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no-food2A few months ago SLP Melanie Potock contributed an insightful post to the ASHA blog. One of her focuses as an SLP is in feeding difficulties in children, which is why she always encourages other SLPs to flip the lip when assessing an oral cavity. Often times an upper lip-tie is a contributing factor if a child has been having trouble feeding. Upper lip-ties refer to the band of tissue or frenum that attaches the upper lip to the upper gums at midline. If you treat pediatric feeding, then it is important to understand the degree of restriction.


Potock suggests considering these four things during the evaluation process:


  1. The mobility of the upper lip for bottle or spoon feeding.
  2. How well it functions in the process of latching.
  3. Does the upper lip provides the necessary stability for effective suck-swallow-breath coordination.
  4. Is the upper lip an effective tool for cleaning a spoon and manipulating foods in the mouth.


Dentists Lawrence Kotlow created an upper lip-tie classification system to better identify and describe need for treatment. According to an article he wrote,


“The soft tissue covering the maxillary bone is divided into 3 zones. The tissue just under the nasal area (zone 1) is called the free gingival area; this tissue is movable. Zone 2 tissue is attached to the bone and has little freedom of movement… Zone 3 extends into the area between the teeth and is known as the interdental papilla. This is where the erupting central incisors will position themselves at around 6 months of age.”


Potock goes on to describe the impact that upper lip-ties may have in the developmental process of feeding and oral hygiene. These may include inadequate seal when bottle feeding which could lead to gassiness and discomfort, and the inability to manipulate food which could lead to pickiness or selective eating.