IBCLC Detailed Content Outline: Development and Nutrition / Infant Focused CERPs - Section I A
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Carole Hervé is a private IBCLC (since 2011). She helps breastfeeding mothers at home or location of their choice, mostly in Paris and in the nearest neighborhood.
Prior to opening her private practice, she has been a La Leche Leader since 2008. Carole is passionate about information-gathering, education, articles writing, communications and training to provide lactation consulting and sensitive support to the families she works with.
She has been trained to support families with Sensory Food Aversion issues by Catherine Senez, a speech therapist in 2013 and is also BNCLC (Biological Nurturing Certified Lactation Consultant®).
She has been a speaker at the GOLD Lactation Online Conference in 2012, and in 2013 she translated 20 presentations from the GOLD Lactation Online Conference into French.
Carole has been strongly involved in the coordination of the International Breastfeeding Day (Journée Internationale de l’Allaitement), an event organized by La Leche League France. Carole is the mother of three children born in 2001, 2003 and 2006.
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.
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COVID-19 Guidance for Maternal and Newborn Care: Who’s Doing What and Why
Karleen Gribble (BRurSc, PhD) is an Adjunct Associate Professor in the School of Nursing and Midwifery at Western Sydney University.
Her interests include infant and young child feeding in emergencies, marketing of breastmilk substitutes, parenting and care of maltreated children, child-caregiver and caregiver-child attachment, adoption reform, and treatment of infants and young children within the child protection, immigration detention, and criminal justice systems.
She has published research on these subjects in peer-reviewed journals, provided media commentary, contributed to government enquiries, provided expert opinion for courts, and engaged in training of health professionals, social workers, and humanitarian workers on these subjects.
Karleen is an Australian Breastfeeding Association Community Educator and Breastfeeding Counsellor. Since 2010 she has been a member of the Infant and Young Child Feeding in Emergencies Core Group and has been at the forefront of the development of policy, training and research in the area of infant and young child feeding in emergencies.
Topic: Infant and Young Child Feeding in Emergencies: Background, Best Practice, and What You Can Do - [View Abstract]
Topic: Milk Sharing: Comparative Risks and Biomedical Ethics - [View Abstract]
Where women are suspected or confirmed as having COVID-19, hospital practices have ranged from isolating infants from their mothers and proscribing the provision of expressed breastmilk to supporting mothers to have skin-to-skin with their infants, early initiation of breastfeeding, direct breastfeeding, and rooming in day and night.
This presentation will briefly summarize the evidence base for breastfeeding and close mother-infant contact in the COVID-19 pandemic. It will also describe the variance in government and professional development guidance around the world, anomalies in guidance, which guidance documents have had the most influence internationally, and provide examples of good and poor practice in guidance development. Finally, this presentation will discuss the importance of emergency planning for infant and young child feeding and the need to learn from the mistakes of the COVID-19 pandemic.
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Mohan Pammi is a professor and neonatologist at Baylor College of Medicine. He was the medical director for a large NICU at Texas Children's Hospital for more than 4 years. His research interests are neonatal infections, microbiome and evidence-based medicine. He is currently funded by National Institute Health for clinical studies on the perinatal microbiome in preterm neonates.
Covid-19 was declared a pandemic by the WHO in March 2020. As the medical community dealt with the implications of rapid spread and high mortality and morbidity of the infection, many changes focused on infection control became paramount in the neonatal intensive care unit including attendance at delivery. We will review the manifestations of covid infection in neonates, risks of vertical and horizontal transmission, its impact on the delivery of neonatal care including visitation policies, restrictions on parental visitations, personal protective wear, social distancing, virtual rounding, breastfeeding, universal surveillance and changes in workflow and costs in the NICU.
Current Trends in Identifying and Managing Neonatal Diabetes Mellitus
Tiffany Gwartney, DNP, APRN, NNP-BC, is an Assistant Professor at the University of South Florida (USF), College of Nursing. In addition to her neonatal clinical practice at Nemours Children’s Hospital in Orlando, Dr. Gwartney has been an Assistant Professor at USF since May 2015, where she has written and deployed experiential learning modules for the evidence-based practice course for undergraduates, integrated delegation simulations for undergraduate leadership students, and taught sim labs for the women, children & families course. Her most recent work was the implementation of a simulation regarding nursing interaction with a maternity couplet who was under airborne precautions, while in full personal protective equipment. This simulation was integrated into her COVID Care Education Module in which undergraduate students in their final practicum participated in a pilot program at designated clinical partner sites, providing bedside care for patients with COVID-19 disease. Her research interests include education, neonatal diabetes, role transition for novice Neonatal Nurse Practitioners (NNP), simulation, management of high-risk newborns in the delivery room, and couplet care for mothers with COVID-19. Dr. Gwartney has had several opportunities to speak internationally regarding the benefits of deliberate routine practice of high acuity, low-volume technical skills, and nationally regarding neonatal diabetes and conflict management. She is a member of Sigma Theta Tau (Iota Chapter) and is actively involved in several neonatal professional organizations: Florida Association of Neonatal Nurse Practitioners, Council of International Neonatal Nurses [education committee member], National Association of Neonatal Nurses [member], and The American Academy of Pediatrics [member, conference planning committee]. Dr. Gwartney enjoys traveling for pleasure but has also found herself working triage in a children’s clinic located in the remote village of Zapote, Guatemala, as well as educating NICU nurses in Paisley, Scotland and Shanghai, China.
