[Published: July 2026 | Last updated: July 2026] | 8 min read
TL;DR
- A lip tie is a thick, tight, or short frenulum – the band
of tissue connecting the upper lip to the gum – that
restricts how far the upper lip can flange outward during
feeding. - The simplest home check is the lip lift test: gently lift
the baby’s upper lip toward their nose. A lip tie is present
if the frenulum is tight, thick, or short enough to restrict
the lip from flanging to approximately 90 degrees or beyond. - A lip tie alone does not require treatment – it only needs
addressing if it is causing feeding difficulties, poor
weight gain, nipple pain in breastfeeding mothers, or
significant dental spacing issues as the child grows. - A home check can identify the presence of a lip tie but
cannot grade its severity or determine whether treatment
is needed – that assessment requires a qualified provider
such as a lactation consultant, pediatric dentist, or
ENT specialist. - The most common signs a lip tie is affecting feeding are
clicking sounds during feeding, excessive air swallowing,
milk leaking from the corners of the mouth, poor weight
gain, and a baby who feeds for very long periods without
appearing satisfied.
What Is a Baby Lip Tie?
A lip tie is a condition in which the frenulum labii
superioris – the small band of tissue connecting the
center of the upper lip to the gum ridge above the
upper front teeth – is too thick, too tight, or too
short to allow the upper lip to flange outward freely
during feeding.
Every baby has a frenulum. The question is not whether
one exists but whether its attachment, thickness, or
tightness restricts the lip’s movement enough to affect
feeding, comfort, or development.
In a feeding baby, the upper lip needs to flange outward
- like a fish mouth – to create a wide, effective seal
around the breast or bottle nipple. A lip that cannot
flange adequately creates a shallow latch, a poor seal,
increased air intake, and a feed that is more effortful
for the baby and more painful for the breastfeeding
mother.
How Common Is Lip Tie in Babies?
Lip tie prevalence estimates vary widely because there
is no universally agreed clinical definition of what
constitutes a lip tie versus a normal frenulum variant.
Studies estimate that clinically significant lip ties
affect between 4% and 11% of newborns (Srinivasan
et al., International Journal of Oral and Maxillofacial
Surgery, 2019).
Lip ties are more common in:
- Babies who also have a tongue tie (ankyloglossia) –
the two conditions frequently occur together - Male babies, who have a slightly higher prevalence
than female babies (Ferrés-Amat et al., Brazilian
Oral Research, 2016) - Babies with a family history of lip or tongue tie
The Simple Home Checks for Baby Lip Tie
These checks can be performed at home to assess whether
a lip tie may be present. They do not replace professional
assessment but provide useful information to bring to
a medical or lactation appointment.
Check 1: The Lip Lift Test
The lip lift test is the most direct and most reliable
home check for lip tie.
How to perform:
- Sit in a well-lit area – natural daylight or a
bright overhead light that illuminates the mouth
clearly. - Place the baby in your lap facing upward in a
comfortable reclined position, or hold them against
your chest facing outward. - Use a clean index finger to gently lift the center
of the upper lip upward toward the nose. Apply
very gentle pressure – this should not cause
discomfort. - Observe how far the lip moves and whether the
frenulum restricts the movement.
What to look for:
- Normal frenulum: The upper lip lifts freely to
approximately 90 degrees or beyond – almost parallel
to the nose. The frenulum is thin, stretchy, and
does not appear to tether the lip to the gum. - Possible lip tie: The upper lip does not lift
freely. The frenulum appears thick, cord-like, or
short, pulling the center of the lip downward
even when the lip is being gently lifted. A notch
or heart shape may be visible at the center of
the upper lip where the frenulum attaches. - Significant restriction: The lip barely moves
when lifted, or the gum blanches (turns white)
at the frenulum attachment point when the lip
is gently lifted – this blanching indicates the
frenulum is tight and under tension.
What this test does and does not tell you:
The lip lift test tells you whether a tight or short
frenulum is present. It does not tell you whether
that frenulum is causing the baby’s feeding difficulties,
or whether it is severe enough to require treatment.
A tight frenulum that does not affect feeding may
not need any intervention at all.
Check 2: The Feeding Observation Check
Observing the baby’s feeding behavior provides indirect
evidence of whether a lip tie may be affecting the
feeding process.
