Topics & Abstracts

Breastfeeding is the normative way to feed babies all over the world. We have access to large amount of scientific evidence that supports it. Advocates of breastfeeding such as health care professionals that protect, promotes and support the breast/chest feeding dyad can struggle sometimes with women or babies who cannot breastfeed as the World Health Organization suggests. Mothers with low milk supply are often supported by family, friends and health care with well meaning advices and remedies to help them do their best. Women who have insufficient glandular tissue (IGT) struggle with their milk supply, despite good breastfeeding management. Is common to see families with this issue in the second or third lactation failure without really understanding what might be going wrong. These babies can have dehydration in the neonatal period, hypernatremia or even death without anybody that could help with a correct diagnosis or help with achievable goals that can benefit both, mother and baby. It is of great importance to help with accurate diagnosis that can benefit also psychologically and choose continue breastfeeding with breast/ chest supplementation.

Objectives:

Objective 1: Describe the theoretical framework that can give us useful information for a timely and appropriate diagnosis of Insufficient Glandular Tissue;

Objective 2: Demonstrate and support the best way possible for the dyad to achieve a healthful breastfeeding experience;

Objective 3: Apply useful tools that can help achieve the personal goals

Many studies from around the world show that supporting moms on their journey can help them to successfully breastfeed and reach their personal feeding goals. Today we see many lactating parents go online through various different social media platforms for support in breastfeeding. Vanessa Simmons discusses how to use a mixture of photography, video, blogging, and support groups on social media to capture and tell stories of WIC families.

Objectives:

Objective 1: List two types of media to capture stories;

Objective 2: Recite three important steps to capturing WIC stories;

Objective 3: Assess which social platform is best for their availability and posting style;

Moderate alcohol use by breastfeeding women appears to be relatively common. Alcohol concentrates in breast milk at levels similar to maternal blood, peaking at 30-60. Most studies find no link with the duration of breastfeeding. However, seven studies have found a link with a shorter duration of exclusive breastfeeding. Alcohol affects oxytocin release, leading to reductions in breast milk consumption in the following hours and reduces infant sleep, both temporary if the mother does not continue to drink. These effects on the infant and the breastfeeding process could be interpreted by mothers as signs of infant dissatisfaction with their breast milk, “insufficient milk,” or other causes for premature supplementation. Chronic alcohol consumption may have a number of more serious effects, including on infant development, but research is limited. Younger infants tolerate alcohol worse, so abstention or avoidance of infant exposure for the first months of breastfeeding may be wise. Messages to mothers on this issue are conflicting, confusing and often outdated. Too little is done to teach mothers how to reduce infant exposure. Research is needed in different cultures into whether various forms of cautionary messages are likely to discourage breastfeeding.

Objectives:

Delegates will be able to:

1: Discuss the scientific literature on alcohol's effects on breastfeeding and ways in which alcohol exposure may affect infants
2: Rate the quality of advice on alcohol consumption during breastfeeding by health professionals and organizations
3: Interpret the scientific literature on this and other issues

A baby’s birth can have a significant impact on breastfeeding outcomes. Medical intervention in normal birthing situations is rife, and globally cesarean rates have soared since 2000. Along with this, breastfeeding rates are less than ideal. A mother who feels a sense of grief about the birth of her baby is consequently more likely to face breastfeeding challenges. IBCLC’s, midwives and medical officers will often begin a breastfeeding consultation by listening to a mother’s unhappy perception of her baby’s birth. This aspect needs to be sensitively supported.

It is high time we take stock and pay more attention to what world health authorities are recommending to improve birthing and thus breastfeeding outcomes. These outcomes can affect a mother’s feelings of empowerment, her physical and mental health. Baby’s health and general development are statistically better when breastfed. There are significant financial savings made by reducing costs in various countries health systems when mothers breastfeed successfully.

There are definite changes we can make, following recommended guidelines and recent research. We can do this individually in our work and also in our affiliations with professional bodies by supporting and encouraging government policymakers and advocacy groups. These are our future challenges.

Objectives:

Objective 1: Describe ways women can get the very best information about their labor and birth options, particularly the advantages and of natural birth where possible;

Objective 2: Demonstrate awareness of the outcomes for mother and baby when medical interventions during labor and delivery are used unnecessarily;

Objective 3: Explain the relevance to breastfeeding longevity and success by mother and baby having skin-to-skin contact as soon as possible after baby's birth.

The medical use of herbs is as old as mankind. In this lecture IBCLC and herborist Katrien Nauwelaerts explains the difference between the regular medical approach of breastfeeding problems and the more holistic solutions used in phytotherapy. Katrien Nauwelaerts explains how the use of herbs can support and sometimes even replace the more traditional clinical treatment of breastfeeding problems such as postpartum depression, low milk supply, oversupply, engorgement, breast infection, plugged ducts, mastitis, candidiasis, thrush, and Raynaud Syndrome etc.

Objectives:

Objective 1: Compare the difference between the regular medical approach of breastfeeding problems and the more holistic solutions used in fytotherapy;

Objective 2: Explain how the use of herbs can support and sometimes even replace the more traditional clinical treatment of breastfeeding problems;

Objective 3: Describe the holistic approach of traditional breastfeeding problems.

