Topics & Abstracts

Institutions:  Department of Nursing, Laniado Hospital, Netanya, Israel, Halav-EM Breastfeeding Clinic
Background: As far as anterior tongue tie is concerned, there is a growing, vast body of knowledge that has been validated. As for posterior tongue tie, the scientific evidence is lacking and the assessment tools are not uniform among practitioners.
Medical diagnoses are not part of the scope of practice of Lactation Consultants. Hence, there is a lot of confusion among professionals (both Drs and Lactation Consultants), resulting in over diagnosis and over treatment on the one hand, and also under treatment on the other.
Aims: To present a unique perspective of an experienced Lactation Consultant who is also a dentist, experienced in diagnosing and treating various types of tongue ties.
Narrative: The discussion will focus on the clinical dilemmas regarding releasing posterior tongue ties and their implications for breastfeeding in newborns as well as in older babies.
Clinical cases of babies with posterior tongue ties will be shown to demonstrate how exclusive breastfeeding can be achieved in clinical cases with posterior tongue ties that were not released. Cases of anterior and posterior tongue ties that had been released although breastfeeding was going well will also be shown. In these cases, additional factors were taken into account, such as the palate structure and the additional consequences that Ankyloglossia may have later in life.
Conclusions: In some cases of posterior tongue ties, good breastfeeding counseling can make the action of releasing the tongue redundant. However, then we are left to consider conservatively what other effects Ankyloglossia may have on our body.

Objectives:

Objective 1: Distinguish between anterior and posterior tongue tie based on the updated literature;

Objective 2: Describe physical and functional characteristics that lactation specialists must assess when considering whether to refer an infant for evaluation and possible treatment of posterior tongue tie; and

Objective 3: List components that must be included in a lactation management plan whenever a lactation specialist is concerned that an infant may have a posterior tongue tie.

Many health, lactation, and childcare professionals find themselves in a position where the families they work with require support with sleep. Without readily accessible, evidence-based, gentle and effective sleep support, some of these families turn to sleep training which often leaves breastfeeding abandoned in the quest for more sleep.

Understanding key sleep biology principles, and being able to apply these to both simple and complex sleep scenarios can empower parents with the tools they need to maintain breastfeeding while also getting more sleep. In this presentation, we will explore some key concepts, and apply them to some practical real-life examples of both adults and infant-related sleep problems.

Objectives:

Objective 1: Describe core principles of sleep biology

Objective 2: Discuss the importance of supporting families with complex sleep problems

Objective 3: List some sleep scenarios

Objective 4: Explain practical support options for optimizing sleep in breastfeeding families

Breast is best. The World Health Organization recommends that exclusive breastfeeding for at least the first six months after birth. Breastfeeding 10 times a day and each lasts for 30 minutes for 180 days; that sum up to 54,000 minutes devoted for "healthy next generation". Wang (2008) propose the B theory of breastfeeding: Baby-Breast-Brain-BackUp axis, an interpretation and application of the lactation mechanism with a new perspective. Breastfeeding is involving physical, psychological and social aspects of life. How does the lactation consultant based on counseling skills, apply the Mindfulness-Based Stress Reduction (MBSR) to empower breastfeeding women, who can activate the positive brain feedback, prompt oxytocin reflexes, and bravely express individual needs. A breastfeeding friendly society therefore be fostered and the breastfeeding family could truly enjoy their breastfeeding goals & lives.

Objectives:

Objective 1: Describe the B theory of breastfeeding and mindfulness-based stress reduction

Objective 2: Apply mindfulness to change the brain’s perception and feedback of breastfeeding

Objective 3: Describe strategies for empowering families to work with their care provider to solve their breastfeeding difficulties

Appalachia - the physical region along the Appalachian mountains, stretching from southern New York to northern Alabama, is often described as simply an area on a map of the United States. However, Appalachia is a separate entity and culture from the rest of the country in many ways. Breastfeeding trends and attitudes can be quite different in this area, and we notice a much lower rate of initiation and duration rates that coincide with these cultural attitudes.

The issue of lower breastfeeding rates in Appalachia goes beyond poverty – as many women in the region are willing to travel out of the area to receive good care. Why isn’t access to care easier to obtain in these rural areas? Why are women getting most of their prenatal education from their family members – making much of the education outdated and incorrect? Why have these women lost trust in their healthcare providers that are local?
The answers to these question reverts back to two major conclusions:

1. Women are still considered second class in Appalachia and;
2. Many healthcare providers do not understand Appalachian culture in order to serve them in the best way possible.

