What This Guide Covers
This guide explains lip ties in babies: what they are, how they affect feeding, and when treatment may help. It is written for parents and caregivers who suspect their infant may have a lip tie.
A lip tie involves the labial frenulum, a small band of tissue that connects the inside of the upper lip to the upper gum. Every baby has this tissue. In some babies, the frenulum is thicker, tighter, or attached closer to the ridge of the gum than usual. When this restricts normal lip movement, it is called a lip tie. [2]
Lip ties range from mild to severe. Many cause no problems at all. Others can make it difficult for a baby to flange (spread outward) the upper lip during breastfeeding, which may lead to latch problems and feeding pain. [1] This guide covers how to spot a lip tie, how it is classified, what treatment involves, and how to decide if your baby needs professional evaluation.
You may also hear lip ties discussed alongside tongue ties (ankyloglossia). The two conditions sometimes occur together. This guide focuses on lip ties specifically but mentions tongue ties where relevant.
Understanding Lip Ties in Babies
A lip tie restricts how far the upper lip can move, which may affect feeding and, later, dental development.
What a Lip Tie Is
The labial frenulum is a thin fold of tissue on the inside of the upper lip. You can see it if you gently lift your own upper lip in front of a mirror. In infants with a lip tie, this tissue is shorter, thicker, or more tightly attached than typical. [2]
Lip ties are sometimes classified using the Kotlow classification system. [6] Class I ties are minor, with a thin membrane attaching high on the gum. Class IV ties are the most restrictive, with thick tissue extending to or over the alveolar ridge (the gum line where teeth erupt) and the incisive papilla. [6] Higher classes are generally more likely to affect function, but the classification alone does not always predict whether the tie will cause problems. [2]
The exact cause of lip ties is not well understood. They are a variation in how the frenulum develops before birth. Lip ties are not caused by anything the parent did during pregnancy.
Signs of a Lip Tie in Your Baby
The most common sign parents notice is difficulty with breastfeeding. A baby with a significant lip tie may not be able to open the mouth wide enough or flange the upper lip outward to create a deep latch. This can cause several noticeable symptoms. [1]
Signs in the baby include a shallow latch, clicking sounds during feeding, prolonged feeding sessions, poor weight gain, frequent gassiness from swallowing air, and falling asleep at the breast without getting enough milk. Signs in the breastfeeding parent include sore or cracked nipples, nipples that look flattened or creased after feeding, plugged ducts, and low milk supply over time. [1]
To check for a lip tie at home, gently lift your baby's upper lip while the baby is calm. If the tissue is tight and the lip does not flip upward easily, or if you see a thick band of tissue extending close to the gum ridge, a lip tie may be present. However, appearance alone does not confirm a problem. Function matters more than anatomy. [3]
How a Lip Tie Affects Feeding
A proper breastfeeding latch requires the baby to open the mouth wide and flange both lips outward around the breast. The upper lip plays a role in creating a seal. When the upper lip is restricted, the baby may compensate by clamping down, sliding off the breast repeatedly, or swallowing excess air. [1]
A systematic review examining the effect of frenectomy for lip tie, tongue tie, and cheek tie on breastfeeding outcomes noted that the evidence for lip tie release specifically is less robust than the evidence for tongue tie release. The review highlighted that many studies examining lip tie release also released a concurrent tongue tie, making it difficult to isolate the effect of the lip tie correction alone. [1]
Some researchers caution against attributing all breastfeeding difficulties to lip ties. Other factors, including positioning, latch technique, breast anatomy, and overall infant oral function, can produce similar symptoms. A thorough feeding evaluation by a lactation consultant is typically recommended before concluding that a lip tie is the primary cause. [3]
Effects in Older Children
If a lip tie persists beyond infancy, it may affect dental development. A thick, low-attaching frenulum can maintain a diastema, a gap between the two upper front teeth. This gap sometimes closes on its own as the permanent teeth come in, but in some cases the tight tissue prevents the gap from closing. [2]
A restrictive lip tie can also make it harder to brush the upper front teeth in toddlers and young children. The tissue may pull or cause discomfort when a toothbrush or finger passes over it, leading to resistance during brushing. This can increase the risk of plaque buildup and early cavities along the gum line of the upper front teeth. [4]
Speech effects from lip ties alone are not well documented. Tongue ties are more commonly associated with speech difficulties. However, some practitioners note that a very restrictive lip tie may affect sounds that require the lips to come together or round, such as "p," "b," and "m." Evidence for this is limited.
What Parents Need to Know Before Seeking Treatment
Not every lip tie needs to be treated, and knowing when to seek help can save time and reduce unnecessary procedures.
When Treatment Is and Is Not Needed
Treatment is typically considered when a lip tie is causing measurable functional problems. In newborns, this usually means documented difficulty with breastfeeding that has not improved with positioning adjustments and lactation support. [3] In older children, treatment may be considered if the tie contributes to a persistent diastema or makes oral hygiene difficult.
Many lip ties do not cause problems. Some babies with visible lip ties breastfeed without difficulty. Others adjust their latch over time. If your baby is gaining weight well and feeding is comfortable for both parent and child, a visible lip tie alone is typically not a reason for treatment. [3]
The decision about treatment works best as a team effort. A pediatric dentist or pediatric ENT (ear, nose, and throat doctor) evaluates the anatomy. A lactation consultant evaluates feeding function. A pediatrician monitors weight gain. Together, these perspectives give a clearer picture than any single assessment.