No matter where we look health disparities, morbidity and mortality continue to persist. This is especially true in the maternal child health field. We all understand the value of breastfeeding and human milk and it is now critical to merge that value across the spectrum of maternal child health. No matter the organization or work we are in; clinical, community, public health, or policy; we must create connections that improve and create holistic approaches to improve health and prevent illness. Linking breastfeeding and human milk in efforts made outside of the field of lactation will improve overall efforts to improve maternal child health. This discussion will give opportunity to explore how to engage with non traditional stakeholders and make the connections where breastfeeding isn't traditionally included to discuss preventative care for maternal child health as a whole.

Objectives:

Objective 1: Explain the importance of breastfeeding and human milk in the overall discussion of preventative care and maternal child health.;

Objective 2: Describe how to bring breastfeeding and human milk into a conversation about health maternal child health disparities.;

Objective 3: List examples of how adding breastfeeding and human milk into the conversation of disparities in maternal child health will elevate our goals in the lactation field;

Reflexes play an important role in role in an infant’s ability to feed effectively. This foundational presentation discusses the process of reflex emergence and integration, the importance of reflexes in breastfeeding/chestfeeding and the impact of disorganized or absent reflexes. Also covered will be the impacts of trauma on infant reflex integration and the role of the lactation consultant in assessment and referral.

Objectives:

Objective 1: Discuss the process of reflex emergence and integration as they relate to breast/chestfeeding.;

Objective 2: Explain the importance of reflexes in breastfeeding. ;

Objective 3: Explain the impacts of trauma on infant reflex integration;

During this presentation the barriers of incarceration as it relates to lactating parents will be discussed. An overview of Program development, Partnerships development and working with corrections will also be considered. I will also show how our Alabama initiative combats those barriers and allows incarcerated women to be able to provide their milk to their infants.

Objectives:

Objective 1: Discuss female incarceration;

Objective 2: Describe program development ;

Objective 3: Explain the impact of incarceration on breastfeeding.

Inappropriate use of growth charts can cause familiar anxiety, unnecessary supplementation, early weaning, unnecessary testing and force-feeding. With half of the population below the mean, at least a 3% of the average weight of people are (and have to be) under the third percentile. Percentile lines are mathematical constructions, and do not represent the actual growth patterns of individual babies.

Objectives:

Objective 1: Discuss the variability of child growth;

Objective 2: Explain the use of the less used charts: growth velocity, weight for height, BMI;

Objective 3: Describe the usual pitfalls in growth assessment.

Breastfeeding programmes that engage fathers are more effective than ones that only involve mothers and professionals. This accords with research that has shown that family is the main influence on breastfeeding. The way that families influence breastfeeding is diverse, depending on the make-up of the family, local culture and location (e.g. urban/rural). The influence of fathers is not necessarily intentional, but what fathers think and do influences the situation in almost every situation. In this presentation I will describe the principles of success that have been learned from programmes with published evaluations. These principles can be summed up in the phrase recently adopted by the World Alliance for Breastfeeding Action, "breastfeeding is teamwork".

Objectives:

Objective 1: Describe the evidence about the influence of fathers on breastfeeding;

Objective 2: Discuss evidence-based principles for engaging fathers to support breastfeeding;

Objective 3: Explain how the support of fathers and the autonomy of mothers can be combined through teamwork;

Identifying musculoskeletal issues that can impact breastfeeding is an important component of proper management. When surveyed, IBCLCs reported that half were not comfortable identifying musculoskeletal issues .Referrals for musculoskeletal problems were thus hypothesized to be delayed as a result of this discomfort. It was recommended that lactation professionals could benefit from more specialized training in identifying musculoskeletal issues, as early intervention for breastfeeding difficulties is a critical determinant in success.
Attendees will be able to take away the skills and tools to better identify musculoskeletal problems, the indications for co-management/referral and the safety and effectiveness of manual therapy for suboptimal breastfeeding . Issues such as TMJ dysfunction, postural asymmetry, cranial asymmetry, myofascial and joint restrictions commonly cause suboptimal breastfeeding. Current literature supports the fact that favorable outcomes are probable when these issues are treated with manual therapy. Thus the timely identification, referral, and resolution of musculoskeletal issues is one factor that can contribute to the resolution of breastfeeding difficulties.

Objectives:

Delegates will be able to:

1. Evaluate for musculoskeletal issues that can interfere with successful breastfeeding
2. Identify indications for co-management and/or referral
3. Communicate with parents and other providers the safety and effectiveness of manual therapy for breastfeeding issues

This case describes a 32-year-old primiparous woman who experienced an anaphylactic reaction associated with breastfeeding and milk expression on postpartum day four. With each episode her symptoms worsened and she developed hives, edema and difficulty breathing and swallowing. She had to be treated for her anaphylactic reaction in a hospital ER and ICU and she was released on postpartum day five on antihistamines.

