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
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.