{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:51:12Z","timestamp":1790268672757,"version":"4.1.0"},"reference-count":17,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Breastfeeding improves health outcomes in neonates. However, infants\u2019 oral anatomy may alter latch and sucking mechanics, hampering breastfeeding. The role of maxillary frenulum (upper lip-tie) has remained controversial.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the association between upper lip-tie clinical findings, such as thickness, attachment, and upper lip mobility, and early breastfeeding problems.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this prospective cohort study (Lingual Frenulum in Newborn Infants substudy), consecutive mother-infant dyads were studied from August 2, 2023, to January 31, 2024, in the mother-child unit of Oulu University Hospital, Oulu, Finland. After 6 months, parents were asked about breastfeeding success.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Main outcomes were the association of various maxillary frenulum clinical findings with breastfeeding problems and possible treatment indications. Study physicians assessed frenulum thickness, tissue type, attachment point, upper lip mobility and skin paleness when stretched, sucking pad, mother\u2019s need to fix the upper lip position, and the need of early tongue-tie treatment. The validated maternal breastfeeding experience scores were recorded. Follow-up information was inquired via emails.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 264 studied mother-infant dyads (151 [57.2%] male infants; mean [SD] gestational age, 39.5 [1.2] weeks), 228 mothers (86.4%) reported early breastfeeding problems in maternal breastfeeding experience scoring. Baseline data were similar between the breastfeeding problem group vs controls. No associations between distinct maxillary frenulum findings and breastfeeding problems were found. Mothers without breastfeeding problems had more often previous breastfeeding experience than mothers who reported breastfeeding problems (28 [77.8%] vs 116 [50.9%],\n P<\/jats:italic>\n \u2009=\u2009.003). Of the mothers with infants treated early for tongue-tie, 17 (43.6%) vs 46 (20.8%) of the nontreated patients\u2019 mothers reported a need to fix the upper lip position during breastfeeding (\n P<\/jats:italic>\n \u2009=\u2009.003). The upper lip-ties of 4 infants (1.5%) had been operated on during the 6-month follow-up period.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this prospective cohort study, an isolated, harmful upper lip-tie was rare in newborn infants. Maternal inexperience, rather than infant\u2019s upper lip-tie anatomy, was associated with breastfeeding problems; no operative treatment indications for maxillary frenulum were confirmed.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.13308","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T15:30:24Z","timestamp":1779118224000},"page":"e2613308","source":"Crossref","is-referenced-by-count":1,"title":["Upper Lip Frenulum Findings and Breastfeeding Problems in Healthy Newborns"],"prefix":"10.1001","volume":"9","author":[{"given":"Laura","family":"Niemel\u00e4","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Oulu University Hospital, Oulu, Finland"},{"name":"Medical Research Center, Oulu University Hospital, Oulu, Finland"},{"name":"Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venla","family":"Lohi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Oulu University Hospital, Oulu, Finland"},{"name":"Medical Research Center, Oulu University Hospital, Oulu, Finland"},{"name":"Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stiina","family":"Aitamurto","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Oulu University Hospital, Oulu, Finland"},{"name":"Medical Research Center, Oulu University Hospital, Oulu, Finland"},{"name":"Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu","family":"Lehtinen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland"},{"name":"Medical Research Center, Oulu University Hospital, Oulu, Finland"},{"name":"Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Outi","family":"Aikio","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland"},{"name":"Medical Research Center, Oulu University Hospital, Oulu, Finland"},{"name":"Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"issue":"10","key":"zoi260396r2","doi-asserted-by":"publisher","first-page":"2266","DOI":"10.3390\/nu11102266","article-title":"Breastfeeding difficulties and risk for early breastfeeding