Lip Tie in Newborns: What Parents Should Know

If you've heard about tongue tie, you've probably also heard about lip tie. The two often come up together, and they can coexist. But lip tie gets less attention in the medical literature, and there's more debate about when—or whether—it needs treatment.

Here's what I share with families in my practice.

What Is a Lip Tie?

A lip tie occurs when the frenulum connecting the upper lip to the upper gum is short, thick, or tight, limiting the lip's ability to flange outward. Every baby has an upper lip frenulum—the question is whether it restricts movement enough to cause problems.

The upper lip needs to flange outward (like a fish lip) during breastfeeding to create a good seal around the breast. If it can't, the seal is compromised and baby may not latch as deeply or effectively.

Lip Tie vs. Tongue Tie

While they're related (both involve a restricted frenulum), they differ in important ways:

Tongue tie has a stronger evidence base. Research clearly supports that functionally significant tongue ties affect breastfeeding and that frenotomy improves outcomes.

Lip tie has less research behind it. There's no standardized classification system that's widely accepted, and less consensus on when treatment is beneficial. Many providers are more cautious about recommending lip tie revision.

That said, a significant lip tie—especially when combined with a tongue tie—can contribute to breastfeeding difficulty.

How Lip Tie May Affect Breastfeeding

When the upper lip can't flange properly:

• Shallow latch. Baby can't get a wide, open-mouth latch because the lip is tucked in.
• Poor seal. Air leaks in at the top of the latch, leading to clicking and gas.
• Nipple pain. The tucked lip can create friction and compression on the nipple.
• Milk dribbling. You may notice milk leaking from the corners of baby's mouth during feeding.
• Compensatory behaviors. Baby may use their gums or jaw to compensate for the lip restriction.

These symptoms overlap significantly with tongue tie symptoms, which is why the two are often evaluated together.

How to Check for Lip Tie

You can do a simple check at home:

1. With clean hands, gently lift your baby's upper lip toward their nose.
2. Look at the frenulum—the tissue connecting the lip to the gum.
3. Note where it attaches. The closer it attaches to the gum ridge (or the thicker and shorter it is), the more restrictive it may be.
4. See if the lip can flange outward freely or if it snaps back.

Important: Almost every baby has a visible upper lip frenulum. Having one doesn't mean your baby has a lip tie. It only matters if it's restricting function.

When Treatment May Help

I consider lip tie treatment when:

• Baby has concurrent breastfeeding problems
• The lip cannot flange outward during feeding despite positioning attempts
• The lip tie is combined with a tongue tie (addressing both may be needed for full improvement)
• Conservative measures (manually flanging the lip during latching) haven't resolved the issue

If the lip tie is isolated—no tongue tie, no significant breastfeeding problems—I generally recommend conservative management and observation.

Conservative Measures

Before considering a procedure:

• Manually flange the lip. During latching, use your finger to gently pull baby's upper lip outward. With practice, this can compensate for a mild restriction.
• Try laid-back nursing. Gravity helps baby open wider in this position.
• Work with a lactation consultant on positioning that accommodates the restriction.

Lip Tie Revision

If conservative measures don't resolve the feeding issues and the lip tie is clearly contributing:

The procedure is similar to a tongue tie frenotomy—the frenulum is released with scissors or laser. It's quick and typically done in the office at the same time as a tongue tie release if both are present.

Aftercare includes gentle stretching of the upper lip (lifting it toward the nose several times a day) for 2–3 weeks to prevent reattachment.

Recovery is similar to a tongue tie frenotomy—a small wound that heals over 1–2 weeks.

Beyond Breastfeeding

Some providers mention long-term concerns with untreated lip tie:

• A gap between the upper front teeth as they come in
• Difficulty with oral hygiene along the gum line
• Speech impact (less evidence for this)

In my experience, many lip ties that seem significant in infancy become less prominent as the child grows. The upper frenulum naturally thins and recedes as the jaw develops. A lip tie that looks dramatic in a newborn may be barely noticeable by age 3.

My Approach

I take a conservative, function-first approach to lip tie:

1. If baby is breastfeeding well, I don't treat it—regardless of how the frenulum looks.
2. If baby has feeding difficulties, I evaluate both tongue and lip function.
3. If tongue tie is the primary issue, I address that first and reassess.
4. If lip tie is clearly contributing to ongoing problems after tongue tie is addressed (or in isolation), I'll recommend revision.

The goal is always to treat the problem, not the anatomy. Not every frenulum that looks restrictive is actually causing issues, and not every feeding problem is caused by a tie.