Are you having trouble breastfeeding and wondering whether a “lip tie” in your baby may be to blame?
So-called lip ties have gained more awareness in recent years because of their purported link to breastfeeding problems. A plethora of practices have popped up promising that surgically correcting babies’ lip ties may be the answer to parents’ nursing prayers and help remedy a range of breastfeeding issues, like difficulty latching.
But before you start scrutinizing your baby’s mouth or run out to book an appointment, be aware that experts including the American Academy of Pediatrics (AAP) don’t believe lip ties are responsible for breastfeeding problems at all.
In fact, Jenny Thomas, M.D, a pediatrician, breastfeeding medicine specialist, and the lead author of the AAP’s clinical report on tongue ties and lip ties, says that since everyone is born with a lip tie — clinical term: superior labial frenulum — the organization doesn’t even really consider it an actual condition.[1]
"We don’t have a good idea about what the lip is supposed to do during the latch,” says Dr. Thomas. “And without a good idea of normal function, it is hard to say what pathology [aka abnormal function] is.”
Dr. Thomas says that there’s very little research looking only at lip ties; the majority have analyzed lip and tongue ties together.
“Most studies that say correcting a lip tie is beneficial also treated the tongue [tie] at the same time,” she notes.
Read on for more about lip ties and the claims that they might be responsible for breastfeeding struggles.
A lip tie is a term for the piece of tissue connecting the upper lip and gum. Everyone is born with a lip tie, and they recede naturally over time. The AAP and other medical experts advise against any surgical treatment for lip ties, and instead recommend working with a lactation consultant to address feeding issues in other ways.
What is a lip tie?
A lip tie describes the piece of tissue connecting the inside of your baby's upper lip to her gum.
This tissue is called the superior labial frenulum or maxillary labial frenulum, and you can probably feel yours if you run your tongue between your upper lip and the top of the gum.[2]
Everyone has a lip tie starting at birth.
What does a lip tie look like?
A lip tie is a narrow piece of skin that connects the upper lip to the upper gum. It can look stringy or like a wider band of tissue, depending. Lip ties typically become less pronounced and recede as baby grows.
How do lip ties affect breastfeeding?
Contrary to tongue ties, which can affect baby's ability to breastfeed in some cases, lip ties do not cause nursing problems in infants, according to the AAP and other medical experts. The notion that correcting a lip tie to improve breastfeeding is widely disputed by the majority of the medical community.
“A lot of those [breastfeeding] problems can be overcome by working with a lactation consultant, figuring out the best latch system for breastfeeding with your particular child's mouth,” says Gina Posner, M.D., a board-certified pediatrician in Fountain Valley, California, an AAP Fellow, and a member of the What to Expect Medical Review Board.
Dr. Thomas says she authored the AAP's paper clarifying the guidelines on lip ties and tongue ties because of the "explosion" of businesses that have cropped up offering lip tie and tongue tie correction procedures.
“Parents with breastfeeding problems also face considerable pressure to have labial frenula (lip) or buccal frenula (cheek) addressed,” the AAP's 2024 paper and statement say. “They are normal oral structures, and intervention to release these ties is not supported by evidence.”[3]
These practices claim that fixing lip and tongue ties can also help fix breastfeeding problems. But Dr. Posner and Dr. Thomas say their intentions aren't necessarily pure.
"Correcting lip ties and tongue ties are procedures that a lot of people are making money off of," Dr. Posner says. "It's very exploited in a lot of ways because any woman who is having trouble breastfeeding [may think] it's because their baby has a tongue tie or a lip tie. But it can only rarely cause true problems."
While tongue ties can be linked to struggles with nursing in some cases, there's no evidence whatsoever that a lip tie impacts breastfeeding. Nor is there agreed-upon literature about what's normal and what isn't when it comes to the superior labial frenulum.
"We don’t have a scoring system of what abnormal looks like," says Dr. Thomas. "Before we put a kid through [a surgical procedure], we should have a clear idea of what that is."
What to Expect Community mom BubblegumBubblegum's baby wound up having both a lip tie and a tongue tie released in an effort to address her own breastfeeding challenges.
"Baby’s latch has been super narrow and tight since birth," she says. "My nipples have been taking a beating — lipstick-shaped, bleeding, blistering. What a treat!"
But experts including Dr. Thomas say that putting a baby through such a procedure carries more risks than leaving it alone, and surgical interventions with lip ties aren't likely to do anything to help with breastfeeding.
"Lip tie recedes over time," she says. "So unlike with tongue tie, the appearance gets less prominent. Because it gradually improves, there are minimal [to no] benefits to surgically intervening."
Plus, the recovery can be very hard on both baby and parent.
"A lot of times, I have parents coming back [after a lip tie procedure] and the moms are so upset because now their child's in pain and won't feed," Dr. Posner says. "And they have to do these exercises with them ... So I have these moms who were already having a rough time, and now they're having an even rougher time."
What is the treatment for a lip tie?
The AAP does not recommend any surgical or invasive treatment for lip tie.
So how would they suggest helping parents having trouble with breastfeeding whose babies might have more severe lip ties?
"We would do a complete feeding history," says Dr. Thomas. "It needs to be a team sport. There are so many other things that can affect breastfeeding, and we want to make sure we're not missing another problem."
She says that in her experience, about 5% to 10% of nursing issues can be linked to tongue tie. "But that means about 90% of breastfeeding problems have other causes," she notes.
Practices that claim to fix lip ties perform a procedure called a labial frenectomy, which involves having the skin surgically released using either a laser or scissors. Recovery doesn’t require any stitches or ongoing medication, but it can be difficult. Parents should be prepared to perform a series of oral stretches with their babies for a period of time afterward.
“The procedure and recovery weren’t easy,” says What to Expect Community mom Achiari2.
Parents should continue to work with a lactation consultant on developing baby’s latch even if they've gone through with lip and/or tongue tie release.
So can you continue breastfeeding if your baby has a more pronounced lip tie?
Yes, you can absolutely continue to breastfeed even if your baby's lip tie is more pronounced. If your little one is having trouble latching on, talk with a lactation consultant and your baby's pediatrician first.
"The fundamental issue that contributes to all of this 'lip tie, tongue tie' obsession is that breastfeeding is very difficult, especially in the beginning," says Florencia Segura, M.D., a pediatrician at Einstein Pediatrics in Vienna, Virginia; an AAP Fellow; and a member of the What to Expect Medical Review Board. "It takes a lot of practice. There are a lot of things that have to happen for everything to go right."
If you are struggling with breastfeeding, here are a few things you can try instead:
- 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!)
Your baby may have an easier time drinking from a bottle, if all else fails. You can experiment with different bottle nipples and flow rates if you and your medical team decide to go that route. And 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.
However, if you're worried that a lip tie could be the culprit, you can put that fear to rest once and for all.
"It’s really hard to be a new parent navigating this," Dr. Thomas says. "But we do not think a lip tie causes breastfeeding problems. There is no data to prove it."
Want more expert tips on breastfeeding, plus support from other parents about what's working for them? Find it in the What to Expect app, where you can also keep track of your baby's feedings, record how they're sleeping, and take notes on what your little one is doing during every new phase.
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