Tongue Tie vs Lip Tie: Understanding the Difference in Babies

When your newborn struggles to feed, loses the latch, makes clicking sounds, or cries after every nursing session, two conditions often come up: tongue tie and lip tie. Understanding the difference between a tongue tie vs lip tie in babies is the first step toward getting your baby the help they need.

This guide covers the key differences, symptoms, breastfeeding impact, and treatment options, including answers to questions most articles skip, like whether a lip tie resolves on its own and what happens with bottle-fed babies.

What Is a Tongue Tie in Babies?

A tongue tie in babies, medically called ankyloglossia, occurs when the lingual frenulum (the thin band of tissue connecting the underside of the tongue to the floor of the mouth) is unusually short, thick, or tight. This restricts tongue movement, interfering with feeding, swallowing, and later speech development.

Tongue ties affect approximately 4–11% of newborns, with a likely genetic component. There are two main types:

• Anterior tongue tie (Types I & II) visible near the tip of the tongue; easier to identify
• Posterior tongue tie (Types III & IV) located further back, partially hidden under the mucous membrane; commonly missed but equally disruptive to feeding
  
  

What Is a Lip Tie in Babies?

A lip tie in babies occurs when the labial frenulum, the tissue connecting the center of the upper lip to the gum line, is too thick, short, or tightly attached. This limits how far the upper lip can flange outward, which is essential for a proper seal during breastfeeding or bottle feeding.

Severity ranges from Grade 1 (mild, flexible tissue) to Grade 4 (tissue tightly fixed to the gum ridge). Mild lip ties may loosen as the baby grows, but moderate to severe cases, especially those causing active feeding difficulties or poor weight gain, are unlikely to resolve without treatment.

Tongue Tie vs Lip Tie: Key Differences

Both conditions involve an overly restrictive frenulum, but they affect different oral structures:

• Tongue tie restricts the lingual frenulum, limiting tongue movement needed for milk transfer and later speech
• Lip tie restricts the labial frenulum, limiting lip flanging needed for a proper seal during feeding
• Tongue tie more directly affects speech development and articulation
• Lip tie more commonly affects dental health, as it can cause a gap between front teeth (diastema) and increase the risk of tooth decay

Can a baby have both? Yes, and it’s more common than most parents realize. Many babies diagnosed with ankyloglossia also have some degree of lip tie. When both tethered oral tissues are present, feeding difficulties are typically more severe. Always ask your provider to assess both.

Tongue Tie Symptoms in Newborns

In the baby:

• Difficulty latching or repeatedly losing the latch on the breast or bottle
• A shallow latch taking only the nipple rather than the areola
• Clicking or smacking sounds while nursing (tongue tie clicking sound breastfeeding)
• Excessive gas, colic-like fussiness, or reflux (tongue tie gas and reflux in babies)
• Poor weight gain or slow weight gain (baby not gaining weight, tongue tie)
• Heart-shaped or notched tongue tip when extended
• Inability to lift the tongue to the roof of the mouth or move it side to side
  
  

In the breastfeeding mother:

• Nipple pain, cracking, or soreness that doesn’t improve with positioning
• Flattened or lipstick-shaped nipples after nursing
• Recurrent blocked ducts, engorgement, or mastitis
• Low milk supply (low milk supply tongue tie) because incomplete milk removal signals the body to produce less
  
  

Lip Tie Symptoms in Babies

• Lips curl inward instead of flaring out during feeding (lip tie breastfeeding problems)
• Milk leaking from the corners of the mouth
• Slow feeding with frequent breaks and poor weight gain
• Clicking sounds during feeding
• Excessive gas or spitting up
• Later: a gap between the upper front teeth (lip tie diastema), higher tooth decay risk, or receding gums
  
  

To do a basic check at home: gently lift your baby’s upper lip. If the labial frenulum is wide, thick, and pulls the gum white when stretched, that’s worth a professional evaluation (how to check for lip tie in newborns).

Breastfeeding and Bottle Feeding Impact

Effective breastfeeding requires the tongue to extend, cup the breast, and move in a wave-like (peristaltic) motion to transfer milk, while both lips flange to create an airtight seal. A tongue tie disrupts tongue mobility; a lip tie disrupts the lip seal. When both are present, virtually every step of feeding is affected.

What most articles miss: tongue tie and lip tie affect bottle-fed babies, too. While bottles can be easier for some tied babies, many still experience excessive air swallowing, milk leaking from the mouth, fatigue during feeds, and reflux. If your bottle-fed baby is showing these signs, ties are still worth investigating.

When to Seek Treatment

Not every baby with a tongue tie or lip tie needs treatment. The decision should be based on function, not anatomy alone. Seek evaluation if your baby has:

• Significant difficulty latching or maintaining a latch (baby not latching tongue tie)
• Poor or declining weight gain
• Breastfeeding pain that doesn’t resolve with positioning support
• Feeds lasting over 45–60 minutes with little satisfaction
• Persistent gas, reflux, or colic symptoms
  
  

Treatment: Frenotomy vs Frenectomy

• Frenotomy: A quick snip of the frenulum with sterile scissors is typically done in-office for newborns with tongue tie. Minimal pain; most babies can nurse immediately after.
• Frenectomy: Complete removal of the frenulum tissue, more common for lip tie correction or complex tongue ties.
• Laser tongue and lip tie release: Uses a soft-tissue laser for high precision, minimal bleeding, no stitches, and fast healing. Increasingly preferred in pediatric dentistry.

After any release procedure, tongue and lip tie stretches and exercises are performed 4–6 times daily for several weeks to prevent reattachment and retrain muscle movement. Continuing with a lactation consultant post-procedure is strongly recommended.

Long-Term Effects If Left Untreated

Untreated tongue tie in toddlers can affect eating solid foods, contribute to speech delay (particularly the sounds/l/, /r/, /t/, /d/), and cause mouth breathing or dental crowding. An untreated lip tie may lead to a persistent tooth gap (diastema), increased risk of tooth decay, and receding gum tissue. Not every case leads to these outcomes, but it’s worth monitoring.