Ultrasound during lactation

Breast milk is the 'gold standard' of infant nutrition providing not only nutrition for optimal growth but immune protection as well. Many women initiate breastfeeding however few continue to breastfeed for the recommended 6 months (WHO). Management of lactating women is predominately experience-based therefore lack of diagnostic tests and evidence-based treatment is likely to contribute to early weaning. Ultrasound imaging is not routinely used as a diagnostic tool during lactation however new research suggests that is a promising modality capable of identifying both breast and infant sucking pathologies. Imaging of the non-lactating breast is well established however little imaging is performed during lactation.Ultrasound during lactation is relatively simple provided settings are optimized to accommodate the increased amount of glandular tissue. Furthermore an understanding of the growth of the breast during pregnancy and changes during lactation as well as lactation pathology enhance diagnoses. Ultrasound can also be utilized to confirm normal function of the lactating breast. While sufficient milk must be synthesised for the optimal growth of the infant it must also be released during breast feeding or breast expression by the milk ejection reflex.Increasing duct diameter and visualisation of milk flow at milk ejection confirms that the reflex is intact. A successful lactation depends upon the infant's ability to remove milk from the breast. Infant tongue action can be visualised during both breast and bottle feeding. Recently this technique has been employed to assess infants with oral anomalies such as ankyloglossia.It can also be applied to the infants of mother experiencing pain during breastfeeding to determine if compression of the nipple is a contributing factor. Ultrasound techniques have also been developed to image swallowing in both breast and bottle fed infants but have not yet been used extensively to identify swallowing pathology.