title: Ultrasound imaging of infant sucking dynamics during the establishment of lactation.
abstract: BACKGROUND
  Infant sucking problems are frequently implicated in early weaning during breastfeeding, yet our understanding of early sucking dynamics is limited.
  
  
  OBJECTIVE
  This study aimed to describe infant sucking patterns during breastfeeding at secretory activation and determine whether they changed by the time of established lactation.
  
  
  METHODS
  Sucking patterns and milk intake of 15 breastfeeding infants were assessed on day 3.2 ± 0.8 and later at follow-up, 16.0 (11.3-22.8) days postpartum. Nipple diameters, tongue movement, nipple position, and suck rate during nutritive sucking (NS) and non-nutritive sucking (NNS) were measured from ultrasound scans of the intra-oral cavity during breastfeeding. Milk intake and LATCH scores were also recorded.
  
  
  RESULTS
  As the tongue lowered during a suck cycle, the nipple increased in size (P < .001), milk flowed into the intra-oral space and the nipple moved closer to the hard-soft palate junction (P < .001). During NS, nipple diameters and the mid-tongue movement were greater than during NNS (P < .001). As the infant aged, the mid-tongue lowered further (P = .002), suck rates became faster (P < .001) and milk intake increased (P = .004), however, no differences were seen for LATCH scores (P = .34).
  
  
  CONCLUSIONS
  Differences in tongue movement between NS and NNS suggest that there is an altered sucking action when milk flow is absent. Similar sucking patterns at day 3 and during established lactation imply that infants have a mature sucking pattern in the early postpartum period.
authors.affiliation: School of Chemistry and Biochemistry, The University of Western Australia, Crawley, Western Australia. 10413297@student.uwa.edu.au
authors.forename: Vanessa S
authors.initials: VS
authors.lastname: Sakalidis
authors.forename: Tracey M
authors.initials: TM
authors.lastname: Williams
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Garbin
authors.forename: Anna R
authors.initials: AR
authors.lastname: Hepworth
authors.forename: Peter E
authors.initials: PE
authors.lastname: Hartmann
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paech
authors.forename: Donna T
authors.initials: DT
authors.lastname: Geddes
mesh_terms: D001942:Breast Feeding; D004435:Eating; D002149:Energy Intake; D006801:Humans; D007231:Infant, Newborn; D009055:Mouth / Q000000981:diagnostic imaging*; D009558:Nipples / Q000000981:diagnostic imaging; D013391:Sucking Behavior; D013997:Time Factors; D014059:Tongue; D014463:Ultrasonography