Age and Timing Considerations
If a frenectomy is needed for feeding reasons, it is typically performed in the first weeks or months of life. Earlier release may allow faster improvement in breastfeeding, though results vary. [1]
For dental or hygiene reasons, the procedure can be performed at any age. Some pediatric dentists prefer to wait until the child is older and can cooperate with aftercare. Others address the issue earlier if it is clearly affecting oral hygiene or causing tissue trauma during brushing.
There is no strict age deadline. The frenulum does not typically become more restrictive over time. Parents who want to wait and monitor the situation can usually do so safely, as long as the child's feeding and growth are adequate.
How to Get Your Baby Evaluated
Start by telling your pediatrician about the symptoms you are seeing. Ask for a referral to a board-certified lactation consultant (IBCLC) for a feeding assessment. If the lactation consultant suspects a lip tie is contributing to feeding problems, they may refer you to a pediatric dentist or pediatric ENT for evaluation. [4]
During the evaluation, the provider will lift your baby's upper lip to assess the frenulum's thickness, length, and point of attachment. They will also evaluate how the lip moves during simulated feeding. Some providers use the Kotlow classification system to grade the tie, [6] while others rely on functional assessment.
What to Expect During a Lip Tie Frenectomy
A frenectomy is a brief procedure that releases the tight tissue to allow the lip to move more freely.
The Procedure Step by Step
Before the procedure, the provider will explain what will happen and answer your questions. For young infants, topical numbing gel is typically applied to the frenulum area. Some providers also use a small amount of local anesthetic. [2]
The release itself usually takes under five minutes. Two main techniques are used. With a laser frenectomy, a dental laser vaporizes the tight tissue. The laser seals blood vessels as it works, so there is usually minimal bleeding. With surgical scissors or a scalpel, the provider cuts the frenulum directly. This method may involve slightly more bleeding but is equally effective. [2]
After the release, the provider will check the baby's lip mobility. You may be encouraged to breastfeed or bottle-feed immediately. Many parents notice a difference in the baby's latch within the first few feedings, though improvement can also be gradual.
Aftercare and Recovery
The area under the lip will look like a shallow white or yellowish wound for about one to two weeks. This is normal healing tissue, not an infection. The wound typically does not require stitches.
Most providers recommend gentle stretching exercises several times a day for one to three weeks after the procedure. These exercises involve lifting the upper lip to keep the healing tissue from reattaching too tightly. Your provider will show you the exact technique. [2]
Mild fussiness and some discomfort are common for the first day or two. Infant-appropriate pain relief, as recommended by your pediatrician, can help. Most babies return to normal feeding behavior within a few days.
Expected Outcomes
Results of lip tie release for breastfeeding improvement are variable. A systematic review found that while many studies report improved breastfeeding outcomes after frenectomy, the evidence specific to lip tie release (as opposed to tongue tie release) is limited. Many of the studies included patients who had both lip and tongue ties released simultaneously. [1]
Some families see immediate improvement in latch and reduced pain. Others find that improvement is gradual and requires continued work with a lactation consultant. In some cases, the lip tie release alone does not fully resolve feeding problems, especially if other factors are involved. [3]
When performed for dental reasons in older children, frenectomy typically results in improved access for brushing. The diastema may begin to close on its own after the tissue restriction is removed, though some children may need orthodontic treatment to fully close the gap.
Cost of Lip Tie Treatment
The cost of a lip tie frenectomy typically ranges from $150 to $800, depending on the technique used and the provider.
Laser frenectomy tends to cost more than a scissors release. Provider specialty, geographic location, and case complexity also affect the price. Costs vary by location, provider, and case complexity.
Medical insurance may cover a frenectomy if there is a documented feeding problem with an appropriate diagnosis code. Dental insurance may cover it when performed for dental indications such as diastema or gum tissue issues. Coverage varies widely between plans. Call your insurance company before the appointment to ask about coverage for procedure codes related to frenectomy.
Some lactation consultants and pediatric dentists offer a pre-authorization letter or supporting documentation to submit to insurance. If your insurance does not cover the procedure, ask the provider's office about payment plans or whether they offer a self-pay rate.
When to See a Specialist
A specialist evaluation is appropriate when feeding problems persist despite working with a lactation consultant on positioning and latch technique.
Consider seeing a pediatric dentist or pediatric ENT if your baby shows several of the following: persistent painful breastfeeding that does not improve with latch correction, poor weight gain or slow growth despite frequent feeding, a visible thick or tight frenulum under the upper lip, and clicking or popping sounds during feeding. [1]
A pediatric dentist is a dentist who has completed additional training focused on the oral health of infants, children, and adolescents. They are experienced in evaluating frenulum attachments and performing frenectomies in young patients. [4] A pediatric ENT is another specialist who commonly performs this evaluation and procedure.
If your child is older and you notice a persistent gap between the upper front teeth, difficulty brushing the upper front teeth, or the gum tissue blanching (turning white) when the lip is lifted, a pediatric dentist can assess whether the frenulum is a contributing factor. [5]
A general dentist can identify a lip tie during a routine exam, but frenectomy in infants and very young children is typically best handled by a provider with specific training in pediatric procedures.
Find a Pediatric Dentist Near You
If you think your baby or child may have a lip tie that is affecting feeding or dental health, a pediatric dentist can evaluate the tissue and discuss whether treatment would help. Use the My Specialty Dentist directory to search for a pediatric dentist in your area who has experience with frenulum evaluations and frenectomy procedures.
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