{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T13:47:24Z","timestamp":1784814444450,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2015,9,2]],"date-time":"2015-09-02T00:00:00Z","timestamp":1441152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013407","name":"Medela AG","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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 &lt; 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.<\/jats:p>","DOI":"10.3390\/ijerph120910833","type":"journal-article","created":{"date-parts":[[2015,9,3]],"date-time":"2015-09-03T03:10:43Z","timestamp":1441249843000},"page":"10833-10845","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Persistent Nipple Pain in Breastfeeding Mothers Associated with Abnormal Infant Tongue Movement"],"prefix":"10.3390","volume":"12","author":[{"given":"Holly","family":"McClellan","sequence":"first","affiliation":[{"name":"School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Kent","sequence":"additional","affiliation":[{"name":"School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Hepworth","sequence":"additional","affiliation":[{"name":"School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hartmann","sequence":"additional","affiliation":[{"name":"School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Geddes","sequence":"additional","affiliation":[{"name":"School of Chemistry & Biochemistry, The University of Western Australia, Crawley, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2015,9,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1002\/bies.20423","article-title":"Evolution of the mammary gland from the innate immune system?","volume":"28","author":"Vorbach","year":"2006","journal-title":"BioEssays"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1017\/S0954422408100749","article-title":"Evolution of lactation: Nutrition v. protection with special reference to five mammalian species","volume":"21","author":"McClellan","year":"2008","journal-title":"Nutr. Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/978-1-4757-4242-8_7","article-title":"The optimal duration of exclusive breastfeeding: A systematic review","volume":"554","author":"Kramer","year":"2004","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_4","first-page":"439","article-title":"Factors associated with weaning in the first 3 months postpartum","volume":"51","author":"Schwartz","year":"2002","journal-title":"J. Fam. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e646","DOI":"10.1542\/peds.2005-1991","article-title":"Predictors of breastfeeding duration: Evidence from a cohort study","volume":"117","author":"Scott","year":"2006","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/S0140-6736(45)91611-4","article-title":"Sore nipples: Cause and prevention","volume":"2","author":"Gunther","year":"1945","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/S0266-6138(86)80042-0","article-title":"Aetiology of sore nipples","volume":"2","author":"Woolridge","year":"1986","journal-title":"Midwifery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.earlhumdev.2007.12.008","article-title":"Tongue movement and intra-oral vacuum in breastfeeding infants","volume":"84","author":"Geddes","year":"2008","journal-title":"Early Hum. Dev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.earlhumdev.2011.10.012","article-title":"Tongue movement and intra-oral vacuum of term infants during breastfeeding and feeding from an experimental teat that released milk under vacuum only","volume":"88","author":"Geddes","year":"2012","journal-title":"Early Hum. Dev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1111\/j.1651-2227.2008.00882.x","article-title":"Infants of mothers with persistent nipple pain exert strong sucking vacuums","volume":"97","author":"McClellan","year":"2008","journal-title":"Acta Paediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1177\/154411130301400604","article-title":"Tongue movements in feeding and speech","volume":"14","author":"Hiiemae","year":"2003","journal-title":"Crit. Rev. Oral Biol. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1016\/j.ultrasmedbio.2010.08.005","article-title":"Validation of nipple diameter and tongue movement measurements with B-mode ultrasound during breastfeeding","volume":"36","author":"McClellan","year":"2010","journal-title":"Ultrasound Med. Biol."},{"key":"ref_13","first-page":"758","article-title":"Measurement of the milk intake of breast-fed infants","volume":"6","author":"Arthur","year":"1987","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_14","unstructured":"R Development Core Team (2011). R: A Language and Environment for Statistical Computing, R Development Core Team."},{"key":"ref_15","unstructured":"Pinheiro, J., Bates, C.J., DebRoy, S., Sarkar, D., and R Development Core team (2011). NLME: Linear and Nonlinear Mixed Effects Models, R Development Core Team. R package version 3.1\u2013102."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1002\/bimj.200810425","article-title":"Simultaneous inference in general parametric models","volume":"50","author":"Hothorn","year":"2008","journal-title":"Biom. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5230","DOI":"10.1073\/pnas.1319798111","article-title":"Biomechanics of milk extraction during breast-feeding","volume":"111","author":"Elad","year":"2014","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s10549-006-9487-2","article-title":"Breast duct anatomy in the human nipple: Three-dimensional patterns and clinical implications","volume":"106","author":"Rusby","year":"2007","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1177\/0890334412474864","article-title":"Longitudinal changes in suck-swallow-breathe, oxygen saturation, and heart rate patterns in term breastfeeding infants","volume":"29","author":"Sakalidis","year":"2013","journal-title":"J. Hum. Lact."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e188","DOI":"10.1542\/peds.2007-2553","article-title":"Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound","volume":"122","author":"Geddes","year":"2008","journal-title":"Pediatrics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/0022-0965(68)90106-9","article-title":"The components of sucking in the human newborn","volume":"6","author":"Sameroff","year":"1968","journal-title":"J. Exp. Child Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1259\/0007-1285-31-361-11","article-title":"A cineradiographic study of bottle feeding","volume":"31","author":"Ardran","year":"1958","journal-title":"Brit. J. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1001\/archpedi.1989.02150170090030","article-title":"Sucking and breathing patterns during breast- and bottle-feeding in term neonates. Effects of nutrient delivery and composition","volume":"143","author":"Mathew","year":"1989","journal-title":"Am. J. Dis. Child"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1136\/bmj.314.7081.644","article-title":"Vasospasm of the nipple\u2014A manifestation of Raynaud\u2019s phenomenon: Case reports","volume":"314","year":"1997","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e360","DOI":"10.1542\/peds.113.4.e360","article-title":"Raynaud\u2019s phenomenon of the nipple: A treatable cause of painful breastfeeding","volume":"113","author":"Anderson","year":"2004","journal-title":"Pediatrics"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/12\/9\/10833\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:47:52Z","timestamp":1760215672000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/12\/9\/10833"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,9,2]]},"references-count":25,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2015,9]]}},"alternative-id":["ijerph120910833"],"URL":"https:\/\/doi.org\/10.3390\/ijerph120910833","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,9,2]]}}}