Lactation anaphylaxis is a very rare condition that was first reported in the scientific literature in 1991. Since then there have been 11 other reported cases. Lactation anaphylaxis can be life-threatening and symptoms can include a rash, hives, edema resulting in difficulty breathing or swallowing, a dangerous decrease in blood pressure and a loss of consciousness. We will review this case and do a brief review of the previous case reports. We will discuss the possible causes for lactation anaphylaxis, the related risk factors, common treatments and possible breastfeeding outcomes. In most cases with proper treatment and management breastfeeding and milk expression can continue. Enhanced awareness of and knowledge about this rare condition will allow lactation consultants and other members of the health care team to better support breastfeeding parents who experience lactation anaphylaxis.

Objectives:

Objective 1: Define what lactation anaphylaxis is, what the common symptoms are and when it is most likely to occur;

Objective 2: Describe common treatments for this condition and options for long-term medical management of this condition;

Objective 3: Discuss how this condition can impact the breastfeeding relationship and how an IBCLC can best support a breastfeeding parent that experiences this condition.

Breastfeeding facilitates good health in infants and mothers, and for all humans throughout life. Medical professionals should be advocates for breastfeeding, and physicians could be one of the most influential advocates. However, many medical students, residents and physicians have very limited opportunities to learn about breastfeeding and human lactation during their medical education. From another point of view, breastfeeding is a private experience as well as a scientific matter. If a physician or a partner successfully breastfeeds, she/he may become a more effective advocate for breastfeeding. So, it is imperative to provide medical students, residents, and young physicians with education about breastfeeding and to enable them to experience successful breastfeeding personally, in order for them to promote and support breastfeeding among their patients.

The Academy of Breastfeeding Medicine is an international organization of physicians who protect, promote, and support breastfeeding, and one of its goals is to develop and disseminate the standard for physician education around breastfeeding and human lactation. ABM has developed protocols and statements for health care providers to utilize for breastfeeding management.

The WHO/UNICEF revised Ten Steps to Successful Breastfeeding in 2018, includes in Step2 “Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding”. This included physician education. There are many ways to educate physicians, and ABM materials could be one option.

Objectives:

Objective 1: Describe the importance of breastfeeding education for physicians;

Objective 2: Identify the significance of successful breastfeeding experience for physicians;

Objective 3: List educational opportunities and materials for physicians to protect, promote and support breastfeeding around participants;

Many mothers do not breastfeed their infants, discontinue breastfeeding or fail to take medications while they are breastfeeding. The principles of drug passage into breast milk are well established, although not well known by many health professionals. This presentation will review the principles of drug passage into breast milk, medications and factors that can cause a risk for adverse reactions in breastfed infants and discuss how to choose the most appropriate medications for mothers who are breastfeeding their infants.

Objectives:

Objective 1: List 3 factors that increase infant impact of a drug in milk;

Objective 2: List 3 strategies to minimize infant intake of drugs in milk;

Objective 3: List the infant age range of greatest risk for drug ingestion while nursing.

Despite irrefutable research evidence for the benefits of breastfeeding, less than 37% of infants worldwide meet WHO targets for optimal breastfeeding. Persistently low breastfeeding rates are due in part due to poor uptake of breastfeeding best-practice guidelines, such as the Baby-Friendly Hospital Initiative. The growing field of knowledge translation in healthcare reveals that it takes from 8-30 years for research findings to be adopted into clinical practice, and that up to 45% of patients don’t receive evidence-based healthcare. This presentation aims to help those providing lactation support to better understand the complexity of factors influencing the use of evidence in practice, as well as what can be done to facilitate the uptake of best practice guidelines to protect, promote and support breastfeeding. Whether or not care providers follow evidence-based practices is influenced by the nature of the evidence (e.g., perceived relevance of the evidence), characteristics of the care providers (e.g., motivations to change practice) as well as characteristics of the care environment (e.g., leadership support for change). Successful strategies for supporting practice change are tailored to local barriers and facilitators to evidence use, and can be informed by the growing number of theoretical models and frameworks for KT in healthcare.

Objectives:

Delegates will be able to:

1: Describe the concepts of ""Evidence-based Practice"" and Knowledge Translation
2: Identify key factors influencing knowledge translation in health care
3: Discuss strategies to facilitate the implementation of evidence-based practices in lactation support

In this presentation participants will learn about parents’ experiences with feedings in the NICU and continuation of lactation after going home, the importance of parent-child mutual-regulation and its implication in feeding success, strategies for lactation professionals to support the nursing relationship, and infant mental health concepts in relationship to feeding.

This presentation will include qualitative and quantitative data to broaden participants understanding of the context of lactation with a premature baby or a baby with special medical conditions. The participants will also receive information about multidisciplinary approaches and initiatives to support families with preemie babies.

Objectives:

Objective 1: Identify opportunities and challenges to establish lactation in the NICU; ;

Objective 2: Analyze the role of feedings in the context of infant development and parental role attainment;;

Objective 3: Identify strategies to support lactation for families with children with special needs and in a variety of contexts.

LGBTQ families have long been made invisible in their experiences of building their families, and this extends to lactation care as well. Queer, trans, and nonbinary parents need and deserve support that centers the unique challenges they may face and celebrates their creativity and resilience. Trans men or nonbinary people who give birth may desire to chestfeed their infants. Non-gestational partners who choose to induce lactation to share in breastfeeding their infants need guidance and advice through this process. Trans women may find breastfeeding to be a strongly gender-affirming experience. Many lactation professionals have a desire to support LGBTQ patients, but lack knowledge of inclusive terminology or specific ways to provide affirming care. This session will review gender-inclusive language, hands-on skills, and clinical pearls to improve lactation care for LGBTQ patients.

