Topics & Abstracts

Each child is born with the same capacity to learn as the next, however not every child lives up to this potential. Can we tackle this ever-widening gap at the beginning of a child’s life? We can by focusing on the word gap, the differential in the number of words children in different socio-economic groups hear in the first 1000 days; which equals over 30 million words a year. We will explore not only different ways healthcare professionals can help families overcome the word gap, but also demonstrate the very real connection between the word gap and the breastfeeding gap.

Aversion to breastfeeding or agitation while breastfeeding is known to occur in some women who breastfeed while pregnant, or who tandem feed a newborn and a toddler. However, it is a little researched area, and the paucity of published literature around breastfeeding aversion and agitation reveals a significant gap in the literature. My presentation presents the findings of an exploratory online survey that sheds light on what appears to be a commonly experienced phenomenon of aversion and agitation whilst breastfeeding, which varies in form, severity and duration. BAA is characterised by feelings of anger or rage, a skin crawling sensation and an urge to remove the suckling infant, but can also be feelings of agitation and irritability whilst the infant is latched. Mothers who experience BAA still continue to breastfeed, but have feelings of guilt and shame about BAA and are often confused about having feelings of BAA. Research is needed to understand the reasons for BAA, its causes, triggers and strategies to minimize the experience in breastfeeding mothers.

The majority of women should be able to breastfeed, but elements of their experience are ultimately stopping them from doing so. Breastfeeding works best when done responsively but many psychological, social and cultural factors work directly or more subtly against responsive feeding, meaning that many mothers experience difficulties with breastfeeding which can lead to premature weaning. These factors can include separation of mother and baby, a lack of understanding of breast milk production, public attitudes and wider pressures of motherhood to name a few. If we want to support mothers to breastfeed we must understand and target these wider factors to create a supportive breastfeeding environment. It is important however that our approaches to breastfeeding promotion and education are perceived positively by mothers in order for them to be effective. In this presentation I’ll be addressing the common barriers to breastfeeding and their impact, along with new research that looks at how mothers perceive common breastfeeding education messaging and what this research tells us about how we can change our approach to ensure our messages have the intended impact.

Breastfeeding is widely acknowledged as being the healthiest way to feed an infant for at least two years. In the United States of America, the CDC 2014 Breastfeeding Report Card states that 79.2% of mothers start out breastfeeding. However, as the babies get older, these numbers plummet. Only 49.4% of these babies are receiving any breastmilk by 6 months of age. We know from the literature that the primary reasons mothers stop breastfeeding in these early months are pain and worrying about their breastmilk supply. These are problems with solutions if the proper support is in place. Why is this support lacking? Is it because for all of the talk, “breast is best”, the importance of breastfeeding is not really valued? What if successful breastfeeding was reframed into a milestone? Baby’s first milestone? This presentation will explore other milestones, walking, talking, and learning to read, and what happens if babies and young children are not reaching these markers in a reasonable time frame. What support systems are in place to help these milestones be achieved if babies are faltering? The possible reasons for a baby not being able to breastfeeding and possible solutions will then be examined from the lens of having proper support systems in place.

Promoting collaborations among caregivers and healthcare providers to ensure consistent and continual breastfeeding support.
This talk uses humor and scenarios to point out the necessity that those entrusted with a family’s care be professional, inclusive and open in order to provide the best support possible.

Often overlooked and as elusive as the butterfly it resembles, the thyroid gland may lurk behind a number of breastfeeding difficulties, including low-supply, over-supply, and overt lactation failure. Recent research has revealed that thyroid disorders during pregnancy and postpartum are more common than previously thought. A substantial amount of our current professional discourse centers around tongue-tie, which occurs in anywhere from 4.2%-10.7% of babies, while thyroid disorders in lactating women may in fact be more prevalent than tongue tie, affecting anywhere from 6.7%-13.3% of women in the postpartum period. Even more alarming is that as many 50-80% of these cases may be missed by a woman’s healthcare provider. During this presentation, you will gain a basic understanding of how the thyroid gland functions and the various ways in which a dysfunctional thyroid can adversely affect lactation. You will also learn which signs and symptoms warrant a referral to a primary health care provider. We will review the latest evidence-based thyroid hormone reference values appropriate for a woman during pregnancy and postpartum so that, if your patient does undergo testing, you will feel confident discussing those results with her. Finally, we will discuss some herbal and dietary recommendations for improving thyroid function.