Neonatal Diabetes Mellitus (NDM) is defined as persistent hyperglycemia (>200 mg/dL) that requires insulin treatment and occurs before six months of age (Habeb et al., 2020). While the incidence of neonatal diabetes is merely 1 in 90,000 to 160,000 live births, the rarity of this disease can make diagnosis challenging and potentially result in delayed treatment (Letourneau et al., 2017). Uniquely set apart from type I diabetes by its strictly genetic etiology, NDM can be associated with developmental delay and epilepsy (DEND). Insulin is a growth factor that is critical for optimal growth. Insulin dependence can be permanent or transient. Management of NDM includes insulin followed by stabilization using oral sulfonylureas (Hattersley et al., 2018). Positive outcomes are contingent upon early diagnosis, euglycemia, early interventions including multidisciplinary involvement, rehab services and parental support with regard to hypo/hyperglycemia management and insulin administration. The purpose of this presentation shall be to describe the etiology, pathophysiology and clinical presentation of NDM, discuss clinical management strategies, and recognize the importance of a multi-faceted, inter-disciplinary approach to caring for an infant with NDM.
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Differentiating Normal Newborn Weight Loss From Breastfeeding Failure
Micaela Notarangelo, PhD, IBCLC, RLC, obtained her IBCLC certification in 2010. She has a private lactation consultant practice in Lerici, Italy and takes a particular interest in everything that concerns breastfeeding science and medicine. From 1992 to 2001, Micaela lived in Japan, where in 1998 she earned a PhD in Economics at Hokkaido University, Sapporo. She also worked as assistant professor at Hokkaido University and Utrecht University. After returning to Italy, she became a La Leche League Leader in 2005 and was the Area Professional Liaison of LLL Italy from 2010 to 2013. In 2017, together with Chiara Toti, IBCLC, Micaela has developed a new two-day course for health care providers about breastfeeding support for babies with lip and/or palate cleft. The course has been held, with the financial support of Aismel, a parents' association, in several major Italian hospitals.
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.
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Disorganized Infant Feeding: Beyond Suck, Swallow, Breathe
Jada Wright Nichols is an Atlanta-based women’s wellness consultant. She graduated from Tennessee State University, with a bachelor’s degree in speech pathology and audiology. She has a master’s degree in occupational therapy and has worked in a variety of rehabilitation settings, across the life-span.
Additionally, she is a massage therapist, lymphedema therapist, holistic nutritionist, birth and postpartum doula, yoga instructor, and international board-certified lactation consultant (IBCLC). She is a lactation consultant at Children’s Healthcare of Atlanta, and the owner of Blossom Health and Maternal Wellness, and Bloom Early Intervention, which provide in-home and virtual services for new and expectant families, as they navigate various aspects of parenting, access, and equity.
Suck swallow breathe coordination is one of the earliest and most meaningful motor milestones of a developing infant. That level of coordination varies between breastfeeding and bottle feeding. Too frequently, if there are any challenges while feeding at the breast, bottle feeding is recommended, often without a complete assessment around the challenge itself. Infant feeding may be disorganized for one of a variety of contributing factors. It is important to be able to identify one or more of those factors, and to facilitate a solution, which may include seeking the insight and intervention of another allied health professional. Honing observation skills, incorporating diagnostic tools, and coordinating feeding assessments and protocols with specialists assist in preserving the initial breastfeeding relationship, with equity.
Kathryn Stagg is mum to 4 boys, twins and 2 subsequent singletons. She trained as a breastfeeding peer supporter and volunteered in the groups for years in and around Harrow, NW London, UK.
Kathryn caught the breastfeeding support bug and decided to further her knowledge training as a Breastfeeding Counsellor with the Association of Breastfeeding Mothers and then qualifying as an IBCLC 5 years ago.
