Objective investigation of maternal and infant breastfeeding interactions associated with persistent nipple pain

Holly McClellan

Research output: ThesisDoctoral Thesis

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[Truncated] Nipple pain and insufficient milk supply are the most common reasons reported by mothers for premature weaning. Previous research into nipple pain has mainly focused on infant attachment to the breast and nipple infection. Further, breastfeeding assessments are experience-based, as evidence-based assessments of breastfeeding behaviours are limited and conflicting. As breastfeeding pain is a leading cause of early weaning, the first aim of the study was to determine whether infants of mothers experiencing persistent nipple pain exert stronger intraoral vacuums during breastfeeding. The second aim was to use objective measures to investigate and compare the pain experienced by breastfeeding mothers with persistent pain to mothers with visible trauma. Third, we aimed to determine if feeding characteristics or milk production were different between mothers with and without persistent nipple pain. Last, we aimed to develop and validate a method to measure and analyse ultrasound images of the infant’s oral cavity during breastfeeding to provide an evidence base for the assessment of infant sucking behaviour.

Sucking and milk production in healthy infants and mothers without nipple pain (control) were compared to mothers with pain that had been referred by their IBCLC after unsuccessful treatment for nipple pain (pain). Infant suck characteristics were monitored for one breastfeed using ultrasound, pressure transducers and the infant test-weigh method. All mothers were asked to test-weigh for a 24-hour period in their home. A third group of mothers with pain and visible trauma were recruited to compare their pain characteristics to persistent nipple pain. Maternal pain characteristics were measured using the Visual Analogue Scale (VAS), McGill Pain Questionnaire (MPQ) and Brief Pain Inventory (BPI). To analyse ultrasound images of infant sucking an extensive measurement protocol was developed and assessed for reliability. Two raters measured midline submental ultrasound scans of term breastfeeding infants by taking six measurements on two extreme frames; tongue-up and tongue-down. Nipple diameter (ND) was measured 2, 5, 10 and 15mm (base) from the nipple tip, and placement of the nipple was measured as the nipple-hard soft palate junction (HSPJ) distance, and tongue depth was measured as the tongue-HSPJ distance.
Original languageEnglish
QualificationDoctor of Philosophy
Publication statusUnpublished - 2012


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