Objectives:

Delegates will be able to: Objective 1: Utilize affirming and inclusive language when caring for LGBTQ patients and families, and implement a number of strategies to make lactation care more inclusive and accessible Objective 2: Describe the process of inducing lactation for non-gestational parents (both cisgender and transgender) and discuss some of the medical and social considerations involved in this process Objective 3: Discuss lactation care for transmasculine and nonbinary people after giving birth, whether or not they have had chest surgery

Breastfeeding rates in the UK are still incredibly low, and around 80% of mothers say they wanted to breastfeed for longer than they did. Because of this, more people are beginning to talk about relactation, but the process is filled with myths, questions, and challenges. This talk will take you through why people want to relactate, including the grief and shame they may be experiencing following a difficult breastfeeding experience. We will talk about how the mother can surround herself with support and why this is so important. We will also look at supporting the baby to return to the breast, pumping tips which can help the mother to succeed, and we will discuss the risks and benefits of galactagogues - including the issues with the lack of comprehensive studies on this topic.

Objectives:

Objective 1: Understand the complex reasons Parents come to relactation, and their feelings.;

Objective 2: Know how to support families both with the direct process of relactation, and in the wider context.;

Objective 3: Describe the evidence, risks and benefits regarding galactagogues.;

Disorganized or absent infant reflexes can create challenges for breastfeeding/chestfeeding. This presentation takes a close look at the role of movement in the integration of disorganized infant reflexes and the use of rhythmic movement as a method for overcoming infant feeding challenges. This talk also covers socio-cultural impacts of trauma, lack of opportunity for movement, and modern care system barriers to reflex integration.

Objectives:

Objective 1: Identify the impacts of movement on development and learning ;

Objective 2: Describe the reflexes that are present in the infant feeding response and explain their normal expression and expected function;

Objective 3: Discuss the impacts of trauma and modern barriers to reflex integration and address opportunities to help mitigate them;

Background: The benefits of massage have been shown in many research studies. Massage relieves stress, pain and muscle tension. We expect to show that the same benefits can be achieved when facial massage is used to optimize a baby’s oral structures to support a functional latch.

Method: We hope to use facial massage as a tool for babies that do not have an optimal latch. Babies born with gestational constraints, traumatic birth, exposure to stress during pregnancy or babies with tethered oral tissues may benefit from a parent massaging their face. Attendees will have access to handouts and a video link and may use their own face to practice the facial massage strokes.

Results: Building strength by oral and facial muscles, relaxing tension in the jaw, the lips, the muscles around the lips, and muscles of facial expression may help optimize the latch and hence prevent nipple damage.

Conclusion: IBCLCs can have an extra tool in their toolkit to offer to new parents. Facial massage techniques to support a functional latch can increase a parent’s confidence in caring for their baby, while increasing the levels of oxytocin and thereby promoting parent-infant bond

Objectives:

Delegates will be able to:

1: Describe to teach parents how to use facial massage as a therapeutic tool
2: Discuss with parents parents the value of attunement and engaging with their baby
3: Use facial massage to deliver messages to a baby’s nervous system and increase facial movement

Lactation consultations delve into perfecting a latch, maximizing milk supply and even recovering from giving birth. Very few visits discuss how breastfeeding can affect intimacy. The research on breastfeeding and intimacy is scarce and the assessment tools and evidence-based solutions are almost nonexistent. Perinatal providers often don’t recognize the relevance or have time to troubleshoot the inquiries. Lactation specialists understand that the situation exists but may not know how to approach the line of questioning or how to provide solutions. This webinar will illustrate the relationship between lactation-specific hormones and sex hormones. It will present the mental and physical struggles that families face when tackling the topic of returning to intimacy when breastfeeding. Providers and lactation consultants will receive recommendations on how to approach, assess and assist in resolving clients’ perceptions and concerns surrounding breastfeeding and intimacy. Discussion will offer web resources and how to add the topic into community resources.

Objectives:

Objective 1: Identify barriers breastfeeding mothers experience in regards to intimacy;

Objective 2: Explain the relationship between prolactin, oxytocin and estrogen and how it relates to physical and mental sexual arousal;

Objective 3: Describe resources and counseling techniques consultants can use to provide support;

As healthcare providers incorporate technological solutions into their practices, they also face the increasingly complex task of protecting the privacy of their patients/clients. Some countries have laws in place that healthcare providers need to understand and follow, but all healthcare providers regardless of practice setting have an ethical responsibility to maintain rigorous standards when it comes to digital privacy.

Because technology changes so rapidly, keeping up-to-date with privacy regulations proves challenging for both large institutions and solo practitioners. Lactation must also be concerned with the privacy of more than one entity while serving a patient base that may have already faced numerous privacy and consent violations during pregnancy and childbirth. By valuing the privacy of lactating persons and their children, legal, ethical, and moral obligations can be met, enhancing client/patient autonomy and improving self-efficacy.

This session provides a framework for understanding digital privacy and privacy threats, and offers resources for implementing policies and procedures that protect patient/client privacy.

