• Alexander K C Leung, C Pion Kao, Reginald S Sauve, Justine H S Fang, Alexander G Leong, and Edmond K H Liu.
• Department of Pediatrics, and the Asian Medical Centre, an affiliate with the University of Calgary Medical Clinic, Calgary, Alberta, Canada.
• J Natl Med Assoc. 2004 Aug 1; 96 (8): 1092-6.

ObjectiveTo determine the internipple distance and internipple index in Chinese children.MethodsThe internipple distance and chest circumference were measured in 3,290 healthy Chinese children (1,715 males and 1,575 females) aged birth to 18 years seen at the Asian Medical Centre. The internipple distance and chest circumference were obtained at the end of expiration whenever possible, with a standard nonstretch tape measure graduated in millimeters with the arms hanging relaxed alongside the body. Patients under two years of age were measured supine and those over two years of age standing. The internipple distance was measured between the centers of both nipples, and the chest circumference was measured across the internipple line. The internipple index was calculated according to the formula: internipple distance (cm) multiplied by 100 and divided by chest circumference (cm).ResultsThe internipple distance and chest circumference increased with age. The internipple index was highest in the neonatal period (26.4 +/- 1.6 for males and 26.3 +/- 2 for females), and decreased steadily until the age of four years (23.8 +/- 1.2 for males and 23.8 +/- 1.4 for females), and thereafter was relatively constant through the age of 18 years in males and the age of 11 years in females. In females, the internipple index decreased gradually from the age of 11 years to 18 years.ConclusionsWhile internipple index is a more practical way to assess nipple placement, there are ethnic differences in the internipple index. Proper reference standards should be used in the assessment whether the nipples are closely or widely spaced.

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