Lactation consultants would benefit from expanding their understanding of the impact of the NICU stay on the family; moreover, they would benefit from identifying the essential role they could play in assisting families to accomplish a positive, healthy, and smooth transition home.
Despite continuing efforts to reduce prematurely worldwide, a significant number of infants are born too early or in a fragile medical condition. Many of these infants experience a lengthy stay at the NICU. Lactation support varies across facilities, but families, especially mothers, develop strong connections with their lactation consultant. As one of their most consistent providers in the NICU, the lactation consultant has the opportunity to recognize families’ need for continuing support after discharge and strategies to protect the breastfeeding relationship, attachment, and mental health in the long term.

This lecture/course is intended to familiarize the medical and allied health community in the recognition of the often-overlooked muscle-related structural barriers to breastfeeding. It provides a discussion of clues to the predisposing factors of these barriers and explores their affect on infant "functional mobility" as it relates to the achievement of successful breastfeeding. It is intended to improve the clinician’s assessment skills as they work with the mother/infant dyad in resolving breastfeeding difficulties/dysfunctions by development of insight into these often hidden and profoundly destructive structural manifestations. Recognition of these barriers with an emphasis on self-help techniques and when/who to refer parents/caregivers to for help, together with how to best meet their teaching/training needs across cultural barriers, is discussed. The ultimate purpose is the achievement of insight to improve the clinician’s evaluation process, better enabling them to promote, enhance and even save the breastfeeding experience of the families served.

In any emergency, infants and young children are particularly vulnerable. Providing appropriate aid is vital to ensure that children have the best chance of surviving. This presentation will describe why infants and young children are at increased risk during times of crisis and outline how aid can support, or sometimes undermine the health of infants and young children. Detail on instruments to support appropriate infant and young child feeding in emergencies will be provided, along with information to assist participants in advocating for appropriate infant and young child feeding in emergencies in their context.

Infant feeding behavior is a complex neurodevelopment behavior. Infant feeding is compressed of infants’ latch and SuPPRT (sucking pressure pattern regulated over time) in both bottle and breastfeeding sessions. In preterm bottle feeding infants, the regulation of these two components is a measure of neurodevelopment. However, infants’ latch and SuPPRT in breastfeeding has not been explored. Dr. Lucas will review infants’ latch and SuPPRT during bottle and breastfeeding and explore how these differences make breastfeeding a more sensitive newborn neurodevelopmental measure. Finally, Dr. Lucas will propose why we should consider differences in infant latch and SuPPRT to be a neurodevelopmental infant measure.

Food/nutrition is a basic need of individuals. Unethical, uncontrolled marketing practices have added to age-old confusions and misconceptions. Products are subtly portrayed as essential and convenient to “modern parents”.
Since the time that WHO/UNICEF has declared an International Code, many WHA resolutions have been resolved. Convention on the Rights of the Child accepts the right to enjoy a highest attainable standard. Innocenti Declaration was adopted on Protection, Promotion and Support of Breastfeeding.
It is important to support woman, by enacting legislation and adopting its enforcement and by providing adequate paid maternity benefits/leave.
The Indian government has enacted the Infant Milk Substitutes, Feeding Bottles & Infant Foods Act.
People should be vigilant enough to realize that legislations are not merely pieces of paper. Health workers have a moral and ethical responsibility to provide health education and report violations by becoming a “Watch-guard”.
Even after many legislations, some manufacturers are behaving as if these recommendations don’t affect them and have ignored or just given lip services. Health workers, and the general population has a great influence on decision making. There is need to follow laws in spirit rather than words.