Signs during breastfeeding that suggest possible lip tie involvement:
- The upper lip curls inward toward the gum rather
than flanging outward during the latch - A clicking or smacking sound during feeding –
caused by the baby repeatedly breaking and
re-establishing suction as the shallow latch fails - Milk leaking from the corners of the baby’s mouth
during feeding – a sign of poor seal rather than
a complete latch - The breastfeeding mother experiences nipple pain,
creasing, or a flattened nipple appearance after
the baby comes off the breast - The baby feeds for extended periods (40+ minutes)
without appearing satisfied or gaining weight well - The baby gulps audibly and appears gassy or
uncomfortable during and after feeds
Signs during bottle feeding that suggest possible lip tie involvement:
- Milk leaking from the corners of the mouth during
bottle feeding despite the correct nipple size - A clicking sound during bottle feeding
- The baby appearing to work very hard to maintain
suction on the bottle nipple - Excessive air swallowing leading to frequent,
painful wind
Important note: These feeding signs are not
exclusive to lip tie. Tongue tie, poor latch technique,
incorrect nipple flow rate, reflux, and other feeding
issues can produce identical symptoms. Feeding
observation provides supporting evidence, not a
diagnosis.
Check 3: The Visual Inspection
A visual inspection of the upper lip and gum area
can identify the physical characteristics associated
with lip tie without requiring the baby to be lifted
or handled significantly.
How to perform:
- In good lighting, gently smile the baby’s upper
lip upward using both thumbs placed at the corners
of the mouth – this stretches the lip and makes
the frenulum visible. - Look at the central attachment point of the upper
lip to the gum.
What to look for:
- Location of attachment: A normal frenulum attaches
high on the gum – well above the gum line between
the teeth. A frenulum that attaches at or below
the gum line, between where the upper front teeth
will emerge, or that extends to the roof of the
mouth (the palate) suggests a higher grade lip tie. - Thickness and appearance: A normal frenulum is
thin and semi-translucent, like a thin piece of
tissue paper. A lip tie frenulum is often thicker,
more opaque, or cord-like in appearance. - Heart-shaped notch: A small notch or heart shape
visible at the center of the upper lip when it
is stretched upward is a common sign of a lip tie.
The notch forms where the tight frenulum prevents
the lip tissue from filling out evenly. - Gum blanching: If the gum tissue immediately
above the frenulum attachment turns white when
the lip is gently stretched, the frenulum is
under significant tension – a characteristic of
a restrictive lip tie.
Check 4: The Flanging Check During Feeding
This check is performed during an active feeding
session rather than between feeds.
How to perform during breastfeeding:
During a feed, gently use a clean finger to nudge
the upper lip outward into a flange position.
Observe whether the lip stays flanged or immediately
returns to the curled-in position.
- Normal: The lip can be guided into a flange
and remains there with minimal tendency to curl back. - Possible lip tie: The lip immediately returns
to the curled-inward position as soon as the guiding
finger is removed, regardless of repositioning efforts.
How to perform during bottle feeding:
Observe the upper lip position during bottle feeding.
The upper lip should flange outward over the bottle
nipple in a relaxed, open position. A lip that is
tight against the bottle, that shows a visible gap
at the top of the nipple seal, or that produces
audible clicking sounds is not achieving an adequate
seal – which may be related to a lip tie.
The Kotlow Classification System: Understanding
Lip Tie Grades
The Kotlow classification (Kotlow, Journal of Clinical
Pediatric Dentistry, 1999) is the most widely used
system for grading lip tie severity. Understanding
it helps parents interpret what a provider means
when they describe a lip tie grade.
| Grade | Description | Clinical Significance |
|---|---|---|
| Class I (Normal) | Frenulum attaches well above the gum line; lip flanges freely | No intervention typically needed |
| Class II (Mild) | Frenulum attaches closer to the gum line; minor restriction | Usually no intervention unless feeding is affected |
| Class III (Moderate) | Frenulum attaches at the gum line; noticeable restriction of lip movement | Assessment recommended if feeding is affected |
| Class IV (Severe) | Frenulum attaches below the gum line or extends to the palate; significant restriction | Assessment and possible treatment recommended |
Source: Kotlow, 1999; adapted from clinical literature
A home check can suggest the presence of a Class III
or IV lip tie through the signs described above.
Grading requires professional assessment because
it involves specific anatomical measurements and
clinical judgment.
Signs a Lip Tie Is Affecting Your Baby
A lip tie that is not affecting feeding, weight gain,
or development does not require treatment. The signs
that a lip tie is clinically significant are:
Feeding-Related Signs
- Poor weight gain: A baby who is not gaining
weight at the expected rate of 150-200g per week
in the first 3 months (AAP, 2023) and where other
causes have been ruled out may be transferring
insufficient milk due to a compromised latch related
to lip tie. - Extended feeding sessions: Breastfed babies
who feed for more than 40 minutes per session
consistently, or who finish a feed and immediately
signal hunger again, may be working harder to
transfer milk due to lip restriction. - Nipple pain and damage: Creased, lipstick-shaped,
flattened, or blanched nipples after a feed – or
nipple pain throughout the feed despite correct
positioning – are signs of a compromised latch
that lip tie may be contributing to. - Excessive gas and colic-like symptoms: A baby
who swallows significant air due to poor seal during
feeding will show more frequent and more severe
gas pain, which can contribute to the crying pattern
described as colic.
