title: Persistent Nipple Pain in Breastfeeding Mothers Associated with Abnormal Infant Tongue Movement.
abstract: BACKGROUND
  Infants of breastfeeding mothers with persistent nipple pain have been shown to apply stronger vacuums to the breast and transfer less milk during one monitored feed. This may be associated with differences in the movement of the tongue. The aim was to analyse the intra-oral nipple shape and movement of the tongue of infants of mothers with and without nipple pain.
  
  
  METHODS
  Breastfeeding infants of mothers with or without nipple pain were monitored using ultrasound and intra-oral vacuum during one breastfeed. From cine clips of the ultrasound scans measurements were made of the depth of the intra-oral space between the hard-soft palate junction (HSPJ) and the mid-tongue; the distance of the tip of the nipple to the HSPJ; and nipple diameters from the tip to the base.
  
  
  RESULTS
  During nutritive sucking, tongue movements of infants of mothers with nipple pain resulted in a smaller intra-oral space (p = 0.040) and restricted nipple expansion compared to controls (p < 0.012). Stronger baseline and peak vacuums compared to controls were confirmed (p = 0.002).
  
  
  CONCLUSIONS
  In these mothers, nipple pain was associated with restricted infant tongue movement. Ultrasound may complement measurement of intra-oral vacuum in monitoring treatment strategies in breastfeeding women experiencing nipple pain.
authors.affiliation: School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia. mcclellan.holly@gmail.com.
authors.forename: Holly L
authors.initials: HL
authors.lastname: McClellan
authors.affiliation: School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia. Jacqueline.Kent@uwa.edu.au.
authors.forename: Jacqueline C
authors.initials: JC
authors.lastname: Kent
authors.affiliation: School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia. Anna.Hepworth@uwa.edu.au.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Hepworth
authors.affiliation: School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia. Peter.Hartmann@uwa.edu.au.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Hartmann
authors.affiliation: School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia. Donna.Geddes@uwa.edu.au.
authors.forename: Donna T
authors.initials: DT
authors.lastname: Geddes
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects*; D004435:Eating; D005260:Female; D006801:Humans; D007223:Infant; D009035:Mothers; D009558:Nipples / Q000473:pathology*; D010146:Pain / Q000209:etiology*; D013391:Sucking Behavior / Q000502:physiology*; D013997:Time Factors; D014059:Tongue / Q000503:physiopathology*
keywords: breastfeeding; infant; lactation; nipple pain; sucking behaviour