Upper Lip Tie in Newborns
The short answer
An upper lip tie occurs when the tissue connecting the upper lip to the upper gum (labial frenulum) is thick, tight, or extends close to the gum line. While all babies have a labial frenulum, a restrictive one may sometimes contribute to breastfeeding difficulties. The significance and treatment of lip ties is more debated among medical professionals than tongue tie.
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By Age
What to expect by age
An upper lip tie may be noticed in the first days of life, often during breastfeeding assessment. Signs that may suggest a significant lip tie include difficulty flanging the upper lip outward during latch, a shallow latch, and air swallowing. However, the diagnosis and treatment of lip ties is more controversial than tongue ties. Many lactation consultants and pediatricians take a conservative approach, focusing on optimizing latch technique before recommending release. If release is considered, it is usually done alongside a tongue tie release if both are present.
If a lip tie is present but feeding is going well and baby is gaining weight, treatment is generally not recommended. Many babies with a noticeable lip tie feed successfully with proper positioning and latch support from a lactation consultant. If feeding difficulties persist despite optimal technique, a lip tie release may be discussed.
By this age, most feeding has been well-established. A lip tie that did not cause feeding problems is unlikely to need intervention. The labial frenulum naturally thins and recedes as the child grows. Some dental professionals believe a thick frenulum may contribute to a gap between the upper front teeth later, but this is typically addressed in older children if needed.
As solid foods are introduced, a lip tie rarely causes significant issues. The frenulum continues to change as the mouth grows. Lip tie is generally not a concern for speech development.
What Should You Do?
When to take action
- All babies have an upper labial frenulum, and having a visible one is normal
- A lip tie that does not interfere with feeding or latch
- Baby is gaining weight well and feeding comfortably
- The upper lip can flange out during breastfeeding, even if a frenulum is visible
- Difficulty achieving a deep latch despite proper positioning
- Persistent painful breastfeeding that is not improving with lactation support
- Baby is not gaining weight well and a lip tie has been identified as a possible contributing factor
- Significant weight loss or failure to thrive potentially related to feeding difficulties
- Mother has severe nipple damage that is not improving despite lactation support and technique adjustment
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Medical Concerns
Tongue Tie Affecting Feeding (Ankyloglossia)
Tongue tie (ankyloglossia) occurs when the tissue connecting the tongue to the floor of the mouth (frenulum) is too short or tight, potentially restricting tongue movement. It affects about 4-10% of newborns and can sometimes cause difficulty with breastfeeding. Not all tongue ties require treatment, but if feeding is significantly affected, a simple procedure called a frenotomy can help.
Newborn Not Latching
Difficulty latching is one of the most common breastfeeding challenges for new parents and newborns. Many factors can contribute, including the baby's positioning, tongue tie, flat or inverted nipples, engorgement, or the baby being sleepy or overstimulated. Most latching problems can be resolved with proper support from a lactation consultant. In the meantime, expressing colostrum or milk by hand or pump ensures the baby receives adequate nutrition.
High Arched Palate Concerns in Newborns
A high arched palate (roof of the mouth) in a newborn can sometimes contribute to feeding difficulties because the baby may have trouble compressing the breast or bottle nipple effectively. Many babies with a high palate feed successfully with positioning adjustments, and the palate shape often changes as the baby grows. In some cases, a high palate is associated with other conditions that your pediatrician may evaluate.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.