Specialist University Hospital of Oulu Oulu, Pohjois-Pohjanmaa, Finland
Background: Breastfeeding improves neonates’ health outcomes. However, anatomical variants in infant oral cavity may alter latch and sucking mechanics, resulting in maternal symptoms. Previously, tongue-tie was shown to hamper breastfeeding while the impact of maxillary frenulum or upper lip-tie is controversial. It may restrict lip movements, inhibiting regular suction. Upper lip-tie diagnostic scorings have been developed but their clinical significance remains unsettled. Despite lacking evidence, upper-lip ties are occasionally treated surgically. Objective: To study the association between upper lip-tie clinical findings and breastfeeding problems. Design/Methods: Healthy, term neonates were eligible in the Lingual frenulum in newborn infants (LINNE) -project in Oulu University Hospital, Oulu, Finland, within a few days after birth. In the present prospective, observational LINNE sub study, physicians assessed frenulum thickness, tissue type, attachment point, upper lip mobility and skin paleness when stretched, sucking blister, mother’s need to fix the upper lip position, its helpfulness, and early tongue-tie treatment. The validated maternal breastfeeding experience scorings (MBES; Lehtinen, PAS 2024) and the number of previously breastfed infants were recorded. 6-month follow-ups were inquired by parental Webropol-emails. Results: From VIII/2023 to I/2024, 264 consecutive mother-infant-dyads were studied (Table 1). Baseline data was similar between breastfeeding problem group vs none. No associations between distinct upper lip-tie findings and breastfeeding problems emerged (Table 2). In the early tongue-tie treatment group (n=44), 17 (43%) mothers reported need to fix the upper lip position during breastfeeding (p=.003). Mothers without breastfeeding problems had more previous breastfeeding experience vs mothers with breastfeeding problem, 28 (78%) vs 116 (51%), p=.003. The anticipated factors predisposing breastfeeding problems were analyzed by logistic regression: only the number of previously breastfed infants reached statistical significance, OR 0.81 (95%CI 0.670-0.972), p=.024. In the 6-month answers, 4 upper lip-ties had been operated, one (0.4%) in the LINNE follow-up visit and 3 (1.1%) by private practitioners.
Conclusion(s): Isolated, harmful upper lip-tie was rare. Maternal inexperience rather than upper lip anatomy associated with the incidence of breastfeeding problems. The need to fix the upper lip position during breastfeeding suggested more likely tongue-tie symptoms. Upper lip-tie role was minor in breastfeeding problems.
Table 2. 241031_YHJ_Table2.pdf Upper lip frenulum findings and their frequencies (n [%]) in infants without or with various breastfeeding problems, and in tongue-tie-treated infants.