During a time when lactation professionals are facing unprecedented negativity on top of the usual challenges, it’s easy to get drawn into the conflict or to start wondering if what we do makes a difference. How do we lift one another up to maintain a positive focus on using our knowledge and skills to guide families who are feeling scared and confused? How do we set aside our biases to make sure we’re listening to all sides? How do we connect and collaborate with other professions to expand the network of support for new families? This panel discussion focuses on answering those questions and providing steps that can be taken to promote collaboration both within the field of lactation and with other members of the health care team to improve breastfeeding knowledge translation and mobilization. This is your chance to hear from Dr. Amy Brown, Christy Jo Hendricks and Joy MacTavish as they share their thoughts on this hot topic during our panel discussion titled “Lifting up the Lactation Profession”.

The age-old practice of mindfulness meditation has increased in popularity across the globe over the past four decades and gained traction within the psychological and medical fields. Mindfulness centers on non-judgmental awareness of one’s bodily sensations, thoughts, and emotions in the present moment. It has been scientifically shown to reduce stress, chronic pain, medical and psychological symptoms, and enhance immune function. Mindfulness practices often focus on psychobiological processes, which makes them well suited as in intervention during the perinatal period, and even more specifically breastfeeding. This presentation outlines the ways in which mindfulness can positively impact lactation, during its normal course and especially when there are challenges. As lactation professionals who clinically and holistically support clients, it is beneficial to be able to share mindfulness strategies that can serve as a bridge between the mental, emotional, and physiological realms. Through a greater understanding of the practical aspects of mindfulness, gentle interventions can be incorporated into each feeding session. By supporting calm and connection within the parent and between the parent and infant, the experience of breastfeeding can be enhanced.

The majority of women begin breastfeeding at birth. Within the first 6 weeks, however, breastfeeding rates fall dramatically. To help women hang in with breastfeeding beyond the first weeks, we must first understand why they struggle. Learn what the research is saying and what you can do in your practice to help women meet their breastfeeding goals. IBCLC’s who specialize in the early weeks of breastfeeding will share case examples based on over 20 years of working with breastfeeding families.

Raynauds is an illusive condition that tends to be confused with other conditions, misdiagnosed, and consequently rarely treated--causing the breastfeeding dyad to suffer. This program provides a review of the symptoms, medical and lactation resources, and clinical applications that facilitate most the effective treatment/comfort for the patient.

Nighttime breastfeeding and proximate mother-infant sleep play a crucial role in sustaining lactation but present challenges for parents in settings where solitary infant sleep is the norm, and bedsharing is viewed as controversial and inherently dangerous. While separate parent-child sleep arrangements are a relatively recent cultural invention, they have become the dominant cultural norm, which also shapes medical infant sleep guidance in the U.S. and other similar settings. Recent breastfeeding promotion efforts, however, conflict with these cultural and medical imperatives for separate sleep. As more parents breastfeed, they find themselves falling asleep next to their babies. Some may fall asleep on unsafe surfaces in their attempt to avoid bedsharing, while others regularly bedshare in secret to avoid social stigma and other repercussions. To ensure both safety and wellbeing for infants and families, an integrated approach to nighttime breastfeeding and infant sleep will be recommended that incorporates evolutionary and cross-cultural perspectives.