Objectives:

Objective 1: Define privacy as a general concept and as it applies to access and handling of digital information and describe the most common threats to privacy in the digital space. Includes comparison of large-scale global approaches to digital privacy, including HIPAA, GDPR, PIPEDA, and other national and regional legislative efforts.;

Objective 2: Explain why protecting digital privacy is both an ethical obligation and a key element of improving equity in the healthcare space and demonstrate the common ways in which health care providers may put patient/client privacy at risk, along with the consequences to both patient and health care provider.;

Objective 3: List specific action items that can be implemented immediately to protect the digital privacy of patients/clients.

It’s a wonderful feeling when you’re able to support a family in getting to a place of successful breastfeeding/chestfeeding. Those moments when things suddenly click and baby starts nursing effectively and their overwhelmed parents are able to finally see an end to their struggles, are heartwarming and we celebrate those achievements for both our clients and ourselves. What doesn’t get talked about very often however, is the struggles that go alongside those triumphs. The caregiver burnout, compassion fatigue, guilt, and overwelming feelings of failure that can derail our confidence in ourselves as care providers. This panel digs deep into the realities of working as a lactation care provider, examining both the struggles and possible solutions.

Mother’s milk is the unequalled nutritional source for the preterm or medically fragile neonate. Beyond its nutritional impact, it contains a myriad of bioactive molecules that are of particular health importance for the sick neonate. A majority of mothers who are pump dependent with an infant in a neonatal intensive care unit have an incomplete supply of their own milk. In this instance, human donor milk is an important supplement to have available while the mother is supported to increase her own milk supply. This lecture will focus on various aspects of the use of human donor milk including a review of the differences between mother’s milk and donor milk and the current methodologies used for processing donor milk. Recommended clinical guidelines will be discussed that are based on the evidence for short and long term health outcomes following the use of donor milk in the neonatal period. Future considerations will be explored including ethical issues with respect to donor milk use.

Objectives:

Delegates will be able to:

1: Discuss the differences between mother's milk and human donor milk
2. Discuss the scientific evidence behind current human donor milk usage guidelines
3. Discuss some of the ethical considerations in human donor milk use

Evidence-based practice directly influences and drives day-to-day clinical practice in the current healthcare environments. Lactation consultants need to keep up to date with research evidence for best practice. Although the primary goal of lactation providers is to provide optimal lactation care to breastfeeding mothers, it is necessary to know how to apply appropriate evidence to use on a regular basis by understanding research process and how to read research articles. The purposes of this presentation are to present basic concepts related to conducting and understanding lactation related research including quantitative and qualitative research methods. In addition, the presentation also will cover the guides to reading scientific research articles. The participants do not require extensive or advanced medical or research methodological knowledge to attend this workshop. Some breastfeeding research papers including case studies, clinical trials, and qualitative research will be used as examples.

Objectives:

Objective 1: Describe basic research and its application to clinical practice;

Objective 2: Differentiate major characteristics between quantitative and qualitative research;

Objective 3: Identify basic steps in quantitative research studies.

Unless access to clean water and appropriate infant formula is reliable, the World Health Organization does not recommend HIV-infected mothers stop breastfeeding. Remarkably, only about 15% of babies exclusively breastfed by their HIV-infected mothers become infected with HIV. This suggests that although breast milk is a vehicle for HIV transmission, the milk itself exhibits a strong protective effect against infection. Breastfed babies ingest 100,000 - 100,000,000 maternal cells every day via breast milk; what remains largely unclear is the contribution of these cells to the milk’s anti-viral qualities. A large study has been undertaken to isolate cells from human milk in order to measure the ability of these cells to engulf and destroy HIV by a mechanism known as phagocytosis. Over 50 samples of breast milk obtained from healthy women have been analyzed. Phagocytosis of HIV was detected in all samples. Activity did not appear to correlate with stage of lactation. Various cell types known for phagocytic capacity were identified and measured, including granulocytes, monocytes, macrophages, and dendritic cells. All samples exhibited strong granulocyte activity.These data further demonstrate that phagocytosis of HIV by immune cells from breast milk can be measured. This information will be critical for design of therapeutic vaccines capable of reducing the likelihood of mother-to-child transmission of HIV in areas where breastfeeding is essential.

Objectives:

Objective 1: Explain how breast milk is both a vehicle for mother-to-child transmission of HIV and also protects against transmission;

Objective 2: List the cellular components of human breast milk;

Objective 3: Describe how maternal cells can be isolated from breast milk and used for analysis of their anti-viral functions.

The International Code on the Marketing of breast milk substitutes is the very cornerstone of breastfeeding protection, promotion and support, and an integral part of infant and young feeding policies around the world; yet it is often misunderstood or considered to be an out of date document with little relevance to breastfeeding issues today. Nothing could be further from the truth. The Code is updated regularly with additional resolutions voted at World Health Assemblies every two years, and covers far more than the marketing of breast milk substitutes in the first six months of life, but promotes optimal nutrition practices up to 36 months, and addresses conflict of interest with infant food companies. Indeed, the rapidly growing global market of breast milk substitutes, estimated at more than $70 billion in 2019, continues to undermine breastfeeding through its evermore aggressive and omnipresent marketing techniques, focused on parents, health professionals and health systems. The stakes are high – understanding and implementing the Code is an essential step towards ensuring optimal nutrition for infants and young children, whether breastfed or formula-fed.

