Milk removal by breastfeeding infants Tongue motion is one of a ‘piston-like’ motion that expands and compresses the nipple evenly The infant generates a ‘baseline’ vacuum that draws the nipple and breast into the mouth creating a seal prior to sucking Drawing the tongue downwards generates stronger vacuum to draw the milk from the breast Moving the tongue upwards reduces the strength of vacuum, compresses the nipple, and stops milk flow Coordination of sucking, swallowing, and breathing by breastfeeding infants Ratios of sucking, swallowing, and breathing are not consistent nor rhythmic in most breastfeeding infants Suck-swallow-breath ratios likely change in response to changing milk flow rates during milk ejection Suck-swallow-breath ratios differ between nutritive and non-nutritive sucking Observation of breastfeeding does not reflect milk removal volumes or patterns