Kathy A has prompted me to share a few highlights from the ALCA Conference here in Hobart last weekend. One particularly fascinating presentation was by Dr John Neil, an OBGYN IBCLC from Melbourne Australia, who has been using ultrasound to systematically study and assess breastfeeding problems. He is producing a video (we saw the in-process version) on his work. The three main things he is observing are "NJD" (nipple junction distance ie normal being when the nipple at maximum protraction is equal or less than 5mm from the hard/soft palate junction); "slide" (normal being when nipple slide during suck is equal or less than 5mm); and "tongue action" (normal for breastfeeding being "rocker" and abnormal being "piston"). He showed bottlefeeding on the video, using a piston tongue action, and breastfeeding using the rocker action. The things that have emerged from his study? NJD is more likely to be abnormal with babies who have attachment problems (statistically significant). No statistical correlation was found between "attachment problems" and slide or piston tongue movement. No stat correlation between nipple pain and NJD, slide or piston tongue action. 100% of babies who had a piston tongue action had used a bottle teat! . Of those who had used a teat, 13 had piston tongue actions, and 18 had rocker. Of those who had not used a teat, 0 had piston and 48 had rocker. He prefers the term "suck confusion" rather than nipple confusion. It was fantastic to see with my own eyes what so many of us believe and others dispute. Suck confusion DOES EXIST. He has also been able to reliably see tongue clicks on the ultrasound - we could clearly see them on the video. As I recall, they occurred when the baby momentarily lost the negative pressure that maintains the nipple at the hard/soft palate junction. I think he described it as a air leak that caused the click. Not totally sure about this. No, the video is not out yet, he is still working on it. Will let you all know when it comes out. Yes, ILCA or the LLLI Physicians Conference should invite him to speak. Ros Escott Tasmania, Australia [log in to unmask]