Objectives:

Objective 1: Cite three key international documents directly referring to the International Code;

Objective 2: Define the products now considered to be breastmilk substitutes according to the Guidance on the inappropriate promotion of foods for infants and young children.;

Objective 3: Describe conflict of interest with industry as defined by the Code and cite three specific types of conflict of interest.

The objectives of this lecture are to understand the definition, pathophysiology, and basic management of hyperlactation. Topics discussed will include proposed mechanisms leading to hyperlactation, health effects on mother and baby, and approach to diagnosis and management. Participants will learn key history and physical findings for hyperlactation, behavioral interventions to reduce milk supply, herbal and medical interventions to reduce milk supply, and will learn how to determine which dyads would benefit from medical intervention.

Objectives:

Objective 1: Define and explain the pathophysiology behind hyperlactation;

Objective 2: List the negative consequences of hyperlactation;

Objective 3: Demonstrate basic management of hyperlactation and indications for referral for medical evaluation.

Late preterm infants struggle with feeding challenges. Due to the oscillating nature of breastfeeding progress in the late preterm population coupled with the innate issues of prematurity, families need support to navigate waters toward breastfeeding success. A model for evidence-based education and breastfeeding assessment will be presented to support infant development and empower mothers to achieve their breastfeeding goals.

Objectives:

Delegates will be able to:

1: Identify feeding challenges of late preterm infants
2: Discuss the use of a breastfeeding/chest feeding assessment scale to determine feeding effectiveness
3: Discuss the development of individualized breastfeeding/chest feeding plan for late preterm infants

Most children, happily, encounter no significant illness during childhood. Of those who do, some will be breastfed. Exclusive breastfeeding for 6 months, as well as continued breastfeeding alongside appropriate introduction of solid foods until the age of two years and beyond is recommended by the World Health Organisation. Breastfeeding is known to confer multiple well-documented protective properties, and the risks of not being breastfed are profound, even in well-developed countries.
Although breastfeeding reduces the overall risk of many serious childhood illnesses and malignancies, it is not a panacea. Many children who are breastfed optimally will still develop a serious health condition. This small group of children, and their families are an important population, with specific needs that are under-represented in policy, literature and professional training.
This presentation will identify specific childhood cancers, their prevalence and common treatments. It will also introduce some of the challenges experienced by parents breastfeeding their child through cancer, and some practical ways to support families facing this ordeal.

Objectives:

Delegates will be able to:

1: Describe the prevalence of childhood cancer
2: List some of the most common treatments
3: Discuss some of the common challenges faced by parents of children with cancer

Breastfeeding can sometimes be challenging for some families even when baby and mother are healthy. The Inmunological and nutritional benefits provided by breast milk must be considered when feeding any baby, it is by far the best start for babies that have any other disease where they can tend to suffer from multiple respiratory infections and other medical complications putting babies health, wellbeing and lives at risk. When there is a baby with a congenital cardiac disease we can face a lack of evidence and homogenous practices regarding breastfeeding. Many mothers feel helpless and many surgeons and cardiologists are not convinced that breastfeeding is better and easier for the infant with congenital heart disease. They are uncomfortable with not knowing the volume baby consumes and are not use to observing oxygen saturation an heart rate when the baby Is feeding at the breast. Current challenges in treating patients with chronic conditions include the prioritization of breastfeeding, identification of the most effective nutritional interventions, and the prevention or recovery of acquired growth failure.
Children with congenital heart disease who breastfeed have better growth, shorter hospital stays, and higher oxygen saturations than children with congenital heart disease who receive formula. It is necessary to support this families with evidenced based information to promote and support of breastfeeding to all mothers and babies. Create programs to meet the needs of this vulnerable babies and train surgical and pediatric staff of the neonatal surgery unit so they can support and facilitate a multidisciplinary work.

Objectives:

Delegates will be able to:

1: Discuss the medical challenges related to congenital heart disease with respect breastfeeding and breastmilk feeding
2: Use the tools for supporting mothers who have infants diagnosed with congenital heart disease to encouraged pumping/feeding for their infants
3: List different methods for feeding a baby with cardiac disease: gavage, bottle feeding, or direct breastfeedings

Lactation professionals often hear from their clients that their breastfed babies have been diagnosed as lactose intolerance. This lack of understanding regarding types of lactose intolerance and potential issues with breastfeeding involving the newborn gut often lead to a cessation of breastfeeding. This session will cover the three main types of lactose intolerance, as well as galactosemia. Maternal gut damage and protein sensitivity and how that can impact the breastfed baby will also be addressed. Attendees will also learn about the most common foods that cause food sensitivity and allergy and what referrals are best made with these issues.