This presentation will discuss: a. What these specific barriers are; b. How we, as health professionals, can approach these barriers; c. How to help to create a new culture trend; and d. How to empower Appalachian women to take hone of their healthcare – specifically their birth and breastfeeding journey.

Objectives:

Objective 1: Describe Appalachian culture in means of a woman’s expectations, from family life to healthcare surroundings.

Objective 2: Discuss specific barriers in women’s healthcare in Appalachian; specifically of birthing age.

Objective 3: Describe tools to help create a new culture trend in Appalachia centered around breastfeeding success and duration

Exclusively pumping (EPing) provides a solution to some breastfeeding problems, while still providing most of the benefits of human milk. In addition, the prevalence of EPing is on the rise. However, there is a lack of data on EPing, especially concerning the reasons for EPing and the information and support needs of EPers. My study collected qualitative and quantitative data on these (and many other) topics from over 2,000 EPers; the findings indicate that EPers often get no or bad advice from their health/lactation care providers. This poor knowledge of and negative opinions about EPing often contribute to EPers feeling frustrated and unsupported. In addition, these undesirable experiences threaten both the initiation and duration of breastfeeding-via-EPing. This presentation focuses on the reasons why EPers breastfeed without nursing, their feelings about EPing, their information needs, and what lactation care providers can do to better support EPers.

Objectives:

Objective 1: Identify why some breastfeeders exclusively pump their milk rather than feed directly at the breast;

Objective 2: Recognize the range of feelings exclusive pumpers have about breastfeeding without nursing;

Objective 3: Provide appropriate information and advice about exclusive pumping to parents, medical professionals, and lactation care providers, including information about how to start, sustain, and cease exclusive pumping; and

Objective 4: Implement a range of measures to support exclusive pumpers.

Have you have ever…
…felt as if a new parent wasn't listening or even trying to sabotage your good efforts?
or
…suspected something is off or wrong because you can't get through to the person in front of you?
If so, this session is for you!
While the postpartum period is a vulnerable time for all new parents, parents with a trauma history and / or living in toxic stress can be especially challenging. The good news is that breastfeeding professionals and peer support advocates are in an optimal position to be effective and confident with these parents. Participants will learn why and how something as common as a trauma history can disrupt their good work.We will discuss trust-building practices, common mistakes to avoid and how to be effective with even the most "high needs" people. This is the practical, skills-building session that you're looking for.

Objectives:

Objective 1: Describe how & why trauma can impact provider / patient trust

Objective 2: Demonstrate the use of trust-building, trauma sensitive practices and tools to more effectively support all families

Objective 3: Use specific language as a way to build trust including what to say, when and how to say it as well as common mistakes to avoid

Children with Sensory Food Aversions consistently refuse to eat certain foods related to the taste, texture, temperature, smell and/or appearance. Feedings or mealtimes are therefore a displeasure for everyone. 
Oral disorders are eating disorders caused by hypersensitivity.

Food aversions are common and believed to occur along a spectrum of severity, with some children reluctant to try new foods, and refusing whole food groups (vegetables, fruits, meats). Indeed, after an aversive experience, some children tend to generalize and refuse foods that look and/or smell like the aversive food (e.g., aversion to broccoli may be generalized to all green foods).

Reactions to the aversive foods can range from grimacing to gagging, throwing up, or spitting out the food. Some babies cannot even accept to be touched near their face, or mouth, they may not accept to be held in a wrap. Some children can't stand to have dirty hands, to walk in the sand, to be touched.

While this can be a challenge when a mother is trying to start solid food, this hypersensitivity may also even start with breastfeeding.

Babies need proper nutrition to grow and thrive, and difficulties with feeding in infancy can be a worrisome and become a dangerous condition. There are many different reasons why a baby may struggle with feeding. All merit evaluation and treatment. This conference aims at exploring solutions to support families who deal with oral aversion.

Objectives:

Objective 1: Describe Sensory Food Aversions

Objective 2: Discuss its impact on babies and the general population

Objective 3: Discuss oral desensitization massages as a tool to help families

There is increasing concern for the risk of hypernatremic dehydration (HD) in infants breastfeeding poorly, and weight loss (WL) is often considered a key variable in deciding whether to supplement a newborn. However, WL is the net sum of different forces, and it might be difficult to determine which actions will be the most effective in protecting both the baby and breastfeeding. This presentation will review the newest scientific evidence about WL, and by a comparison of the results of previous quantitative studies will provide a more comprehensive framework to interpret weight changes and feeding behaviors that can be suggestive of an increased risk of HD, in order to facilitate the detection of infants who can benefit from additional breastfeeding support and those who might eventually require supplementation. The data confirm that both birth and breastfeeding perinatal practices have influence on WL and the risk of HD, and are therefore important modifiable factors to improve breastfeeding outcomes.

