The Upper Lip Frenulum and Breastfeeding Success
by Anne Eglash MD, IBCLC, FABM
The researchers for this week’s article evaluated the upper lip frenulum anatomy in healthy newborns, to determine if there is an association between the ‘grade’ of the frenulum (where it attaches to the upper gum) and breastfeeding success. Further, there is a belief that upper lip ‘ties’ correlate with tongue ties, and the researchers were interested to see if they could measure this relationship.
The study enrolled 100 healthy term newborns in Rochester NY, USA. Each newborn had their upper lip and tongue frenulum measured by 2 raters. Demographic information was collected, and the infant breastfeeding assessment tool (IBFAT) was used within the first week and at 2 weeks postpartum to evaluate maternal comfort with breastfeeding.
The researchers found that presence of the most prominent upper lip frenulum, which attaches all the way to the edge of the upper gum, was not associated with maternal pain during breastfeeding.
- Approximately 25% of the infants had a grade 3-4 upper lip frenulum that extended to the edge of the upper gum.
- Approximately 50% of the infants had a grade 1 upper lip frenulum, meaning that the frenulum was barely noticeable and not considered a ‘tie’.
- Infants who had more prominent upper lip frenula were more likely to have a tongue tie that extended to the tip of the tongue.
See the Answer
Abstract
Objectives
Methods
Results
Conclusions
For this reason, I wish the authors did not title this article ‘Upper Lip Tie’. ‘Tie’ implies pathologic tethering.
One limitation of this study is that only 39.5% of mothers completed the 2-week follow-up survey on breastfeeding success/pain.
The authors suggested that perhaps it is not so much the length of the upper lip frenulum but the stretchiness and lip attachment site of the upper lip frenula that might determine impact on breastfeeding. I have to agree with this. My evaluation of infants includes sweeping my gloved finger beneath the upper lip to evaluate floppiness/flexibility. If the upper lip is tacked down, which is rare, then the upper lip cannot act as a relaxed seal/gasket on the breast, which is its main function.
There are certainly cases where the upper lip is relaxed on oral exam, but when at the breast, the upper lip tenses and curls due to other dynamics, such as having to hang-on for dear life.
Like nearly all problems in breastfeeding, starting with the basics of optimal positioning and latch is the best way to help dyads without doing harm.
Angela Kirkwood
This is great evidence based news! Upper lip “ties” have been the buzz work in recent years but I was always skeptical that it caused concern due to the tongue being the primary source of milk extraction. Now my opinion is no longer anecdotal! Thank you researchers!
Jennifer Harlan
My daughter had a grade 3 upper lip frenulum. I never had problems with breastfeeding her. She transferred milk really well. It wasn’t until 18 months when we noticed something wrong with her teeth. She ended up having 4 cavities on her front top four teeth. I was told the cavities were there because the frenulum was trapping breast milk between her lip and gum and rotting the teeth. As a Lactation Consultant I knew this wasn’t possible. Breast milk when drawn from the breast goes towards the back of the mouth/ throat. it doesn’t sit at the front on the mouth. My daughter had started eating solids around 7 months of age and I knew this was most likely the cause. Even though we brushed her teeth because of the ‘upper lip tie’ we weren’t getting up high enough on her gums to brush the upper part and remove trapped food that was up there. So in my personal experience an Upper Lip Frenulum wasn’t a problem for breastfeeding but became a problem for my daughter once solids were introduced. We ended up having it clipped when she underwent surgery for her teeth to prevent further damage.
Catrina Popelier BSN, RN, IBCLC
I am curious. Most of the studies I have seen have failed to do follow up between 2-3 months. I have many moms who are successful at first but around 8-12 weeks when the breast normalizes and the sensation of fullness abates for the mother, I’ve had infants who begin the downward spiral of not being able to stay latched at the breast and many times these are the kids who do have some sort of tie. I know this is anecdotal and I’ve only held a caseload of 30 babies and mamas at a time, following them until two years of age for the past 9 years, but are there any recent studies that point to this phenomena? The rate of moms who breastfeed diminish exponentially until this time (it seems) and then those who make it past are my long haulers.
Thank you
Rosa Gardiner
The 39.5% compliance out of 100 dyads is not convincing to me. Especially since I’ve seen a number of breastfeeding relationships salvaged after frenulum revision! I know anecdotal data is not enough but neither are 2 studies with small numbers of participants…
Jessica Lee
I have been an IBCLC since 2009 and have worked in newborn clinics, postpartum in hospitals and WIC offices as well as private practice. The upper frenulum can and does cause extreme pinching of nipple and creasing and blanching of upper lip from a shallow latch due to infant over compensating to hold onto breast due to the decrease in upper flange. I would say it’s overall rare and I’ve never recommended a mom consider lasering or clipping the upper frenulum. There are positional tweaks one can do to aid the infant in latching more securely onto the breast to decrease pain for mother and transfer properly. Although my comment may be anecdotal, it is certainly relevant and many LC’s would agree, I’m sure, we do see this in the field and it can cause problems.
Christina
What are the positional tweaks?