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
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