Objectives:

Objective 1: Identify three main types of lactose intolerance.;

Objective 2: List two reasons lactose intolerance as a diagnosis in a healthy, term newborn is unlikely.;

Objective 3: Define galactosemia.;

Objective 4: List four most common foods that can cause food sensitivity/allergy for the breastfeeding newborn.;

Neurologic conditions often have a significant impact on the breastfeeding/chestfeeding dyad. The majority of these conditions are congenital, however some may be acquired during the first year of life. Breastfeeding/chestfeeding management of the hypotonic and hypertonic infant will be discussed. Hypotonic neurologic conditions that will be reviewed include floppy infant syndrome, infantile botulism, medullary lesions, Prader-Willi Syndrome and Trisomy 13, Trisomy 18 and Trisomy 21. The hypertonic neurologic conditions cerebral palsy and drug exposed infant will be discussed along with neural tube defects and Congenital Zika Syndrome. Case studies of special needs babies with these neurologic conditions will be presented.

Objectives:

Delegates will be able to:

1: List 3 congenital diagnosis that have neurological implications for the breastfed/chestfed infant
2: Define symptoms of hypotonia and hypertonia in infants
3: Verbalize breastfeeding/chestfeeding challenges for the hypertonic infant

As a health professional you may find yourself supporting a mother who is breastfeeding or requires support to breastfeed her baby with Down syndrome. Babies with Down syndrome can often have additional health needs, which may affect how successful they are with breastfeeding. Down syndrome or trisomy 21 is the most common genetic cause of intellectual disability for around 1 in 700 births worldwide. People with Down syndrome are not all the same but may have similar characteristic physical features, health and developmental challenges and some level of intellectual disability. Research has shown many benefits associated with breastfeeding a baby with Down syndrome. It contributes to establishing long term skill development, particularly with speech and feeding skills, as well as aiding brain growth. It also provides an opportunity for mother baby bonding during stressful periods after learning of their baby’s diagnosis. Regardless of these known benefits, some mothers may nevertheless be told their baby will not be able breastfeed. This presentation will explore some of the common challenges mothers may face when breastfeeding a baby with Down syndrome and tips on how to address these for the mother and baby. The material presented will also assist health professionals to support mothers with babies who may have similar health/developmental needs.

Objectives:

Delegates will be able to:

1: Explain what Down syndrome is
2: Describe the challenges the mother and her baby with Down syndrome may face with breastfeeding, and how they can be managed
3: Describe how the benefits of breast milk and breastfeeding can support the health needs of a baby with Down syndrome

Mast Cell diseases are rare but still underdiagnosed. Even among specialists, there is a lack of consensus on terminology, diagnostic techniques and even diagnostic criteria. Clinically, mast cell diseases manifest in divergent ways. Triggers, symptoms, management and treatments differ widely from patient to patient. To date, there is no cure, just palliative management of this chronic, sometimes life-threatening condition. Because of this, there is a poor understanding of Mast Cell-related issues in the broader medical community, particularly in the realms of pregnancy, birth and lactation.
This webinar will provide participants with a general overview and understanding of the various types of Mast Cell Diseases including Mast Cell Activation Syndrome (MCAS), Mast Cell Activation Disease (MCAD) and Mastocytosis. Participants will learn how to put this knowledge into practice to provide their Mast Cell clients with specialized, empathetic, and supportive care. It will discuss how to provide patient-centered care, the importance of coordinated care and the crucial role lactation specialists play within their client’s multidisciplinary health care team. It will examine Mast Cell treatments that are compatible with lactation.
Additionally, light will shed on approaches lactation specialists can utilize to empower their clients with the tools needed to establish and maintain the breastfeeding relationship desired, including helping clients manage their parenting and breastfeeding expectations given the limitations imposed by their disease.

Objectives:

Objective 1: List 3 common symptoms of Mast Cell diseases;

Objective 2: Identify 3 common triggers for Mast Cell patients;

Objective 3: Name 2 commonly prescribed Mast Cell treatments compatible with lactation;

Objective 4: Describe 1 way you can help your client manage their parenting and/or breastfeeding expectations;

Dysphoric milk ejection reflex (D-MER), is not a new phenomenon. In the past, it was almost like Voldemort, the Problem That Must Not Be Named. But for over 10 years now, it has had a name and been brought into daylight. Though still not widely known or understood by many, the hypothesis of the mechanism and possible sustainable solutions are becoming better documented all the time. D-MER has been the subject of two case studies, one case series, and a qualitative research study. Two other studies as also in process at this time.

Mothers with D-MER feel, as a reflexive response with every single milk release, a wave of negative emotions ranging (depending on severity) from homesickness to hopelessness and despair, perhaps even anger and suicidal ideation. These emotions dissipate shortly after milk release and reoccur with the start of every MER, whether with breastfeeding, expressing or with spontaneous releases. Many sufferers keep the problem to themselves preferring the weaning of their baby to being incorrectly labeled as depressed or victims of abuse. Upon experiencing D-MER mothers are initially convinced the problem is physiological and not psychological, and they are correct.

As both a lactation consultant and a sufferer of D-MER, I first named and identified D-MER over 10 years ago. Now, through the case studies that have been done, collaboration with other medical and breastfeeding care providers, and the collection of information from the anecdotal reports from over 1,000 mothers, there is now a foundation of understanding of D-MER. Though the evidence base for D-MER is still mainly unestablished at this time, there are many professionals always working to bring evidenced-based information to the study of human lactation. This is exactly what the slow work and understanding of D-MER is about; the process of bringing new information into the light for further research and understanding.

