Upper Lip Tie in Newborns
Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist
Content reviewed against published AAP, NIH guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect upper lip tie in newborns, here is what the evidence says.
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.
Key takeaways
- 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.
- Usually normal when: All babies have an upper labial frenulum, and having a visible one is normal
- Call your doctor if: Significant weight loss or failure to thrive potentially related to feeding difficulties
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to AAP, NIH guidelines, 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. At 0-1 month, 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. It is generally considered normal when all babies have an upper labial frenulum, and having a visible one is normal. However, you should contact your pediatrician promptly if significant weight loss or failure to thrive potentially related to feeding difficulties.
Normal vs. Concerning
By Age
What to expect by age
0-1 month
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.
1-3 months
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.
3-6 months
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.
6-12 months
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 to Tell Your Pediatrician
- Describe when you first noticed upper lip tie in newborns and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if difficulty achieving a deep latch despite proper positioning.
- Mention if persistent painful breastfeeding that is not improving with lactation support.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
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
What You Can Do at Home
- Keep track of when you notice upper lip tie in newborns — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that all babies have an upper labial frenulum, and having a visible one is normal — this is generally within the range of normal.
- At 0-1 month, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
- While monitoring at home, seek immediate care if significant weight loss or failure to thrive potentially related to feeding difficulties.
Related Conditions
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.
Related Resources
Frequently asked questions
Is upper lip tie in newborns normal?
When should I call the doctor about upper lip tie in newborns?
When is upper lip tie in newborns normal?
What causes upper lip tie in newborns?
What should I mention to my pediatrician about upper lip tie in newborns?
Is upper lip tie in newborns normal at 0-1 month?
Is upper lip tie in newborns normal at 1-3 months?
Should I go to the ER for upper lip tie in newborns?
Does upper lip tie in newborns go away on its own?
References
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Upper Lip Tie in Newborns.
Things to mention
- Describe when you first noticed upper lip tie in newborns and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if difficulty achieving a deep latch despite proper positioning.
- Mention if persistent painful breastfeeding that is not improving with lactation support.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- 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
Urgent signs to report immediately
- 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
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of upper lip tie in newborns are normal. Talk to your pediatrician if significant weight loss or failure to thrive potentially related to feeding difficulties.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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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.