Objectives:

Objective 1: Compare physiological weight loss and weight loss from breastfeeding failure or mismanagement

Objective 2: List factors which can contribute to higher neonatal weight loss

Objective 3: Discuss feeding behaviors that are associated with higher risk of hypernatremic dehydration and appropriate interventions to protect breastfeeding

Depression research contains many conclusions that appear to contradict each other regarding the role of breastfeeding. For example, breastfeeding lowers the risk of depression, but depression increases the risk that breastfeeding will fail. Moreover, breastfeeding problems increase women's risk of depression. These findings are not as contradictory as they may seem. By understanding the underlying physiological mechanism, we can understand these seemingly paradoxical findings. This presentation will describe the link between the stress and oxytocin systems, and how they relate to both maternal mental health and breastfeeding. When the stress system is upregulated, depression and breastfeeding difficulties follow. Conversely, when oxytocin is upregulated, maternal mental health and breastfeeding rates improve. This talk also includes the role of birth interventions and mother-infant sleep, as well as practical strategies that increase oxytocin.

Objectives:

Objective 1. Describe the stress and oxytocin systems and how they are governed by the paraventricular nucleus

Objective 2. Discuss how birth interventions, such as Pitocin and epidurals, increase the stress response and decrease naturally occurring oxytocin

Objective 3. Discuss the role of exclusive breastfeeding in better maternal sleep and mental health

Classic animal studies have shown that maternal care of rat mothers e.g. licking and grooming and arched back nursing, impacts offspring outcomes such as behavior, development, and stress regulation. These outcomes persist over subsequent generations. Epigenetics, the study of how environmental influences affect gene expression, mediates these effects. In this session we will discuss and explore how similar epigenetic mechanisms in humans possibly relate to the protective effects of breastfeeding and maternal tactile stimulation on infant stress reactivity.

Objectives:

Objective 1: Describe basic epigenetic processes;

Objective 2: Explain the relationship between DNA methylation and infant HPA stress response; and

Objective 3: Describe the impact of exclusive breastfeeding on DNA methylation and decreased cortisol reactivity in infants.

In times of civil instability and changing global climate, we risk natural disasters, infrastructure failure, terrorist situation, police brutality, mass migration, chemical accident, war or other type of emergencies. Infants and young children under the age of 2 are the most vulnerable due to their dependence on adults for survival and their delicate physiology. We know that lactation in emergencies saves lives, yet the unrest that occurs in the days immediately after the disaster may contribute to premature weaning. At the same time, many babies are not breast or chestfed at all or only partially. This session will explore the methods to preserve breastfeeding, decrease the use of formula and other human milk substitutes, promote relactation, and teach appropriate complementary feeding in a disaster appropriate, low tech and resource limited environment. We will also discuss the colonial and patriarchal of humanitarian relief and how to make equity our focal point.

Objectives:

Objective 1: Identify the unique feeding needs and risks of infants and young children and their parents following a disaster situation;

Objective 2: Incorporate low technology interventions and feeding techniques, focusing on preserving or augmenting lactation or reducing risk with substitute feeding for families affected by the lack of resources including utilities and equipment; and

Objective 3: Develop intervention techniques that emphasize equity, linguistically and culturally appropriate services, local community identified initiatives and resources, and the rejection colonial models of humanitarian intervention.

Some breastfeeding parents find that their stored milk tastes sour or rancid, and sometimes this milk is refused by their baby. These flavors and odors are often described as metallic, fishy, rancid, sweaty or soapy. But what exactly causes these ‘off’ flavors and what can be done about milk that is refused? Is the solution always to scald milk? Milk with high lipase action leads to milk with increased levels of free fatty acids during storage that can produce rancid and sweaty flavors. Enzymes such as lipase can be inactivated by heating prior to milk storage. Milk with high levels of polyunsaturated fatty acids is susceptible to fat oxidation during storage leading to fishy and metallic flavors. Storage recommendations to reduce oxidation of fatty acids in milk include using short storage times, thawing at cold temperatures, and avoiding light exposure during storage. Case studies of both oxidized milk and high lipase action will be presented along with possible solutions.