Signs in Older Children
If lip tie is not identified in infancy, the following
signs may emerge as the child grows:
- A visible gap between the upper front teeth (diastema)
caused by the frenulum inserting between the teeth - Difficulty achieving a full lip seal when drinking
from a cup - Speech difficulties related to lip mobility,
particularly with labial sounds (m, b, p) - Difficulty breastfeeding being resolved but dental
spacing becoming apparent when teeth emerge
Lip Tie vs Tongue Tie: Key Differences
Lip tie and tongue tie are separate conditions that
frequently occur together. Understanding the difference
helps parents identify which check is relevant.
| Feature | Lip Tie | Tongue Tie |
|---|---|---|
| Location | Frenulum connecting upper lip to gum | Frenulum connecting underside of tongue to floor of mouth |
| Home check | Lift upper lip; observe frenulum | Lift tongue; observe how far it elevates and whether it heart-shapes at the tip |
| Primary feeding effect | Poor lip seal; air swallowing; milk leaking from corners | Reduced tongue mobility; ineffective milk transfer; clicking |
| Nipple effect | Nipple pain from shallow latch | Nipple compression and pain |
| How often they occur together | Approximately 50-85% of tongue tie cases also have a lip tie (O’Callahan et al., 2013) | – |
If a home check for lip tie is positive, check for
tongue tie as well – the two conditions should
be assessed simultaneously by a professional because
their combined effect on feeding is greater than
either condition alone.
When to See a Professional
A home check is a starting point, not a conclusion.
Seek professional assessment from a lactation consultant,
pediatric dentist, or ENT specialist if:
- The lip lift test shows clear restriction or gum
blanching - Feeding is painful for the breastfeeding mother
despite correct positioning and latch support - The baby is not gaining weight at the expected rate
- The baby shows consistent signs of feeding difficulty
- clicking, gulping, milk spillage, extended feeds
- The home check is inconclusive and feeding concerns
remain
Who can assess lip tie:
- International Board Certified Lactation Consultant (IBCLC): The first referral for breastfeeding-related
lip tie concerns. An IBCLC assesses both the anatomical
restriction and its functional impact on feeding before
recommending a referral for treatment. - Pediatric dentist with frenuloplasty experience:
Can assess and treat lip tie using laser or scissor
frenuloplasty. Look for a dentist with specific
training in infant frenuloplasty. - ENT (Ear, Nose, and Throat) specialist: Frequently
the referral pathway for lip and tongue tie assessment
in many health systems. - Pediatrician: Can provide an initial assessment
and referral but may not have specialist frenuloplasty
training.
What Happens If a Lip Tie Is Confirmed
If a professional confirms a lip tie and recommends
treatment, the procedure is called a frenuloplasty
or frenotomy. For infants, it is typically performed
using:
- Laser frenuloplasty: A soft tissue laser divides
the frenulum with minimal bleeding and no sutures
required. The procedure takes 1-2 minutes and
the baby can feed immediately afterward. - Scissor frenotomy: The frenulum is divided with
surgical scissors under topical anesthetic. Also
very brief in duration with minimal recovery.
After the procedure, stretching exercises are typically
recommended to prevent the frenulum from reattaching
as it heals. These exercises involve gently lifting
the upper lip and stretching the healing site 4-6
times per day for 3-4 weeks.
Most families notice an improvement in feeding within
24-48 hours of the procedure as the baby adapts to
the increased lip mobility. Some improvement is more
gradual – particularly in breastfeeding situations
where the mother’s supply and the baby’s latch
technique both need time to adjust.
When Lip Tie Does Not Need Treatment
Not every lip tie requires intervention. Treatment
is recommended only when the lip tie is causing
a functional problem – most commonly a feeding
difficulty, nipple damage, or in older children,
a dental spacing or speech issue.
A lip tie that is identified on home check or professional
assessment but is not causing any of these problems
does not require treatment. The presence of a tight
frenulum alone is not an indication for frenuloplasty
(NICE Guidelines, 2022).
Over-treatment of lip ties – particularly in babies
whose feeding difficulties have other causes – is a
recognized concern in the clinical literature. A
second opinion from a different provider is entirely
appropriate when treatment is recommended and the
parent is uncertain.
Common Mistakes Parents Make When Checking for
Lip Tie at Home
- Performing the check in poor lighting. The lip
lift test requires clear illumination of the frenulum
and gum tissue. A dim room makes it impossible to
see the attachment point, thickness, or blanching
that indicate restriction. - Applying too much pressure during the lip lift.
