.
Does an upper lip tie affect teeth?
There are claims short and tight lip ties and tongue ties make brushing teeth more difficult and will lead to cavities in young children.
There’s no evidence to suggest this is true. Good oral hygiene and a healthy diet will help prevent tooth decay.
Neither is there any evidence to show lip tissue inserting well into the gum area between the front teeth (anterior papilla) will cause a gap to occur when the teeth erupt.
There is some research showing a gap between baby teeth is likely to close when the adult teeth come through.
Besides, who said having a gap in your front teeth is a bad thing anyway? There are beautiful and amazing people, such as Madonna, Elton John, and the late Robin Williams, who do.
Can babies successfully breastfeed with a lip tie?
Frenulums are normal. They give stability to the upper lip, lower lip, and tongue in the mouth.
Labial frenulums are normal. Many breastfed babies nurse successfully with varying degrees of lip tissue to gum line insertions.
Breastfeeding difficulties are caused by many things.
Many assessments for lip-tie are based on outdated advice about how babies attach to the breast – for example, that top and bottom lips need to flange-like ‘Special K’ lips.
When a breastfeeding baby is well attached, it’s hard to see the top lip, let alone the bottom lip, which is usually buried in the underside of the breast. If the top lip tissue is causing a functional problem, it can be considered a lip tie.
Breastfeeding latch depends a lot on the individual anatomies of both mother and baby.
There are other treatments to solve breastfeeding problems. A lactation consultant can help with adjusting position and attachment.
Osteotherapy is also an option if the baby’s mouth doesn’t open widely, due to muscle tension.
In some cases where families decided to give it time, the latch improved, and no further intervention was needed.
Does an upper lip tie need to be fixed?
A labial frenulum under the top lip is normal in babies. It isn’t considered a tie if there are no functional problems or breastfeeding concerns.
There’s no evidence to suggest releasing a lip tie will magically fix problems with breastfeeding or bottle-feeding, nipple pain, or poor weight gain in babies.
A decision about oral surgery for a baby or toddler isn’t one to make lightly.
Parents should do research and find the right support to help them manage whatever difficulty is making them consider this procedure for their baby.
For breastfeeding problems, lip tie surgery is a last resort, when a lactation consultant has ruled out other methods.
In this case, the benefits of continuing breastfeeding your baby would outweigh the possible risk of having the surgery done.
Only the parents will know what’s the right thing to do for their baby.