Objectives:

Objective 1: Describe the biochemical processes involved in human milk oxidation and high lipase action;

Objective 2: Differentiate between milk that is rancid due to oxidation and milk with high lipase action; and

Objective 3: Choose strategies to help mothers with sour or rancid milk reduce the impact of oxidation or lipase action on their stored milk.

Weaning is a very controversial topic when talking about breastfeeding. Nevertheless, a lactation consultant should be the professional addressed to guarantee mothers a good experience when finishing this process. When the child is 18 months or older, it is possible to develop a plan of gradual weaning that can adjust to their routine, and please both mother and child - respecting everyone's time and rhythm. When a mother is ready to move on and wishing to re-encounter herself, if we have a baby that is ready to communicate in other ways besides the breast, it is important to develop skills and a plan of action to give breastfeeding the beautiful end it deserves.

Objectives:

Objective 1: Help mothers develop a respectful and gradual plan for weaning;

Objective 2: Help mothers with strategies to follow gradual weaning; and

Objective 3: Skills for a proper interview and defining mother objectives.

We don’t often think about “marketing” breastfeeding/chestfeeding and human milk, but when it comes to public health messaging, that’s exactly what we’re doing. Marketing is defined as “the action or business of promoting and selling products or services, including market research and advertising”. Recent public health campaigns have been successful at increasing breastfeeding initiation rates, but the duration of exclusive breastfeeding remains low, certain groups that question the safety of exclusive breastfeeding are gaining traction, and lactation professionals continue to be seen as “pushing breastfeeding” and causing feelings of guilt of shame. Clearly it is time for a change. This panel of experts will look at the reasons why marketing of breastfeeding and human milk is important, the impact of recent marketing campaigns, and what we could be doing better.

Objectives:

Objective 1: Describe the importance of marketing breastfeeding and human milk

Objective 2: Describe the impact of recent public health marketing campaigns

Objective 3: List at least 3 examples of ways in which marketing of breastfeeding and human milk could be improved

Fed is Best is a foundation with a major social media presence who seek to warn parents and practitioners about the dangers of insufficient exclusive breastfeeding. Through their social media campaigns that have galvanized a backlash against exclusive breastfeeding, lactation care providers, and the Baby-Friendly Hospital Initiative. Although lactation specialists disagree with much of their content, they have raised awareness about mothers who do fall through the cracks of our care system and may suffer as a result. The steep drop-off in rates of exclusive breastfeeding is an indication of this. This presentation will examine three provider-level barriers that negatively impact breastfeeding and what we can do to improve care so that mothers will reach their breastfeeding goals.

Objectives:

Objective 1: Describe how providers influence mothers’ oxytocin levels, either positively or negatively, and the long-term effects of these interactions.

Objective 2: Describe how birth and postpartum interventions (such as rooming in and skin-to-skin care) can influence oxytocin levels.

Objective 3: Describe the implications of the lack of basic breastfeeding support that can occur due to a mother's race/ethnicity or body-mass index

The language and practices of health professionals can impact upon how a woman feels about breastfeeding and her breastfeeding baby. This presentation will report on the observed, and audio recorded, language used by health professionals during the early establishment phase of breastfeeding. Much of the language positioned breastfeeding as the mechanical production of nutritious fluid rather than a relational interaction between mother and baby. At times the infant was positioned as an antagonistic being with the capacity to ‘think and decide’ whether to cooperate with breastfeeding. An alternative discourse emerged from a more relationship-focused approach to breastfeeding support. This presentation will report on projects which have included the observation of interactions between breastfeeding women and midwives, and/or lactation consultants and/or trained breastfeeding peer supporters. Exemplars of best practice for health professionals, and peer supporters, who provide breastfeeding support during the early establishment of breastfeeding, will be provided.

Objectives:

Objective 1: Describe the impact of the language used when discussing breastfeeding with new mothers

Objective 2: Discuss the components of communication which can enhance mother-infant connectivity and those which can hinder this connection.

Objective 3: Analyze their own language and practices when providing breastfeeding support and assess whether communication can be enhanced.

Legalization of marijuana for medicinal and recreational purposes presents challenges for health care providers in maternal-child health. Inconsistent messaging regarding marijuana use and lactation management is creating alarm for patients and health care organizations alike. Oftentimes, policies and policing of marijuana use are filtered by biases. This webinar will explore current literature regarding marijuana use and breastfeeding, as well as, confusing and inconsistent messaging and policies regarding marijuana use while breastfeeding. Discussion will include recommendations for equitable care practices regarding this topic.