cessation.","volume":"11","author":"Gianni","year":"2019","journal-title":"Nutrients"},{"issue":"10","key":"zoi260396r3","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1001\/jamaoto.2017.0948","article-title":"Diagnosis and treatment of ankyloglossia in newborns and infants: a review.","volume":"143","author":"Walsh","year":"2017","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"2","key":"zoi260396r4","first-page":"263","article-title":"Does ankyloglossia interfere with breastfeeding in newborns? A cross-sectional study.","volume":"7","author":"Souza-Oliveira","year":"2021","journal-title":"J Clin Transl Res"},{"issue":"5","key":"zoi260396r5","doi-asserted-by":"publisher","first-page":"E1701","DOI":"10.1002\/lary.29140","article-title":"Upper lip tie: anatomy, effect on breastfeeding, and correlation with ankyloglossia.","volume":"131","author":"Shah","year":"2021","journal-title":"Laryngoscope"},{"key":"zoi260396r6","doi-asserted-by":"publisher","DOI":"10.1177\/2333794X17718896","article-title":"The superior labial frenulum in newborns: what is normal?","volume":"4","author":"Santa Maria","year":"2017","journal-title":"Glob Pediatr Health"},{"issue":"10","key":"zoi260396r7","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1001\/jamaoto.2019.2302","article-title":"Anatomic Distribution of the Morphologic Variation of the Upper Lip Frenulum Among Healthy Newborns.","volume":"145","author":"Ray","year":"2019","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"10","key":"zoi260396r8","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1016\/j.ijporl.2015.07.033","article-title":"Breastfeeding difficulties and oral cavity anomalies: the influence of posterior ankyloglossia and upper-lip ties.","volume":"79","author":"Pransky","year":"2015","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"5","key":"zoi260396r9","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1002\/lio2.889","article-title":"Upper lip tie: a novel classification scale with improved inter-rater reliability.","volume":"7","author":"So","year":"2022","journal-title":"Laryngoscope Investig Otolaryngol"},{"issue":"5","key":"zoi260396r10","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1136\/archdischild-2014-306211","article-title":"Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance.","volume":"100","author":"Power","year":"2015","journal-title":"Arch Dis Child"},{"issue":"12","key":"zoi260396r11","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.32755","article-title":"Labial frenotomy for symptomatic isolated upper lip tie.","volume":"14","author":"Freeman","year":"2022","journal-title":"Cureus"},{"issue":"12","key":"zoi260396r12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0338491","article-title":"Tongue-tie diagnosis using the Lingual frenulum in newborn infants (LINNE) -scoring: a validation study.","volume":"20","author":"Lehtinen","year":"2025","journal-title":"PLoS One"},{"issue":"9596","key":"zoi260396r13","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"issue":"1","key":"zoi260396r14","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.jpeds.2010.06.058","article-title":"Sucking pads in a full-term newborn.","volume":"158","author":"Thariat","year":"2011","journal-title":"J Pediatr"},{"issue":"5","key":"zoi260396r16","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1002\/lary.26306","article-title":"Breastfeeding improvement following tongue-tie and lip-tie release: a prospective cohort study.","volume":"127","author":"Ghaheri","year":"2017","journal-title":"Laryngoscope"},{"issue":"3","key":"zoi260396r17","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1177\/0890334410362520","article-title":"The influence of the maxillary frenum on the development and pattern of dental caries on anterior teeth in breastfeeding infants: prevention, diagnosis, and treatment.","volume":"26","author":"Kotlow","year":"2010","journal-title":"J Hum Lact"},{"key":"zoi260396r15","doi-asserted-by":"crossref","DOI":"10.1002\/0471445428","volume-title":"Statistical Methods for Rates and Proportions","author":"Fleiss","year":"2003"},{"key":"zoi260396r1","unstructured":"World Health Organization. Guidelines on Infant Feeding 2020: Principles and Recommendations for Infant Feeding in the Global Context and a Summary of Evidence. December 20, 2023. Accessed April 10, 2023. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/infant-and-young-child-feeding"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2849117\/niemel_2026_oi_260396_1778512970.36259.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T15:30:26Z","timestamp":1779118226000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2849117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.13308","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}