The check requires very gentle upward pressure. Forcing
the lip upward aggressively causes discomfort and
may produce a crying response that closes the mouth
before the frenulum can be clearly observed. - Concluding a lip tie is present from the home check alone. A home check identifies the possibility
of lip tie. Confirmation, grading, and treatment
decisions require professional assessment. - Assuming a lip tie is causing all feeding difficulties. Feeding problems in newborns have
multiple causes. Tongue tie, poor latch technique,
low milk supply, overactive letdown, reflux, and
incorrect bottle nipple flow rate all produce
symptoms that overlap with lip tie. Professional
assessment distinguishes between these causes. - Delaying professional help while repeatedly performing home checks. If feeding is painful,
weight gain is poor, or the baby shows consistent
feeding difficulty, seek professional assessment
promptly. Repeated home checking does not resolve
the underlying problem and delays effective support.
Frequently Asked Questions About Checking for Baby
Lip Tie at Home
How do I check my baby for a lip tie at home?
The simplest home check is the lip lift test: gently
lift the baby’s upper lip toward their nose using
a clean index finger in good lighting. A lip tie may
be present if the frenulum appears thick, cord-like,
or short; if the lip does not flange to approximately
90 degrees; if a heart-shaped notch is visible at
the center of the lip; or if the gum blanches (turns
white) at the frenulum attachment point when the lip
is gently lifted.
What does a lip tie look like in a baby?
A lip tie frenulum is typically thicker, shorter, or
more cord-like than a normal frenulum. It may attach
low on the gum – at or below the gum line between
the upper front teeth – rather than high on the gum.
When the upper lip is gently lifted, a notch or heart
shape may be visible at the center of the lip, and
the frenulum may appear taut rather than loose.
Can a lip tie fix itself?
Some mild lip ties loosen naturally as the baby grows
and the gum changes shape during teething and tooth
eruption. Class I and Class II lip ties that are not
causing feeding difficulties frequently require no
intervention and do not cause long-term problems.
Class III and Class IV lip ties that are causing
feeding or dental issues are unlikely to resolve
without treatment.
Does every baby with a lip tie need treatment?
No. A lip tie only requires treatment if it is causing
a functional problem – most commonly feeding difficulty,
nipple pain in breastfeeding mothers, or dental spacing
or speech issues as the child grows. A lip tie confirmed
on assessment that is not causing any of these problems
does not need intervention (NICE Guidelines, 2022).
What is the difference between a lip tie and a
tongue tie?
A lip tie is a restricted frenulum connecting the
upper lip to the gum. A tongue tie is a restricted
frenulum connecting the underside of the tongue to
the floor of the mouth. Both can affect feeding
and frequently occur together. A lip tie primarily
affects lip seal and air swallowing during feeding;
a tongue tie primarily affects tongue mobility and
milk transfer.
How do I know if my baby’s feeding problems are
caused by a lip tie?
Signs that lip tie may be contributing to feeding
problems include: upper lip curling inward during
feeding rather than flanging outward, clicking sounds
during feeding, milk leaking from the corners of
the mouth, nipple pain or damage in breastfeeding
mothers, poor weight gain, and extended feeds
without satisfaction. These signs overlap with
other causes of feeding difficulty, so professional
assessment is needed to identify the specific cause.
At what age can a lip tie be treated?
Lip tie treatment (frenuloplasty) can be performed
at any age from the newborn period onward. In infants,
it is typically performed as early as the first weeks
of life when feeding difficulties are significant.
In older children, it is often performed when dental
spacing or speech concerns emerge. There is no age
at which treatment is no longer possible, though
the procedure and recovery differ between infants
and older children.
Is a lip tie check painful for the baby?
The lip lift test and visual inspection, when performed
gently with clean hands and good lighting, should not
cause pain. The baby may show mild discomfort or
startle briefly when the lip is lifted. If the baby
shows significant distress during the check, stop
and attempt the check again when the baby is calm
and in a different position.
Key Takeaways
- The simplest home check for baby lip tie is the
lip lift test: gently lift the upper lip toward
the nose and observe whether the frenulum restricts
movement, appears thick or cord-like, or causes
gum blanching at the attachment point. - A heart-shaped notch at the center of the upper
lip when stretched upward is a common visual sign
of lip tie. - The most telling feeding signs of lip tie involvement
are: upper lip curling inward during feeding, clicking
sounds, milk leaking from the corners of the mouth,
nipple pain in breastfeeding mothers, and poor
weight gain. - A home check identifies the presence of a possible
lip tie but cannot grade its severity or determine
whether treatment is needed – professional assessment
is required for those determinations. - Lip tie only requires treatment when it is causing
a functional problem. A confirmed lip tie with no
feeding, dental, or speech impact does not need
intervention.
