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Lip Tie vs Tongue Tie: What's the Difference?
Lip tie and tongue tie are both tight frenulums, but in different locations. Tongue tie is a short lingual frenulum (under the tongue) that restricts tongue movement; lip tie is a tight maxillary frenulum (upper lip) that prevents the lip from flanging outward. Both can cause poor latch, nipple pain, and inefficient milk transfer. About 30% of tongue-tied babies also have a lip tie. Assessment requires observing a full feed, not just looking at anatomy. Treatment is a frenotomy (snip) or frenuloplasty (laser), and both may need release for best feeding outcomes.
- Two ties, one problem: poor feeding
- What is a lip tie?
- What is a tongue tie?
- Side-by-side comparison
- How lip tie affects breastfeeding
- How tongue tie affects breastfeeding
- How to tell if your baby has a lip tie
- How to tell if your baby has a tongue tie
- Assessment: why you need a professional
- Treatment options
- Post-release care
- Lip tie and dental issues
- When to seek help
Two ties, one problem: poor feeding
You've heard about tongue tie. But what about lip tie? And can a baby have both? The answer is yes — about 30% of tongue-tied babies also have a lip tie, and releasing only one may not fully fix feeding problems.
This guide explains the difference, how each affects breastfeeding, and what to do if you suspect either or both.
What is a lip tie?
The maxillary frenulum is the thin band of tissue connecting the inside of the upper lip to the gums above the front teeth. In most babies, it's thin and flexible, allowing the upper lip to flange (flip outward) widely during feeding.
A lip tie occurs when this frenulum is thick, tight, or attached too low on the gum line, restricting how far the upper lip can lift and flange outward.
Lip ties are classified by the Kotlow classification (1–4), based on how close the attachment is to the gum line:
- Class 1: Attached at the gum line (mildest)
- Class 2: Attached slightly above the gum line
- Class 3: Attached midway up the gum
- Class 4: Attached high up, near the palate (most restrictive)
However, like tongue tie, classification alone doesn't determine whether treatment is needed — functional impact is what matters.
What is a tongue tie?
The lingual frenulum connects the underside of the tongue to the floor of the mouth. A tongue tie (ankyloglossia) occurs when this frenulum is short, thick, or tight, restricting tongue movement — especially lifting and extending.
Tongue ties are also classified (Coryell 1–4, or by the HATLFF functional assessment tool), but again, function matters more than appearance.
Side-by-side comparison
| Feature | Lip Tie | Tongue Tie |
|---|---|---|
| Location | Upper lip to gum line | Underside of tongue to floor of mouth |
| Restricts | Lip flanging and mouth opening | Tongue lift, extension, and side-to-side movement |
| Feeding impact | Poor seal, clicking, milk leakage, shallow latch | Poor milk transfer, nipple damage, inefficient sucking |
| Visible sign | Lip tucks under instead of flanging out; gap between front teeth | Heart-shaped tongue tip; can't lift tongue to roof of mouth |
| Prevalence | ~3–5% of newborns (varies by definition) | ~4–10% of newborns |
| Co-occurrence | ~30% of tongue-tied babies also have a lip tie | |
How lip tie affects breastfeeding
For a good latch, baby needs to open wide (120°+) and flange both lips outward — like a fish. A tight upper lip can't flange, so:
- Baby can't open wide enough to get a deep latch
- The upper lip tucks under, creating friction on the nipple
- Suction seal breaks, causing clicking sounds during feeds
- Milk leaks from the corners of baby's mouth
- Baby takes in extra air, causing gas and fussiness
- Nipple becomes compressed and painful (often a stripe or line mark on the top of the nipple)
- Feeds take longer because baby can't maintain suction
How tongue tie affects breastfeeding
For effective milk transfer, baby's tongue needs to cup the breast and move in a wave-like motion to compress milk sinuses. A tight tongue can't:
- Lift to the roof of the mouth to form a seal
- Extend past the lower gum to draw the nipple back
- Move side to side to drain all areas of the breast
Result:
- Nipple pain and damage — creased, flattened, "lipstick" shaped nipples
- Poor milk transfer — baby feeds long but doesn't get enough
- Slow weight gain
- Clicking and choking (suction breaking)
- Frequent feeding (baby is always hungry)
- Recurrent clogged ducts and mastitis (incomplete drainage)
- Early weaning due to pain and frustration
How to tell if your baby has a lip tie
You can check at home, but a proper assessment requires observing a full feed.
Home check
- Gently lift baby's upper lip with your finger
- Look at the band of tissue connecting the lip to the gum
- Try to flange the lip outward — does it lift easily, or does it resist?