Objectives:

Objective 1: List current clinical recommendations regarding marijuana use and breastfeeding based on current evidence;

Objective 2: Describe opportunities for growth related to equitable care practices of lactation management regarding marijuana use; and

Objective 3: Verbalize the impact of policies and bias on the influence lactation management and marijuana use.

The purpose of this presentation is to first review basic components of the breast physical exam, and then transition into the management of challenging maternal complications of lactation. We also briefly will review breast imaging that may be required for diagnostic purposes in this setting.

Objectives:

Objective 1: Describe key aspects of the breast physical exam, including evaluation of regional nodal basins

Objective 2: Discuss the challenging complications of lactation and describe their appropriate management

Objective 3: Explain breast imaging and other radiology studies that a patient may be recommended to undergo during lactation

Aims: The aims of this study were to explore the role of education and support in the development of self-efficacy in first-time mothers during the transition to motherhood.

Methodology: Using a qualitative approach, first time mothers, whose babies were less than 15 months old, were recruited from among women who had attended various models of antenatal classes They took part in a semi-structured interview on their experiences and personal constructs relating to the perceived quality of support they received were then elicited.

Findings: Becoming a mother was a process that held great meaning for all the mothers. For the women interviewed, breastfeeding was both a practice and a process which held meaning for these women. The impact of the various forms of antenatal classes in developing self-efficacy for all parental tasks is explored. The elicitation of personal constructs provides a novel format for women to evaluate the quality of the support they received – a topic which has been seldom researched.

Objectives:

Objective 1: Describe the concept of self-efficacy in new mothers

Objective 2: List themes in the transition to motherhood

Objective 3: Describe the styles of support preferred by many mothers

This presentation will give an overview of the reasons that can cause painful breastfeeding and how we can intervene either via breastfeeding management or medically.
The reasons might be

- poor latch
- problems with sucking, like tongue tie or other anatomical issues, also nipple confusion
- vasospasms
- infections, mastitis
- Mammary Constriction Syndrome
- injuries or medical conditions of the skin, such as psoriasis, dermatoses, eczema
- oversupply
- plugged ducts
- incorrect pumping or hand expression
- allodynia/functional pain
- psychological and emotional aspects

Important aspects concerning breastfeeding management and counselling and possible therapeutic interventions will be discussed as well as the impact of painful breastfeeding on the breastfeeding dyad and the whole family.

Objectives:

Objective 1: Describe common and rare reasons for pain during breastfeeding

Objective 2: Demonstrate how to help the mother to help herself

Objective 3: Explain suggestions for adequate medical therapy, if necessary

Due to the global shortage of mental health professionals, many primary care providers have become the first-line responders to a wide variety of psychiatric concerns. While lactation consultants and breastfeeding support counselors are not called upon to diagnose and treat mental health disorders, they nonetheless often become enmeshed in the topic due to the holistic nature of breastfeeding management. An understanding of the major psychiatric topics that can arise during lactation consultation is therefore a valuable asset.

In this presentation, we will describe mental health benefits and drawbacks of breastfeeding, and explore the controversy surrounding the “breast is best” campaign as it regards maternal mental health. We will also briefly explore the pharmacological and non-pharmacological options in treatment of major psychiatric disorders (e.g. generalized anxiety, major depressive disorder, bipolar mood disorder, schizophrenia) as they relate to lactation. Finally, we will review the scientific literature related to potential long-term mental health effects of breastfeeding on babies.

Objectives:

Objective 1: Critique the controversial “breast is best” campaign and its relationship to mental health

Objective 2: Discuss the mental health benefits and drawbacks of breastfeeding

Objective 3: Discuss the approach to management of psychiatric conditions such as schizophrenia, bipolar mood disorder, major depressive disorder, and generalized anxiety during lactation

Objective 4: Analyze the research surrounding possible long-term mental health effects of breastfeeding for babies

Breastfeeding rates are exceptionally low in Lebanon. Only 40% of mothers exclusively breastfed through the first month and 2.4% continued to exclusively breastfeed between 4 and 5 months. In 2012, I developed, implemented and evaluated a pilot Breastfeeding Peer Counselor (BPC) Training Program in Beirut, Lebanon. I chose this format since BPCs are adaptable to local contexts and studies have shown that that improve rates of breastfeeding initiation, duration, and exclusivity in a variety of settings and across diverse populations.

