Breastfeeding: Science, Solutions & Strategies

Milk removal drives milk production and feeds the baby. The ability to remove milk from the breast depends strongly on the milk ejection or letdown reflex. While normally robust, a number of factors can influence it, some more obvious than others. When milk flow suddenly becomes an issue, the rush is on to determine why and what to do about it. This session will take a deeper look at how this reflex works, factors that can affect it positively or negatively, and potential strategies to help.

1.5 L Cerp (II, III, IV, VI) 

• II Physiology and Endocrinology
• III Pathology
• IV Pharmacology & Toxicology
• VI Clinical Skills

Skillful lactation consulting requires the ability to interpret sucking speed, suck:swallow ratios, and coordination of swallowing and breathing. This session presents recent research on normal sucking rhythms of breastfeeding infants. Compensatory strategies used by infants with prematurity and cardiorespiratory anomalies are discussed, and are illustrated with clinical videos. Cervical Auscultation (listening with a stethoscope over the baby’s neck or chin during feeding) is a useful tool for lactation consultants in assessing suck:swallow:breathe rhythms. Inaudible swallowing sounds become audible, and difficulties coordinating swallowing and breathing are more easily identified. This advanced practice presentation uses recorded sound files of cervical auscultation of breastfeeding infants to illustrate difficulties that can be identified using this method. Use of this information in clinical problem solving is stressed.

1.5 L Cerp (I, III, VI) 

• I Development and Nutrition
• III Pathology
• VI Techniques

Based on Lisa’s seminal article on the topic, this presentation explores what we do and do not yet know on topics that impact lactation clinicians, including the “true” rate of insufficient milk, FIL, infertility, hypoplasia, hypertension, nutrition, maternal age, serotonin, and more. Current challenges in obtaining the research we all want will also be discussed with an eye to how we can help. “Unsolved Mysteries” is a relational presentation that engages the audience by allowing them to choose the topics for discussion; attendees are guaranteed to walk away with new insights/information.

1.5 L Cerp (I, II, III, V, VII) 

• I Development and Nutrition
• II Physiology and Endocrinology
• III Pathology
• V Psychology, Sociology and Anthropology
• VII Clinical Skills

Many infants with unilateral breast refusal and asymmetrical tongue movements have a tight neck muscle from their intrauterine position. This presentation discusses torticollis and related craniofacial asymmetries and the effect on breastfeeding, as well as creative ways to position babies at the breast and support normal feeding.

1.5 L Cerp (I, III, VI, VII) 

• I Development and Nutrition
• III Pathology
• VI Techniques
• VII Clinical Skills

When the topic of galactogogues comes up, a commonly heard refrain is “there is no evidence that galactogogues work…” But that’s not true! The results of a Cochrane review that cast a world-wide net will be presented, along with insights about historical differences in the goals of studies and other interesting facts gleaned during the review process. By the end of the session, the participant will be able to list four components of a model study (a better “mousetrap”), as well as 10 galactogogues that have been studied, and discuss the strength of the evidence.

1 L Cerp (IV, VII) 

• IV Pharmacology
• VII Clinical Skills

Many practitioners are concerned that tongue-tie is being over-diagnosed and over-treated. This talk discusses what we know and don’t know about lingual and labial frenula, and how to distinguish between a consistent clinical picture that requires referral for further evaluation and the more ambiguous constellation of symptoms that might point to other reasons for an infant’s sucking difficulties.

1.5 L Cerp (I, III, VI) 

• I Development and Nutrition
• III Pathology 
• VI Techniques

The connection between the thyroid gland and milk production has not been well-recognized or appreciated. The good news is that new animal research is providing us with insights into the possible effects of thyroid dysfunction. This talk takes a detailed look at hypothyroidism, hyperthyroidism, postpartum thyroiditis and thyroid cancer and the unique challenges each presents for lactation, and then discusses treatment strategies and interfacing with the health care team.

1 L Cerp (II, III)

• II Physiology and Endocrinology
• III Pathology

Irritable infants are commonly diagnosed with reflux, but might also be suffering from feeding-related difficulties or allergies. This presentation explores the recent research on regurgitation, reflux and GERD in infants and their relationship to feeding problems. Clinical evaluation and management of breastfeeding issues that can contribute to reflux are also covered.

 1.5 L Cerp (III, VI, VII)

• III Pathology
• VI Techniques
• VII Clinical Skills

We all have those clients who just seem to get the best of us, and we aren’t always sure why or what to do about it. This session explores who those people are, including situational issues (including Covid-19) and the impact of personality disorders on the helping relationship. Appropriate boundary-setting and proactive strategies are discussed to help the learner cope more successfully with these challenges.

1 L Cerp (V, VII)

• V Psychology, Sociology and Anthropology
• VII Clinical Skills

Health professionals, including lactation consultants, have a duty to practice in an evidence-based manner. The human brain is a marvel, but it conserves energy by automating tasks and simplifying analysis. This presentation explores the use and misuse of heuristics and evaluation of evidence in the formulation of clinical reasoning in health care professionals assisting breastfeeding families in the context of ethical practice. It includes strategies to improve the accurate interpretation of research and avoid cognitive errors in a ‘blame-free’ context. In addition, it reviews new information on genetic susceptibility to confirmation bias and basic information about the brain pathways involved.

1.25 E Cerp (VII)

VII. Clinical Skills