What Is a Lip Tie in Babies?
A lip tie is a band of tissue, called the labial frenulum, that connects the upper lip to the gums. Every baby has this band. In nearly all infants it is a normal anatomical structure that does not cause problems^[1][3]^. Anatomical research has found that a prominent maxillary frenulum attachment is present in up to 83% of asymptomatic infants, which shows that a visible band of tissue does not by itself signal a problem[7].
For many years, some providers blamed the upper lip frenulum for feeding pain, shallow latches, and slow weight gain. The most recent clinical reports do not support that view. The American Academy of Pediatrics 2024 Clinical Report concluded that the maxillary labial and buccal frenae are normal oral structures that do not affect breastfeeding success[3]. The American Academy of Otolaryngology-Head and Neck Surgery reached the same consensus in 2020, and the Academy of Breastfeeding Medicine also does not recommend surgery on the upper lip frenulum for feeding problems^[3][4]^.
Diagnoses of oral ties have risen sharply in recent years. The AAP notes a nearly 10-fold increase in ankyloglossia and related oral restriction diagnoses between 1997 and 2012, with rates roughly doubling again between 2012 and 2016[3]. Much of this rise has been driven by social media rather than rigorous clinical evidence, which is one reason current guidelines emphasize careful evaluation before any surgical recommendation[3].
Lip ties are sometimes confused with tongue ties. They are separate conditions. A baby can have one, the other, or both. Tongue tie (ankyloglossia) has more research linking it to feeding problems in some infants. The evidence linking upper lip ties to feeding difficulty is much weaker^[3][4]^. Care for any feeding concern often involves a team that may include a pediatrician, an International Board Certified Lactation Consultant (IBCLC), and a pediatric dentist[1].
What Causes a Lip Tie?
A lip tie develops before birth when the tissue between the upper lip and gum does not fully thin out and recede. The frenulum is a remnant of fetal tissue that originally connected the upper lip, maxilla, and palate. As development continues, this tissue undergoes programmed cell death (apoptosis) and thins, though varying degrees of tissue remain in almost all babies[7]. Why some babies have a thicker or lower-attached band is not fully understood[1].
Genetic and Developmental Factors
Lip ties often run in families. A parent or sibling with a lip tie or tongue tie raises the chance that a baby will also have one. The trait appears to be inherited in many cases, though no single gene has been identified.
Anatomical Variations
Frenulum anatomy varies widely. Some babies have a thin, flexible band. Others have a thicker band, or one that attaches very close to the edge of the gum. Real-time ultrasound studies of breastfeeding infants show that the upper lip rests passively against the breast to help form a seal and does not need to flange dramatically to allow milk transfer. This is one reason the upper lip frenulum is not considered a mechanical barrier to feeding^[3][4]^.
These differences are part of normal anatomy and are not caused by anything a parent did during pregnancy. Most lip ties are noticed shortly after birth during feeding or routine newborn checks.
Symptoms and How a Lip Tie Is Diagnosed
Parents sometimes notice signs during feeding that lead them to ask about a lip tie. It is important to know that these same signs are most often caused by other factors, such as positioning, low milk supply, or tongue restriction, rather than the upper lip frenulum^[3][4]^.
Signs in the Baby
Signs that prompt evaluation include a shallow latch, clicking or smacking sounds during feeds, and lip blisters caused by friction. Some babies fall asleep quickly at the breast because feeding is tiring, then wake hungry shortly after. The 2024 AAP Clinical Report and 2020 AAO-HNS Consensus Statement both conclude that these signs are not reliably linked to the upper lip frenulum. The tongue, not the upper lip, is the main driver of milk transfer. The infant tongue must elevate, extend, and cup the areola to create the vacuum that draws milk from the breast, so a restricted tongue is far more likely to cause feeding trouble than a visible upper lip frenulum^[3][4]^.
- Difficulty flanging the upper lip outward during nursing
- Frequent gassiness or fussiness from swallowing air
- Slow weight gain in some cases
- Lip callus or blister in the center of the upper lip
Signs the Nursing Parent May Notice
A nursing parent may experience nipple pain, cracked or creased nipples after feeds, plugged ducts, or low milk supply. These symptoms often improve when the baby achieves a deeper latch, with or without any oral procedure[3].
How Diagnosis Works
Diagnosis is clinical, meaning it is based on examination rather than imaging or lab tests. A pediatric dentist, ENT, lactation consultant, or pediatrician will look at the frenulum, watch a feeding session, and ask about symptoms in both the baby and the nursing parent^[1][3]^.
Because symptoms overlap with many other feeding issues, a careful evaluation matters. The AAP emphasizes that suboptimal breastfeeding is a complex, multifactorial issue and that multidisciplinary communication between lactation specialists, feeding therapists, surgeons, and pediatricians is paramount[3]. An International Board Certified Lactation Consultant (IBCLC) is typically the first line of evaluation. If a tongue tie is suspected, the tongue should be carefully assessed because tongue tie has stronger evidence supporting release in select infants than lip tie does^[3][4]^. Seek care if feeding is painful, weight gain is slow, or your baby seems frustrated at the breast or bottle.
Lip Tie Treatment Options
The American Academy of Pediatrics (2024) and the American Academy of Otolaryngology-Head and Neck Surgery (2020) explicitly recommend against surgery on the upper lip or cheek frenulum as a treatment for breastfeeding problems^[3][4]^. The Academy of Breastfeeding Medicine also does not recommend this surgery[3]. Conservative support from a lactation consultant is the recommended first step. A minor surgical release called a frenectomy is not supported by current evidence for infant feeding difficulties^[3][4]^.
Conservative Management
Most feeding problems improve with help from a lactation consultant. Adjusting positioning, latch technique, and feeding angle often resolves pain and improves milk transfer without any procedure.