The program successfully trained 8 BPCs and led directly to the establishment of the largest mother-to-mother peer breastfeeding online support network in the Middle East (over 11,000 members to date). This presentation will provide participants with the knowledge to develop, adapt, and implement their own BPC Training programs suited to their local context. In addition, this presentation will reflect upon ethical considerations of such programs and will offer guidance on the process of program evaluation. This will allow participants to identify their own program’s strengths and weaknesses, which can improve the effectiveness of subsequent organizations.

Objectives:

Objective 1: Identify at least 2 reasons Breastfeeding Peer Counseling (BPC) Training Programs are effective in increasing breastfeeding rates;

Objective 2: Describe 5 basic components to consider when developing a BPC Training Program; and

Objective 3: List at least 1 quantitative and 1 qualitative method to utilize when conducting a BPC Training Program evaluation; and

Objective 4: Discuss at least 2 ethical considerations to take into account when developing, implementing and/or evaluating a BPC Training Program.

Rummaging in the tool bag: how we can borrow from other disciplines, and enhance our care.

As infant feeding specialists, we should be open to discovering new tools that renew our practice. Historically, we’ve incorporated elements from elsewhere, e.g. Active Listening (Rogers and Farson, 1957), borrowed from psychology and conflict resolution.

Changes to the UK support landscape, mean that parents may not access traditional breastfeeding peer support, and instead see health staff. A diversity of background, can mean staff bring additional skills that then complement those acquired under the UNICEF Baby Friendly standard.

For specialist professionals, such as IBCLCs, some of these tools can also complement practice, and can be used to great effect.

This presentation proposes to look at some elements we can borrow that enhance our clinical practice. We will review aspects of Active Listening, and then move on to examine elements in the Signs of Safety model and Solihull Approach. These are just two examples of widely practiced approaches in the UK, and there are many other fields to be borrowed from.

Objectives:

Objective 1: Describe new approaches to clinical practice;

Objective 2. Outline a brief review of Active Listening and its origins, an introductory overview to Signs of Safety and the Solihull Approach;

Objective 3. Discuss specific examples of elements that can be deployed in breastfeeding support practice from these approaches; and

Objective 4. Describe other (evidenced) science/health fields that can be helpful to us as lactation professionals.

Current information on working with teen mothers includes issues such as body art, nutrition, grandmothers, and adolescent brain development. Strategies for connecting with and teaching these mothers will be addressed.

Objectives:

Objective 1: List at least three unique challenges for the teen mother;

Objective 2: Describe breastfeeding barriers for the teen mother; and

Objective 3: Discuss strategies for supporting the teen mother.

In many countries, expert witnesses serve the role of educating triers of fact on issues that are typically outside the experience and knowledge of lay people or professionals who do not have the needed expertise. IBCLCs can serve as expert witnesses in legal proceedings related to situations that involve lactation (e.g., divorce, custody, and visitation; protecting lactation in the work place). Serving well in this role requires a clear understanding of the strengths and constraints inherent in the IBCLC’s scope of practice, using strategies that can make an expert witness more effective, and knowing how to find relevant resources. This session provides IBCLCs with introductory information that will 1) help them make a more informed decision about becoming an expert witness and 2) allow them to perform more effectively and confidently in that role.

Objectives:

Objective 1: List 3 documents that clarify the strengths and constraints of the IBCLC when serving as an expert witness;

Objective 2: Describe 3 strategies that can make the IBCLC a more effective expert witness; and

Objective 3: Name 3 resources that can help the IBCLC educate triers of fact.

Evolution has created human milk as a way to protect the baby postnatally, patterning the immune system and microbiome, and providing diverse developmental cues for each organ system to develop normally. Milk also provides nutrition. When screened donated human milk (DHM) is available, mothers facing the most stressful circumstances of having an ill premature baby tend to have high chances of establishing breastfeeding. If donor milk is used appropriately as a bridge to lactation, they are less likely to perceive that their bodies have failed. The work of the Hearts Milk Bank over 18 months have laid the foundation for a UK-centred drive to upscale milk bank capacity, facilitate research to determine the optimal use of donor milk, and support a shift in perception about the role of human milk, underpinned by the latest science.

Objectives:

Objective 1: Describe the history of milk banking

Objective 2: Discuss the roles of milk donation in public health, including beyond the NICU

Objective 3: Describe the physiology and significance of an exclusive human milk diet

We know that responsive feeding gets breastfeeding off to the best start. New parents are told that breastfed babies often feed 8 – 12 times a day, but in practice many new mothers will find themselves breastfeeding more frequently than this. Research exploring breastfeeding frequency is however conducted primarily with younger infants, focuses simply on breast versus bottle, or was funded by industry.

