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PhD student Holly McClellan has been utilising ultrasound imaging to help discover why breastfeeding can be such a painful and distressing time for some mothers.

Although breastfeeding is a practice that’s been around for aeons, it appears there’s still a lot we don’t know about it.

All mammal species feed their young a unique composition of milk that promotes optimal immunity and development. Most mammals are born with the ability to co-ordinate sucking, swallowing and breathing to remove milk from their mother’s nipple/teat.

Unfortunately, many mothers encounter breastfeeding difficulties, and a proportion of cases aren’t resolved by current clinical assessment.

Apart from an individual’s medical history and a visual assessment of breastfeeding technique, there are few diagnostic tests or reference values for variations in infant breastfeeding behaviours.

To further complicate things, controversy exists as to whether the infant employs a sucking (vacuum) or stripping action (compression) to remove milk.

Holly and researchers from UWA’s Human Lactation Research Group within the School of Biomedical, Biomolecular and Chemical Sciences have optimised an ultrasound imaging technique to visualise the tongue and nipple in the oral cavity during feeding. The sucking vacuum applied by the infant is measured simultaneously by placing a very small tube connected to a pressure transducer, alongside the mother’s nipple.

Holly’s supervisor, Dr Donna Geddes , used this technique to show that milk removal from the breast occurred as the infant’s tongue lowered and vacuum increased in strength.

Some infants however, apply vacuums that are strong enough to cause nipple pain. As pain is second only to perceived low milk supply as a cause of premature weaning, investigation of the cause of such pain is essential.

Holly analysed the strength of suction in infants of mothers with persistent nipple pain, and found that the vacuum levels were in some cases more than twice as strong as those observed in control infants despite help from a lactation consultant, who specialises in enabling mothers to breastfeed.

The next part of Holly’s project is to determine whether the strong suction levels are associated with an abnormal tongue action.

Ultrasound imaging is notoriously difficult to standardise and measure, so Holly needed to develop a method to objectively assess ultrasound images of infant sucking.

She devised a technique to measure the changes in nipple diameter during sucking. The diameter of the nipple was measured at intervals along its length during sucking, to provide an indirect method of determining the pattern in tongue movement. Validation of the technique will be published in Ultrasound in Medicine and Biology later this year.

This technique confirmed that expansion occurs along the length of the nipple as the tongue lowers, thus providing further evidence that infants use suction rather than compression to remove milk from the breast.

Holly is currently using this method to analyse the tongue action in infants causing pain.

These studies have the potential to provide the basis for the development of both diagnostic tests and interventions to extend the duration of breastfeeding for women and infants.