Last February a lactation update session for professionals entitled “Physiotherapy in BF, Lip Out as a diagnostic tool and treatment of the seal” took place in LactApp. It was given by José Luís García-Morales, pediatric physiotherapist, IBCLC and director of Grupo Aúpale.

Lip Out refers to an evaluation technique and treatment of the alterations that the tongue may present in the oral sealing function for breastfeeding. The technique consists of removing the infant’s lower lip in order to observe the tongue and assess whether it is able to maintain the intraoral vacuum when suctioning.

The assessment of the Lip Out technique can be performed by inserting the evaluator’s finger inside the infant’s mouth (Finger Lip Out or FLO) or during a breastfeeding session (Breast Lip Out or BLO), in the latch or during suctioning. 

Depending on the structure of the infant that we remove, we will have different degrees:

– Grade 1: evert the lower lip only, without moving the rest of the skin structures. This can be done from the side of the lip.

– Grade 2: the finger is placed in the fold between the chin and the lip, to slide the skin ventral and caudal to remove the lip without moving the jaw. This can be done from the side of the lip.

– Grade 3: the infant’s mouth should be opened from the chin by moving the jaw downward, and assess whether the tongue is able to make a complete seal without the help of other oral structures.

Classification
	FLO (Finger Lip Out)		BLO (Breast Lip Out)
Moment in the breastfeeding session	Latch	Suction	Latch	Suction
Structure of the infant being assessed		Type 1		Type 1
	Type 2			Type 2
	Type 3		Type 3

 García-Morales, J.L. (2022) 

This is a technique that can be used as diagnostic support for other tools to assess:

– Ankyloglossia with or without restrictive frenulum.

– Dysfunctional and/or disorganized sucking pattern.

– Loss of seal

– Tongue asymmetry

– Diagnostic support in suckling function 

– Sensorimotor dysfunction without the presence of a short frenulum

When Lip Out is intended to be classified with a specific grade, it is necessary to make the assessment directly from the breast, a grade should not be established by finger assessment, FLO can help to guide the grade, but the definitive grade is established with BLO.

In addition, it is essential to assess if there is any problem associated with the grades, as it is possible to find an infant with a BLO grade 2 (i.e., losing tongue seal when removing the lip from the chin-lip fold while suckling) but doesn’t present problems (presents adequate weight gain and no pain for the mother) and therefore doesn’t need treatment.

 

Reference:

Garcia-Morales, J.L. (2022)

“Lip Out. Physiotherapy in Breastfeeding”.