This presentation reports novel findings from a research study of 18,000+ mothers with a baby or child aged 0 – 5 years old. It examines how often babies feed during the day and night for each age range by milk feeding type, mode, and approach (e.g. schedule versus responsive) and how frequent day and night feedings remain the norm for breastfed babies into the preschool years. The data also explores differences in maternal perceptions of infant variations in hunger e.g. in response to growth spurts, variations over different days, and cluster feeding, highlighting how breastfeeding mothers describe a more varied pattern of infant feeding compared to those formula feeding.

Together the findings challenge notions that most babies breastfeed between 8 – 12 times per 24 hour and that irregular patterns or varied numbers of feeds are normal for breastfed infants. Although many breastfeeding practitioners will recognise this pattern, these findings will provide both an addition and challenge to the scarce existing research literature on infant feeding patterns.

Objectives:

Objective 1: List normal patterns of infant feeding by milk type and mode between 0 - 5 years

Objective 2: Describe the differences in maternal perceptions about the variation in milk feeding patterns e.g. in response to cluster feeds and growth spurts

Objective 3: Analyze the drivers and impact of feeding schedules upon feeding frequency and breastfeeding rates

Objective 4: Explain on the importance of public health messaging around normal breastfed baby feeding patterns

The most frequent cause of weaning worldwide is mother´s feeling that she does not have enough milk or that her infant is hungry despite her efforts… and frequently this perception becomes a reality. What support systems and clinical strategies can we use to protect mother´s normal capacity for milk production?

Objectives:

Objective 1: Describe prenatal strategies that will help prevent low milk supply;

Objective 2: describe postpartum strategies that will protect optimal initiation of milk production; and

Objective 3: recognize and acquire the essential skill of recognizing effective suckling.

Is it a tongue tie? What else could be going on? Having a deeper understanding of the orofacial complex and functional oral motor patterns can help take your assessment techniques to the next level. Curious about jaws, tongues, palates, oral tone, suck patterns, and more? This presentation will focus on understanding the finer details and the bigger picture when it comes to infant oral assessment.

Objectives:

Objective 1: Demonstrate the basics of infant oral anatomy assessment;

Objective 2: Describe immature vs. mature suck patterns; and

Objective 3: Identify at least 3 aspects of oral assessment.

What good is a successful patient consult if the follow-up instructions are not thorough or are too complicated to follow? In this talk, we’ll review best practices in Care Plans, and explore innovative approaches to developing plans. The goal is to increase patient compliance and the right Care Plan can be a powerful tool towards full compliance. We will discuss pitfalls of traditional plans, dos and don'ts in writing plans, and crafting plans that are culturally sensitive and realistic. We’ll also explore using to technology to create adaptable and adjustable plans.

Objectives:

Objective 1: Discuss the importance of care plans in full spectrum care;

Objective 2: Consider key components of impactful plans; and

Objective 3: Acquire skills to write inclusive care plans.

The purpose of this presentation is to first review basic components of the breast physical exam, including assessment of the breast, nipple areolar complex (NAC) and regional nodal basins. We also briefly will review breast imaging that may be required for diagnostic purposes in the setting of lactation.

Objectives:

Objective 1: Describe key aspects of the breast physical exam, focusing on the breast and nipple areolar complex (NAC);

Objective 2: Describe exam and purpose of regional nodal basin drainage;

Objective 3: Describe which diagnostic imaging studies are indicated in the setting of lactation.

The comfort and effectiveness of breastfeeding depend largely on how deeply the baby is attached to the breast and how stable the body positions of mother and baby are. This presentation reviews infant requirements and capabilities for breastfeeding and best practices to facilitate optimal latch.

Objectives:

Objective 1: List 4 subtle signs of a shallow latch;

Objective 2: List 2 ways to facilitate infant and maternal innate feeding capabilities; and

Objective 3: Detail strategies for optimizing latch when breastfeeding tools are needed.

In this talk, Dr Lisa Amir explains how to take a history in a breastfeeding consultation. Developing rapport, listening and asking the right questions are essential to helping women experiencing challenges with breastfeeding. This talk will consider taking a history from clients before and during pregnancy, as well as early postpartum and later in their breastfeeding journey.

