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).

Conclusion: 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.

Keywords: breastfeeding; infant; lactation; nipple pain; sucking behaviour.

Figure 1

Submental ultrasound image of nipple in infant’s mouth during breastfeeding at, (A) the tongue up position, and (B) the tongue down position. (C) is a diagrammatic representation of the nipple shape and tongue position at tongue up (blue) and tongue down (pink); HP, hard palate; SP, soft palate; N, nipple; AT, anterior tongue; MT, mid-tongue; PT, posterior tongue.

Figure 2

Sequential submental ultrasound frames (F1 to F20) of the infant intra-oral cavity with the tongue contour marked in white. TU, tongue up; TD, tongue down.

Figure 3

Nipple diameter at 2, 5, 10 and 15 mm from the tip of the nipple in the Control group (black lines) and Pain group (grey lines) in the tongue up position (solid lines) and the tongue down position (dashed lines). Data are presented as mean ± SEM for three suck cycles for each of 25 Control group infants and 25 Pain group infants.