title: Breastfeeding frequency, milk volume, and duration in mother-infant dyads with persistent nipple pain.
abstract: BACKGROUND
  Nipple pain and insufficient milk supply are major causes of early weaning. We have found that persistent nipple pain was associated with strong infant sucking vacuums during breastfeeding. Several studies indicate that nipple pain and abnormal infant sucking have the potential to reduce milk transfer. We aimed to determine whether women with persistent nipple pain had low milk supply.
  
  
  METHODS
  The 24-hour milk production and feeding characteristics of mothers with persistent nipple pain (n=21) were compared with those mothers without nipple pain (n=21). Milk productions were measured by test-weighing the infant before and after every feed from each breast over a 24-26-hour period. Comparisons were made using Student's t tests and linear mixed models as appropriate.
  
  
  RESULTS
  Lower milk productions were associated with longer meal durations for mothers with pain. There were no significant differences in the average 24-hour milk production or any feeding characteristics between the groups. However, four women with persistent nipple pain had milk production levels below 500 mL/day.
  
  
  CONCLUSIONS
  The majority of breastfeeding women experiencing persistent nipple pain were able to achieve normal milk production levels. Feeding duration and frequency were similar to those of women not experiencing pain. However, longer meal durations in the pain group were associated with lower levels of milk production. Further investigation is necessary to identify mothers most affected by maternal nipple pain.
authors.affiliation: School of Biomedical, Biomolecular, and Chemical Sciences, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Holly L
authors.initials: HL
authors.lastname: McClellan
authors.forename: Anna R
authors.initials: AR
authors.lastname: Hepworth
authors.forename: Jacqueline C
authors.initials: JC
authors.lastname: Kent
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Garbin
authors.forename: Tracey M
authors.initials: TM
authors.lastname: Williams
authors.forename: Peter Edwin
authors.initials: PE
authors.lastname: Hartmann
authors.forename: Donna Tracy
authors.initials: DT
authors.lastname: Geddes
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects* / Q000706:statistics & numerical data; D002149:Energy Intake; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007774:Lactation / Q000502:physiology* / Q000523:psychology; D008297:Male; D008895:Milk, Human; D009034:Mother-Child Relations; D009558:Nipples / Q000293:injuries*; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D011247:Pregnancy; D013391:Sucking Behavior / Q000502:physiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014886:Weaning; D014904:Western Australia / Q000453:epidemiology