Objectives:

Objective 1: Discuss that the importance in “taking a history” to help resolve clients’ concerns;

Objective 2:List the different phases of a consultation: from opening to closing; and

Objective 3: Describe how to communicate effectively and the use of open-ended questions.

While some clinicians might roll their eyes when ‘lactation cookies’ are mentioned we know foods and herbs have long been used to nourish the postpartum parent and enhance lactation. Some topics this talk aims to cover: Does nourishment matter when it comes to breastmilk quality or quantity? How can we approach galactogogues for lactating mothers in an individualized way? How can clinicians evaluate evidence and determine safety regarding galactogogues? We know that parent coping with milk supply concerns are often desperate to ‘try anything’. Clinicians have an important role in helping families understand the risks and benefits of galactogogues. By helping parents identify resources and information around foods and herbs, we can help empower them to make informed choices.

Objectives:

Objective 1: Understand why foods and herbs may be needed to support optimal lactation;

Objective 2: Understand the different ways that galactogogues support lactation;

Objective 3: Understand a personalized approach to selecting appropriate galactogogues; and

Objective 4: Locate resources on galactogogues and herbal safety.

Although an alternative feeding method, such as bottle, cup or finger feeding, represents a less than ideal way to feed infants, at times introducing one of these methods may ultimately save the breastfeeding relationship. In this session, Dr. Hazelbaker presents the research on and the theory of finger feeding. She then proposes areas for further research. She includes a sub-lecture on the physiology of finger feeding and compares finger feeding against bottle and cup from the physiological perspective. Participants come away with a new understanding of finger feeding, enabling them to make sound clinical decisions regarding a therapeutic choice when a baby must be fed away from the breast.

Objectives:

Objective 1: Explain the theoretical physiological basis for finger feeding;

Objective 2: Describe the various tools and methods of finger feeding; and

Objective 3: Discuss a decision rule for using finger feeding.

All too often, the breastfeeding helper finds herself in the uncharted territory of fielding artificial nipple questions and helping mothers select the best bottles for their breastfed babies. By broadening your artificial nipple knowledge and learning about bottle features you can minimize the negative impact of bottle use. Once you become familiar with bottle features and their impact on a baby’s suck, you can also use this knowledge to improve latching and sucking skills.

Objectives:

Objective 1: State two important features to consider when selecting a bottle;

Objective 2: Recognize baby behaviors that indicate a different flow rate is needed;

Objective 3: Learn how to select a bottle as a tool for improving a baby's suck.

Most IBCLCs interact with nipple shields in their work whether a family has brought one in that they are already using or they have suggested using this tool themselves. Are we using them too much or too little? When does it make sense to use this tool? Some lactation consultations say never and some give them out too often. In this session, a brief history of nipple shields will be presented along with the possible reason one might use a nipple shield. The pros and cons of nipple shield use in clinical settings will be debated. Finally, the latest research will be discussed to determine which clinical experiences are grounded in best practice.

Objectives:

Objective 1: Explain the differences between the nipple shields of the past and the nipple shields being used today;

Objective 2: list three possible reasons a family might use a nipple shield to support breastfeeding;

Objective 3: Describe three factors to consider when helping families decide whether to use a nipple shield or not.

Many breastfeeding parents rely on a breast pump to help provide milk for their babies when they are separated or not feeding directly from the breast for other reasons. Others will use a breast pump to bring in or grow their milk production. Some of these parents may find pumping uncomfortable. Many others have difficulty expressing enough milk to meet their babies’ needs. There are also those who produce an overabundance of milk while pumping. This session addresses all of these parents by providing ideas for making pumping as effective, efficient, and comfortable as possible.

Objectives:

Objective 1: Describe reasons why a parent would need/choose to use a breast pump;

Objective 2: Identify alternatives to pumping;

Objective 3: Choose a breast pump appropriate for a parent’s circumstances;

Objective 4: Participant will be able to properly care for her breast pump;

Objective 5: Know how to make pumping as comfortable as possible; and

Objective 6: Know how to maximize the amount of milk output from pumping.

This presentation reviews available commercial and clinician-assembled supplementer devices and their use during breastfeeding in a problem solving context. It includes special considerations for infants with oral clefts and cardiorespiratory conditions.

Objectives:

Objective 1: Detail cogent clinical factors in the choice of supplementer devices;

Objective 2: Describe advantages and disadvantage of three tools for supplementing at the breast; and

Objective 3: Describe ways to modify supplementers for cleft affected infants.