If the baby is gaining weight, feeding is comfortable, and the parent is not in pain, watchful waiting is the recommended approach. Many feeding signs blamed on a lip tie resolve as positioning improves[3].
Laser Frenectomy
A laser frenectomy uses a soft-tissue laser to release the frenulum. The procedure typically takes 1 to 2 minutes per site. The laser seals small blood vessels as it cuts, which usually means minimal bleeding.
Laser frenectomies are performed by some pediatric dentists or specialists trained in the technique. The 2024 AAP Clinical Report notes a marked increase in laser use by dentists and oral surgeons but states that no evidence supports laser over other methods of frenotomy[3]. Some literature suggests that scissor frenotomy is preferred in infants because lasers can carry added risks, including thermal injury and nerve damage[3].
Scissors Frenectomy
A scissors frenectomy uses sterile surgical scissors to clip the frenulum. It is also brief, often under a minute. Some bleeding is expected and usually stops within a few minutes with gentle pressure or feeding.
When a release is pursued for a tongue tie (not a lip tie), both laser and scissors techniques can be used. The 2020 AAO-HNS Consensus Statement found insufficient evidence that laser is superior to traditional surgical scissors for frenotomy[4]. The best choice depends on the baby's anatomy, the provider's training, and family preference. Discuss the pros and cons with your specialist.
When Treatment Is Recommended
Major medical bodies are aligned: the American Academy of Pediatrics, the American Academy of Otolaryngology-Head and Neck Surgery, and the Academy of Breastfeeding Medicine all recommend against routine surgery on the upper lip frenulum as a treatment for breastfeeding problems^[3][4]^. Before any procedure is considered, other causes of feeding difficulty should be thoroughly evaluated, including positioning, low milk supply, reflux, and tongue restriction. For a true tongue tie that is interfering with feeding, a lingual frenotomy may be considered in selected cases under specialist guidance^[3][4]^.
Recovery and Aftercare
If any oral frenectomy is performed, mucosal tissue in the mouth typically heals within 1 to 2 weeks[1].
The First 24 to 48 Hours
Babies can typically feed right after the procedure. Mild fussiness is common for a day or two. Your provider may recommend infant acetaminophen for short periods, based on the baby's age and weight.
A small white or yellow patch will form at the surgical site. This is normal healing tissue (a fibrinous slough), not infection.
A Note on Stretching Exercises
Some providers have historically recommended active stretching of the wound several times a day to prevent reattachment. The American Academy of Pediatrics (2024) and the American Academy of Otolaryngology-Head and Neck Surgery (2020) advise against this practice. The AAP specifically recommends that providers avoid post-frenotomy stretching exercises in which parents open the wound several times to prevent reattachment. The AAP states that stretching wounds or bodywork exercises after surgery is not recommended and may cause aversion^[3][4]^.
Oral aversion happens when an infant connects the mouth and feeding with repeated pain, leading the baby to refuse to feed. This complication can be more dangerous than the original anatomical issue. If your provider recommends post-operative stretches, ask about current pediatric guidance and consider seeking a second opinion before starting them[3].
Follow-Up Visits
Most providers schedule a follow-up about one week after the procedure to check healing. Continued lactation support during this period often helps families make the most of the release.
Cost of Lip Tie Treatment
Lip tie frenectomy costs vary widely. Current 2025 to 2026 pricing in the United States typically ranges from about $250 to $1,200 for a single site, with most infant procedures falling between $250 and $800[6]. Some advanced frenuloplasty procedures (which involve repositioning of tissue and sutures) run higher, with professional fees reported up to about $1,375[6]. Hospital-based procedures performed under general anesthesia (rare for simple lip ties) can run substantially higher, with total costs reported up to about $8,000[6]. Costs vary by location, provider, technique, and case complexity.
Some pediatric dentists bundle the frenectomy with a consultation and follow-up visit. Laser procedures often cost more than scissors procedures because of the equipment used[6].
Insurance Coverage
Coverage depends on the plan and whether the procedure is billed to medical or dental insurance. Coverage for labial frenectomy has become harder to obtain because current evidence does not support the procedure for infant feeding issues, and many carriers now classify it as elective^[5][6]^.
Call your insurance carrier before the appointment and ask about CPT and CDT codes the provider plans to use. Before 2021, the ADA used a single code (D7960) for buccal, labial, and lingual frenectomies, which caused billing confusion when more than one site was treated on the same day. Effective January 1, 2021, the ADA replaced D7960 with site-specific codes: D7961 (buccal or labial frenectomy), D7962 (lingual frenectomy), and D7963 (frenuloplasty)[5]. Request a written cost estimate from the office for any out-of-pocket amount.
Payment and Financing
Many pediatric dental offices accept HSA and FSA funds. Some offer payment plans for families paying out of pocket. Ask about all options during the consultation.
Specialist vs. General Dentist for Lip Tie
If a feeding evaluation suggests an oral tissue issue, an International Board Certified Lactation Consultant (IBCLC) is typically the first line of assessment. When a provider opinion on the frenulum itself is needed, a pediatric dentist, pediatric ENT, or other clinician experienced in infant oral anatomy can evaluate it^[1][3]^.
Pediatric dentists complete additional residency training focused on infants, children, and adolescents. They are familiar with the anatomy of newborns and the equipment used for laser frenectomies. Many coordinate care with lactation consultants and pediatricians.
For more information about specialist training and what to expect, visit the pediatric-dentistry page. A team approach, including a feeding specialist, often produces the best results.
Find a Pediatric Dentist Near You
If you have questions about your baby's feeding or oral anatomy, start with a lactation consultant or pediatric dentist. Use our directory to find a board-certified pediatric dentist in your area who works with lactation consultants and follows current pediatric guidance.
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