Most lactation professionals love client interactions, but only send reports to health care providers out of a sense of duty. But writing and sending reports to our client’s health care providers can be more just an administrative task. Yes, it complies with IBLCE’s Code of Ethics to “Principle 4: Report accurately and completely to other members of the healthcare team” but it can also increase collaboration, improve client outcomes, and grow your practice.
This presentation seeks to reframe the process of writing and sending reports from a dreaded task to a clinical, ethical, and holistic way of supporting our clients while positively positioning ourselves as allied health professionals. Beyond the ethics (yes or no) and practicalities ("S.O.A.P." or not), a report to a health care provider is a source of communication about the consultation as well as marketing about your clinical skill, role in the client’s lactation experience, and lactation practice. With a combination of the why and how, this presentation outlines the ways in which reports to health care providers can be beneficial to the client, the health care provider, and the IBCLC, as well as devoting some time to specific strategies that lactation consultants can implement to streamline the process of sending reports so that we can get to the next client.

Breastfeeding women find themselves in need of assistance in a wide variety of legal contexts. This session reviews the options available to lactating women in custody disputes, as criminal defendants, as witnesses, when called for jury duty, and as immigration detainees.

Did you know that a mother who breastfeeds her child is more likely to “match” as an organ donor than a mother who does not breastfeed her child? How does that happen? The answer may lie in the Maternal-Newborn Microbiome, AKA “The Oro-boobular” axis. The scientific world is exploding with excitement over the discovery of the microbiome. While it appears clear that a suckling infant’s intestinal microbiome communicates with the mother’s lactocyte and perhaps beyond, little is known about the effects of this communication in practical terms. This presentation will review what is known and attempt to explain what it means, both now and in the future.

The historical evolution of infant feeding includes direct breastfeeding, wet nursing and bottlefeeding. Before the invention of bottles/ vessels to feed babies, wet nursing was the safest and most common alternative way to feed a baby. As bottles and nipples were developed, scientific advancement improved formulas, wet nursing fell out of favor. It gradually went from being widely accepted as the most normal way to feed a baby to where we currently are as a modern society. It is negatively seen as being weird and risky behavior. When mothers do not breastfeed or give their babies human milk, they use formula to feed their babies. Given the current knowledge of lack of complete nutrition formula has more mothers are showing an interest and actively pursuing wet/cross nursing. This presentation will help us understand the history of wet nursing and offer reasons to support, advocate and be encouraging to mothers who want to participate in the practice of wet/cross nursing.

In Alameda County, Black women are initiating exclusive breastfeeding, but only ~15% remain breastfeeding by 3 months. For impoverished Black women, especially those in their teen years or who may have less than high school education, these numbers are even lower (9-12%). There is minimum breastfeeding support for black families.
When Black mothers in West Oakland who received peer and professional breastfeeding support through Breast Friends, exclusive breastfeeding at 3 months rose to 63%. This project expanded the Breast Friends model to East Oakland while also training 12 new peer counselors (including 1 father), 24 new group facilitators, and enhancing breastfeeding messaging in the California Black Infant Health program. The project surpassed our expectations. 5 out of the 12 trained peer counselors are now working in other community organizations as Community health outreach worker, peer counselors, doulas and WIC staff.

With the recent spread of the virus, Zika and the bacterial infection, Lyme Disease, many pregnant and breastfeeding families worry about the potential impact on their babies. There is a great deal of inaccurate information on the internet regarding these diseases that many parents encounter. Having good resources and current information on these emerging diseases is imperative for new families. This presentation will address transmission of the diseases, risks to babies prenatally and during breastfeeding, and precautions for pregnant and breastfeeding mothers to take.

Some women who initiate breastfeeding will not meet their duration goals. There are a number of factors that contribute to undesired weaning. For a woman who ceases breastfeeding before she desires to do so, it can be devastating. For the lactation professional or peer supporter, this can also feel like failure. Grief counseling and ethical principles are applicable to supporting a mother grieving the loss of the breastfeeding relationship she desired. This presentation uses case studies to address the questions of how breastfeeding supporters ethically and compassionately support mothers who end their breastfeeding journey before they wish to, how lactation professionals and peer supporters can manage our own feelings in these situations, and what are the ramifications of these cases as we continue to share accurate breastfeeding information in the face of media-driven culture in which infant feeding is loaded with guilt, shame, and fear.

