Perhaps the most important factor in successful breastfeeding is a baby’s ability to latch onto your breast and achieve a good seal. While this might seem an obvious conclusion and a straightforward action, in practice, not every baby will latch well at the outset. Sometimes establishing that first really good latch can be challenging. However, once this initial difficulty is overcome, achieving a good latch and seal often becomes easier.
However, if a baby is born with abnormalities of the soft tissue in their mouth, breastfeeding may become challenging. One of the more commonly identified abnormalities is tongue-tie, however, another exists which can be equally detrimental to breastfeeding and often goes undiagnosed. This condition is called lip-tie.
What is a lip-tie?
Inside the human mouth, under the upper lip and roughly between the two front teeth is a piece of skin that connects to the upper gum. This piece of skin is called the labial frenulum. In some babies the labial frenulum is too short or thick and too tightly pinned to the upper gum, restricting the movement of the upper lip. When this occurs the baby is said to have a lip-tie. While in some cases a lip-tie might be minor and not pose any significant issue to breastfeeding, in other cases a lip-tie can make effective feeding almost impossible.
What are the degrees of lip tie?
The extent of a lip-tie is classified using four classes:
- In a Class I lip-tie the labial frenulum is just visible, does not extend down below the gum line and while there may be some minor restriction of movement this does not generally impact breastfeeding;
- With a Class II lip-tie the labial frenulum extends down beyond the gum line and appears to be inserted just between where the front teeth will erupt;
- For a Class III lip-tie the labial frenulum extends well down the gum into the area between where the front teeth will erupt;
- In a Class IV lip-tie, the labial frenulum extends down between the front teeth, wraps under and is attached to the hard palate, which is the hard surface you can feel if you place your thumb behind your front teeth.
Class I Lip Tie
Lip II Lip Tie
Class III Lip Tie
Class IV Lip Tie
How does lip-tie affect breastfeeding?
As we mentioned earlier, successful breastfeeding depends on a baby being able to establish a good latch and seal. This occurs when the baby opens its mouth wide, flairs its upper lip and is able to take both the areola and nipple into its mouth.
When a baby has a lip-tie, they are unable to flair their top lip out effectively and so may take only the nipple into their mouth. This causes pain for the mother and can result in nipple damage but also results in the baby being unable to effectively draw milk from the breast. The baby may seem to ‘slip off’ the breast or seem to refuse to open their mouth wide to latch.
How can lip-tie be fixed?
Where a baby is healthy and developing well and the mother does not report significant discomfort in breastfeeding, she might decide not to have the lip-tie fixed. However where the baby is not gaining sufficient weight and/o