To understand how an upper lip tie may affect feeding we need to look at how the baby attaches to the breast. Older breastfeeding literature talked about both the upper and lower lips flanging during breastfeeding to form ‘fish lips’. The idea that ‘fish lips’ are a good sign still litters the internet and popular literature on breastfeeding. However, ideas about the role of the upper lip have changed. In actual fact only the lower lip should flange. Catherine Watson Genna IBCLC in her latest 2017 edition of Supporting Sucking Skills in Breastfeeding Infants says ‘lips are gently applied to the breast with the lower lip flanged completely outward and the upper lip neutral to slightly flanged (p 28). She goes on to quote an article by Kay Hoover IBCLC from 1996 on page 37. ‘The nasolabial crease should remain soft, and the upper lip should be neutral to slightly everted on the breast and should be relatively immobile during sucking.’ She goes on to say ‘an overly flanged upper lip is a sign of shallow attachment or overuse of the lip to compensate for tongue immobility’.
So, babies who flange the top lip are doing so because they are compensating for a shallow latch due to poor positioning or a tongue tie. They are using the top lip to hang onto and compress the breast. Obviously if the top lip is tense the baby will find it harder to employ the lip to compensate for the tongue tie. However, if the tongue-tie is divided the need to flange the lip will be eliminated and the presence of a lip tie will become irrelevant. Currently there is no published research to support that lip ties are associated with feeding issues.
The Association of Tongue-tie Practitioners have a statement on lip tie on their website which summarises the UK situation www.tongue-tie.org.uk (See below)
Currently there is no published evidence supporting a link between breastfeeding issues and lip tie. NICE have not issued any guidance on this issue, and therefore, training is not available in the UK in lip tie division for practitioners. This situation may change in the future if new research and evidence influences best practice guidelines. Currently nurse/midwife tongue-tie practitioners working in the UK cannot offer lip tie division as the Nursing and Midwifery Council’s Code of Conduct states that nurses, midwives and health visitors must ‘deliver care based on the best available evidence or best practice’ and ensure any advice given is evidence based if suggesting healthcare products or services. The Code also requires that nurses and midwives recognise and work within the limits of their competence. On the rare occasions that lip ties are divided by surgeons in the NHS it is usually done in relation to concerns about dental issues, not breastfeeding. If you have concerns about lip ties we suggest you discuss this with your dentist.
The idea that upper lips ties are significant and need to be treated seems to originate largely from the United States where dentists perform many of the tongue-tie divisions and increasingly divide upper lip ties at the same time. Dentists initially appear to have developed an interest in upper lip tie because it was thought it could predispose babies to dental decay if they continue to breastfeed through the night once teeth come in. The tie may act as a pocket where milk can pool and cause decay. (E. Kernerman IBCLC, Live Tongue-tie Webinar, 3/4/14). However, again we have no research to support the idea that lip tie is associated with dental decay in breastfed babies.
Not all dentists agree that treating lip ties in babies to prevent future dental problems is a good idea. The dental literature describes lip ties as normal anatomy. They form in the womb and are mean to be there, unlike tongue-ties which are caused by incomplete separation of the tongue from the floor of the mouth. Associate Professor Angus Cameron from the Sydney Tongue-tie Clinic in Australia has this to say about lip tie division in babies on his website http://sydneytonguetie.com.au/#about :
Releasing a upper labial frenum is a traumatic procedure that may also lead to more dental problems later including the persistance of an anterior diastema (gap between the front teeth) that is difficult to close orthodontically
There are also suggestions that lip ties may cause speech issues. I have not seen any research to back this up or found any speech therapists who feel they are significant in terms of speech.
The strongest indications for treating a lip tie seem to be to prevent dental decay or gaps in the front teeth when adult teeth come through. Some dentists in the UK are starting to refer older children for treatment before orthodontic work. Because of the lack of evidence to support a link between lip tie and feeding difficulties the NHS does not offer lip tie division for feeding issues. However, some NHS Trusts will treat older children to prevent dental problems. So if you have concerns about upper lip tie I would suggest talking to your dentist.
Here is a link to an article I wrote in 2016 which provides more detail on this issue: lip-tie-article
Dr Alison Hazelbaker also has some interesting information on this issue here: http://www.alisonhazelbaker.com/blog/