You may have heard of “tongue-tie,” or anchored tongue which is when the frenulum under the tongue is abnormal and restricts the movement of the tongue (Tonguetie.net). But an extended upper lip frenulum is different. An extended upper lip frenulum can cause different issues for infants, babies and children. In some cases the upper lip frenulum should be snipped. When should it be snipped, by whom and is it covered by insurance?
Author’s Note: My son currently has an upper lip frenulum and we are in the process of figuring out what to do. Our discovery process has involved the advice of speech therapists and a reputed doctor of Otolaryngology. There are few resources for parents whose children have an issue with the upper lip, because the “tongue tie” is much more common.
Where is the Upper Lip Frenulum?
The upper lip frenulum is located under the top lip, in the center, and attaches the lip to the upper gums. In some infants, it is attached further down the gums. If your thumb and your finger in your mouth and reach up to the inner part of your lip, you can feel the frenulum
Upper Lip Frenulum and Infants
When our baby was born, his upper lip frenulum was attached to his gums. His frenulum goes pretty far down, but none of the NICU doctors or nurses every considered it an issue. When your baby is premature, even if he is healthy and a healthy weight or a preemie, there are other health issues that take precedence over the frenulum.
The problem that an attached upper lip frenulum can cause for an infant, including a premature infant, is that it can make it more difficult for the baby to latch on during breast feeding. In our case, the nurses and the lactation consultant, as wonderful as they all were, attributed my son’s continued inability to latch on to be because he was a preemie and not strong enough.
I only discovered recently that an attached upper lip frenulum can restrict movement of the upper lip, and it could have been the cause of my baby’s inability to properly latch on and breast feed directly. Instead, I provided breast milk for him by using a breast pump for to six times a day for a year and two months.
Had the visiting nurse, the lactation consultant, or the pediatrician let me know that his abnormally tight and long upper lip frenulum could have been causing him to struggle with latching on, we could have explored surgical options earlier.
As experienced and educated as all of these people were, this was never brought up as a possible problem.
Upper Lip Frenulum and Circumcision
It also came to my attention recently that it used to be customary for a doctor performing a circumcision to also snip the upper lip frenulum if it was attached. This was not offered as an option to us by the hospital or the doctor.
This is not as odd as it sounds, since the penis also has a frenulum.
How It Could Delay Expressive Speech
For toddlers, an attached upper lip frenulum can cause other developmental problems, including speech delays. For toddlers who have developed intellectually and in a way that is appropriate for their age, but still have a speech delay, the attached upper lip frenulum could be to blame.
The upper lip is more restricted, making it more difficult to pronounce certain sounds and articulate clearly.
Note: it’s also important to have a hearing test for any child with a speech delay to rule out that problem.
Also, even with the evaluation of a speech therapist, who has ruled out all other possible reasons for speech delay there is no way to know if the restricting frenulum is the cause of the delay. It could be, which might be enough to consider surgery.
Surgery or Not?
Parents of children with this possible physical speech impediment have a number options. One is to have speech therapy. Even with speech therapy, and exercising and strengthening of the upper lip, the child may still physically struggle with making certain sounds.
The next option is to have a consultation with a doctor of Otolaryngology. Otolaryngology is basically the ear/nose/throat doctor or surgeon. The Otolaryngology will make a recommendation on whether or not the upper lip frenulum should be surgically snipped. This is called a frenectomy.
if it was not snipped earlier, this surgery typically occurs at age one.
Many health insurances will not cover surgery to the upper lip frenulum even if they cover surgery to correct a “tongue” tie on the bottom of the mouth.
The next option is to visit a pediatric dentist. If the frenulum has not been snipped, it may interfere with the two upper front teeth. Some pediatric dentists will advise waiting to do anything.
As the child grows, the frenulum that has not receded up will then become an orthodontic issue, and it may be snipped later as part of the orthodontic process.
The Problem for Parents
The main problem for parents of a child with an attached upper frenulum and a speech delay is whether or not they should have it snipped. Not having it snipped could further delay the child ‘s expressive language development, which in turn affects the ability to participate in preschool.
Also, there is not way to know that snipping the frenulum would actually help the child develop expressive language any faster. The surgery could be an unnecessary expense, and experience for the child.
On the other hand, the risks of the surgery could be trumped by the fact that this snipping of the frenulum could be the key to solving the speech delay. As a responsible parent, I worry about the risks of any surgery, even out-patient surgery.
It could help this boy, who tries so hard to repeat words and enunciate properly. As a responsible parent, I also struggle with the concept that I want to give my son every opportunity to develop his expressive language without physical limitations.
Sources
Consultations with medical professionals; personal experience
Frenum Presentation,http://www.brianpalmerdds.com/frenum.htm
Tonguetie.net, http://www.tonguetie.net