In the PowerPoint presentation that I have to present, I discuss how D-MER presents, its tell-tale manifestation, and its spectrum and intensities. The presentation also explains the currently proposed mechanism of the MER anomaly, how health care providers can identify a mother it D-MER and how to help and support mothers with the condition.

Objectives:

Objective 1: Explain and define what D-MER is and what it is not;

Objective 2: Distinguish how D-MER presents and it’s variances;

Objective 3: Hypothesize and illustrate the possible cause and treatment of D-MER;

Objective 4: Describe how to best help a mother with D-MER;

Breast cancer is the most frequent malignant tumor during reproductive age.

Breast cancer is the most frequent malignant tumor during reproductive age. Around 1/10000 nursing mothers are diagnosed with breast cancer every year. In this rare and difficult situation, patients and healthcare providers should be knowledgeable about the prognostic and practical implications of such an event. Chemotherapy may pass into the milk and breastfeeding is usually contraindicated during chemotherapy. Weaning should be gradual, to avoid breast inflammation and mastitis. A thorough psychological support should be given to the nursing mother to help her into the oncological trajectory.
On the other hand, the number of young breast cancer survivors is increasing and more and more patients enquire about the possibility of subsequent pregnancies and breastfeeding. The breast treated with conservative surgery and subsequent radiation is less responsive to hormonal stimulation, with reduced glandular hyperplasia and hypertrophy. Milk production is usually decreased in the previously affected breast and surgery may affect duct integrity. Nonetheless, each breast has the capability to self regulate milk production according to the baby’s suckling habits, and many evidences support the notion that one breast is enough. Specific education programs should focus on adequate baby positioning, correct latching and reinforcement of the advantages of on demand breastfeeding. Data from our group demonstrate the feasibility of breastfeeding after breast cancer, but qualified lactation counseling to support patients and caregivers is needed.

Objectives:

Objective 1: Explain how breast cancer occurring during breastfeeding should be treated;

Objective 2: Demonstrate how to counsel mothers with a previous breast cancer diagnosis about breastfeeding;

Objective 3: Use the appropriate techniques of gradual weaning and breastfeeding support when one breast only can be used;

Breastfeeding parents who are navigating autoimmune disorders of inflammation such as lupus, and rheumatoid arthritis face unique challenges. This presentation will look at the lived experiences, limited research, and express challenges of these parents including the most common and debilitating symptoms for the prenatal and post partum periods, and ways these conditions can affect mammary gland development or interfere with lactogenesis stages. Also covered will be how managing the symptoms of these disorders affects the stress of recovery and breastfeeding or pumping goals, what methods of support can be offered and areas for future clinical improvement and advocacy.

Objectives:

Objective 1: List the most common and dehabilitating symptoms for the prenatal and post partum period;

Objective 2: Describe ways these conditions can affect mammary gland development or interfere with lactogenesis stages;

Objective 3: Describe how managing the symptoms of these disorders effect the stress of recovery and breastfeeding or pumping goals, and what methods of support can be offered to help parents who have these goals overcome their steep challenges;

Background: Higher intensity and longer duration of breastfeeding is associated with protection against type 2 diabetes development. While exclusive breastfeeding is optimal, women with gestational diabetes mellitus (GDM) have lower exclusive breastfeeding rates than non-diabetic women. While women with GDM have expressed that they feel that their milk “comes in” late, there is limited biochemical validation of their perception and a lack of information regarding the difference in metabolite composition of colostrum which may influence the transition to lactogenesis II. Methods: Researchers conducted a prospective case-control pilot study involving the comparison of metabolite concentrations and maternal perception of milk “coming in” between postpartum women with GDM and without GDM. Results: There were lower concentrations of lactose and citrate, metabolites that indicate transition to lactogenesis II, in colostrum samples of women with GDM compared to non-diabetic women. Furthermore, a higher proportion of women with GDM reported a perceived delay in their milk “coming in.” Conclusions: Lower levels of lactose and citrate in the colostrum samples of women with GDM compared to those without GDM indicate delayed lactogenesis II with GDM which may suggest a biological mechanism associated with lower breastfeeding rates among women with GDM. Additionally, maternal perception of delayed lactogenesis II among women with GDM appears to be validated by biomarkers. The implications for practice relate to lactation support in the early postpartum period among women with GDM.

Objectives:

Objective 1: Explain the importance of breastfeeding for women with GDM;

Objective 2: List early breastfeeding challenges faced by women with GDM;

Objective 3: Use evidence-based lactation strategies to support women with GDM;

Many breastfeeding/chestfeeding parents seeking to grow their families through Assisted Reproductive Therapies (ART), including IVF will be faced with limited or conflicting information and challenging decisions. When they turn to lactation professional for support it’s important that the receive knowledgeable and compassionate care. This presentation will equip lactation professionals with an understanding of not only the various therapies, procedures, and medications, by the mental and emotional aspects that breastfeeding/chestfeeding families may experience in their fertility journey.

Objectives:

Objective 1: Describe the basics of fertility treatments including IVF;

Objective 2: List at least two medications that may be used in fertility treatment. And how they may impact lactation;

Objective 3: List at least three strategies for supporting clients facing decision making about lactation while undergoing fertility treatment;