- Check if the lip tucks under when baby cries or opens wide
Feeding signs
- Clicking sounds during feeds
- Milk leaking from the corners of the mouth
- Pain on the top of the nipple (a stripe or line mark)
- Baby can't maintain latch — keeps slipping off
- Feeds take 45+ minutes
- Baby is gassy and fussy after feeds
How to tell if your baby has a tongue tie
Home check
- When baby cries, look under the tongue — is there a tight band?
- Does the tongue tip look heart-shaped or notched?
- Can baby lift the tongue to the roof of the mouth?
- Can baby extend the tongue past the lower lip?
Feeding signs
- Nipple pain that persists beyond week 1 or gets worse
- Creased, flattened, or lipstick-shaped nipples after feeds
- Baby falls asleep quickly then wakes hungry 20 minutes later
- Poor weight gain or slow weight gain
- Chewing or biting the nipple
- Pumping yields more than baby gets at the breast
Assessment: why you need a professional
Looking at the frenulum isn't enough. A proper assessment by an IBCLC includes:
- Observing a full feed — watching latch, sucking pattern, milk transfer, and baby's behavior
- Functional assessment — using tools like the HATLFF (tongue) or checking lip mobility
- Checking both — if one tie is found, the other is always assessed
- Weight and diaper check — measuring actual milk transfer
- Ruling out other causes — prematurity, low tone, maternal oversupply, etc.
Treatment options
Frenotomy (snip)
A quick procedure with sterile scissors, usually in-office. Takes 10–30 seconds, minimal bleeding, baby can feed immediately.
Frenuloplasty (laser)
Uses a laser to reshape the frenulum, sometimes with sutures. More precise for thick ties, less bleeding, but more expensive and requires a specialist.
Both procedures are effective for lip tie and tongue tie. If baby has both, many providers recommend releasing both at the same visit for best results.
Post-release care
Release is only half the work. After the procedure:
- Breastfeed immediately — feeding helps soothe and practice the new range of motion
- Tongue/lip exercises — your provider will show you specific exercises to prevent reattachment and build strength
- IBCLC follow-up within 24–48 hours for a feeding assessment
- Bodywork — pediatric chiropractic, craniosacral therapy, or OT can help release compensating tension in the jaw, neck, and body
- Be patient — it can take 1–2 weeks for feeding to fully improve
Lip tie and dental issues
Beyond breastfeeding, a significant lip tie can contribute to:
- Gap between front teeth (diastema) — though this can also be normal and close as adult teeth come in
- Difficulty with speech — some sounds require lip movement
- Dental hygiene challenges — the tight frenulum can make brushing the upper front teeth difficult
- Lip incompetence — difficulty closing lips at rest
However, not all lip ties cause these issues, and many children outgrow mild ties as the frenulum stretches with growth.
When to seek help
Contact an IBCLC if:
- Nipple pain persists beyond the first week or gets worse
- Baby has clicking, milk leakage, or poor weight gain
- Feeds take 45+ minutes and baby still seems hungry
- You suspect either tie from the home checks
- You've been told it's "just a bad latch" but positioning help hasn't worked
An IBCLC can assess both ties, observe feeding, and refer to a provider for release if indicated.
Find help near you
Want 1:1 support? These board-certified IBCLCs cover the full lactation journey and book directly.
Frequently asked questions
Can a baby have both lip tie and tongue tie?
Yes — about 30% of tongue-tied babies also have a lip tie. If one is found, the other should always be assessed. Releasing only one may not fully fix feeding.
Does every lip tie need treatment?
No. A tight-looking frenulum that doesn't affect feeding, speech, or dental health may not need release. Functional impact, not appearance, should drive treatment decisions.
How do I check for lip tie at home?
Gently lift baby's upper lip and look at the band connecting it to the gum. Try flanging the lip outward — if it resists or tucks under, it may be a lip tie. But feeding assessment by an IBCLC is needed for diagnosis.
Is laser better than scissors for lip tie?
Both are effective. Laser may be more precise for thick ties and causes less bleeding. Scissors are faster and less expensive. Provider expertise matters more than the tool.
Will a lip tie cause a gap in my baby's teeth?
A significant lip tie can contribute to a gap (diastema), but many babies have gaps that close as adult teeth come in. Dental concerns should be assessed by a pediatric dentist.
Related guides
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Not sure this applies to you?
A 30-second check tells you exactly where you are — and if you need 1:1 help, book a consult with an IBCLC who knows the latest care.
Sources & references
- Academy of Breastfeeding Medicine, Protocol #36: The Mastitis Spectrum (2022)
- CDC, Breastfeeding guidelines
- ILCA, International Lactation Consultant Association
- PubMed peer-reviewed literature on lactation and mastitis
Last reviewed: September 2026. Medical review pending IBCLC partnership.
Medical disclaimer: This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.