To Release or Not to Release Upper Lip Tie in Infants

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This recent article highlights and validates my experience over the past 5-6 years as a pediatric ENT, especially practicing here in Florida. The research finds that almost 63% of newborn referrals to pediatric ENTs for nursing difficulty (tongue tie or lip tie), given by lactation specialists, pediatricians and speech therapists, did not need any release.  

I feel so validated as I have had the same experience in practice. I have pretty much stopped releasing any isolated LIP TIE due to nursing difficulty, most often for newborns referred to me because it’s assumed that if their upper lip doesn’t “evert” while they are nursing, it must be too short and should be cut. This is currently the most common reason babies are referred to me for a presumed upper lip tie diagnosis as cause for nursing difficulty.

Over 95% of referrals for that diagnosis end up being a reassurance visit with me, and as I watch a mother nurse in the office, I often am helping them understand that the main reason for poor latching is due to the mother having a somewhat flat or inverted short nipple, or a missed diagnosis of tongue tie. 

I rarely release ANY infant /newborn lip tie. For newborns and very young infants, the only time I ever release a very short and excessive upper lip frenulum is if there is also tongue tie that is being released. As for older kids, if they have a thick excessively long upper lip frenulum, then I may offer release only if child also has severe tongue tie and will be scheduled for lingual frenotomy under brief anesthesia. As babies grow, the upper lip grows also and will lengthen. I always tell parents that the evidence does not support that a release of the upper frenulum will always lead to the closure of central diathesis between the central incisor for toddlers/older children.

This paper, published in in Jama Oto/HNS, validates our experience and what we message to parents, SLPs, lactation specialists, etc.

We are simply doing “too much” to newborns and babies, and it’s so important to reassure mothers and stop misguiding the public.

Please refer to my prior blog on this topic, if you missed it.

Lip/Tongue Tie

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