Breastfeeding rates upon discharge is rising in Hong Kong over the past 20 years. Breastfeeding has become more of a topic than ever before. However, it is still very common to have early introduction of formula and exclusive breastfeeding rate is still low. Most private hospitals do not allow 24 hours room in. Many mothers need to go back to work when the baby is only six weeks old. In Hong Kong, it is very common to practice a confinement period after birth. This traditional Chinese wisdom has many benefits for the mothers and babies. Mothers of other cultures can also make use of some of the practices to benefit themselves.

In Lebanon, nearly all mothers attempt to initiate breastfeeding. Despite high initiation rates, only 40% of mothers exclusively breastfed through the first month and nationally, a mere 2.4% continued to exclusively breastfeed between 4 and 5 months. Early weaning is a pressing public health concern as infant and under-5 morbidity rates are high. Environmental issues like water quality and sanitation can be problematic when supplemental formula or contaminated water is used. This presentation examines the breastfeeding trends in Lebanon and explores the complex and often overlapping historical, social, cultural, economic and policy determinants behind early weaning. Next, this presentation analyzes newly emerging factors such as the power of social media, collaboration of lactation specialists and the rise of influential mother support networks. The presentation will conclude by highlighting the growing breastfeeding support infrastructure in Lebanon, for the most part, facilitated by breastfeeding mothers themselves.

Good doctor–patient communication is essential for positive health care outcomes. Ideal doctor–patient communication generally is reflected in a partnership communication style. However, in Southeast Asian settings, we often see a more one-way style with little input from the patient. Helpline services is breaking the ice, and is considered a new option modality for patients in Indonesia. The ease in contacting medical professionals through phone and text messages seems more comfortable, personal and inexpensive.
Breastfeeding support via a helpline helps mother to feel reassured, confident and more determined to continue breastfeeding, and in majority of occasions resolves their particular concerns.
Lactation Clinic in Puri Cinere Hospital, Depok, West Java, Indonesia was established in August 2011 and operated a helpline since the beginning of its establishment. Helpline service is open 24 hours daily, through phone, text messages, whatsapp, or blackberry messenger directly to doctors who are also breastfeeding counselors. There are six doctors who take turns every month to receive calls and reply to messages. Helpline numbers are distributed to patients during post natal rounds or at patients doctors appointments in lactation clinic.
A longitudinal study conducted in March to December 2014 shows 202 helpline cases in 9 months. There were 29 cases (14%) questioning EBM handling, 24 cases (12%) asking about complementary feeding, 19 cases (9%) of infant stool, 19 cases (9%) medication and mother's milk, 15 cases (7%) frenotomy after care and other various problems. 63% cases were successful managed via helpline, and 37% cases were referred to the Lactation Clinic to get further help.
There were many cases resolved through helpline calls and messages. High success rate of helpline management shows that helpline program is effective to help mothers and resolved their particular concerns; especially in Indonesia.

Bloody nipple discharge is an unusual experience during lactation for both the mother and her attending physicians. Painless bleeding from the breasts in the early post-partum period can be a physiological condition called a rusty pipe syndrome. This report describes the case of bilateral bloody nipple discharge that started after caesarean section and subsequently ceased within a few days.
Natural breastfeeding is the best way of nourishing newborns and infants. The process of breast milk production starts as early as between weeks 16 and 22 of pregnancy and colostrum can appear from the nipple in the following weeks. Milk containing blood can be a cause of concern for the mother and her physician. The reasons can be various; however not all of them would be caused by bleeding from the glandular tissue.

This presentation provides clear and concise methods for maternal-­‐child-­‐health professionals and home visiting programs to become active supporters of breastfeeding families. The information shared is both for the novice and the experienced. Learn ways to build partnerships, improve advocacy and set organizational policies that are supportive of increased breastfeeding rates.