Kathryn started Breastfeeding Twins and Triplets Facebook group almost 8 years ago and it now has over 9000 members. It has recently been made into a UK charity. Kathryn is passionate about delivering high quality breastfeeding support to as many twin and triplet families as possible, creating resources and educating health care professionals and breastfeeding supporters. She runs a small private practice and continues to teach music part time, her original career path. Kathryn is the author of Breastfeeding Twins and Triplets; a guide for professionals and parents.
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Topic: Don't Let Us Fool You: Breastfeeding in Late Preterm and Early Term Babies - [View Abstract]
Late preterm and early term birth is a barrier to establishing breastfeeding. These babies are often well enough to stay with their mothers and treated like a full term baby. Yet they are often sleepy, uncoordinated and inefficient at the breast leading to a higher chance of unstable blood sugar, weight issues, jaundice and low milk supply. This leads to a high rate of supplementation. Skilled breastfeeding support is the key to helping these babies breastfeeding effectively. This presentation will discuss anticipatory guidance in relation to an early birth, how to protect breastfeeding during the first few days and weeks, and how to move towards exclusive breastfeeding should supplementation be necessary.
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Donor Human Milk and Human Milk Products in the NICU
After 37 years as an attending neonatologist and 18 years as medical director of lactation services, Nancy retired from clinical practice 2019. She graduated from medical school and did her training in pediatrics at the University of North Carolina, Chapel Hill. She did her fellowships in Neonatal-Perinatal Medicine and ECMO at UCSD Medical Center in San Diego. She has been a board-certified lactation consultant since 1988.
Nancy co-founded the San Diego County Breastfeeding Coalition in 1994. She was the Breastfeeding Coordinator for AAP CA Chapter 3 from 1992 until 2020, Board Member of HMBANA 2015-2019 and established the first Donor Milk Depot in San Diego over 25 years ago. Nancy is a past president of the Academy of Breastfeeding Medicine. She wrote, and continues to update, the very first ABM Protocol on Hypoglycemia and Breastfeeding.
In 2014 Nancy was awarded the Golden Wave Award by the California Breastfeeding Coalition for her efforts to reduce obstacles to breastfeeding in California, and the WIC Breastfeeding Champion Award in 2017. She received AAP Special Achievement Awards in 1997 and 2021 for her breastfeeding education and promotion efforts.
On a personal note, she is the mother of a (formerly breastfed) archaeology student and lives in San Diego, CA, with her significant other, their dog, Darwin, and a beautiful view of the ocean.
Topic: NICU Nutrition: Best Practice for Best Outcomes - [View Abstract]
Topic: NICU Nutrition: Current Status, Opportunities & Challenges - [View Abstract]
The preferred feeding for all NICU infants is human milk, preferably started on day 1. If mother’s own milk is not immediately available, the clinician should consider the use of heat-treated donor human milk (DHM), which has most of the properties of fresh human milk (immunoglobulins, growth and developmental hormones, enzymes, anti-inflammatory factors, etc.), is sterile, and reduces NEC while improving feeding tolerance. The use of human milk and human milk-derived products has been steadily increasing in world-wide NICUs. In many areas of the USA, it is the standard of care. We will explore the benefits and risks of various donor human milk products, as well as the cost-effectiveness, and challenges for NICUs in using these products.
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Early Breastmilk Exposure and Later Cardiovascular Health in Premature Infants
Prof EL-Khuffash is a Consultant Neonatologist and Paediatrician. He is a qualified International Board Certified Lactation Consultant. His two primary clinical and research areas of expertise are heart function in neonates and the promotion of breast feeding, and breast feeding support, to new mothers. He also has extensive expertise in general feeding issues encountered by babies over the first few months.
Prof EL-Khuffash sees families for prenatal breast feeding and fetal anomaly consultations and postnatal infant assessment, 2 and 6 week checks, and breastfeeding/general support including early irritability and reflux in his consultation rooms in the Rotunda Private Clinic.
Prof EL-Khuffash has considerable knowledge of breast feeding medicine and experience in providing antenatal and postnatal breast feeding advice and support to new mothers. This includes identifying and addressing challenges to breastfeeding in both the mother and the baby. He also specialises in general feeding difficulties and early feeding issues encountered by babies.
Prof EL-Khuffash graduated from Trinity College, Dublin in 2002 and enrolled in the Royal College of Physicians of Ireland paediatric specialist training scheme in 2005. He completed a Doctor of Medicine (MD) degree in University College, Dublin in 2008 and his neonatal specialty training in Toronto, Canada (2009-2011). Following this, he was appointed as a consultant Neonatologist and Assistant Professor of Paediatrics at the University of Toronto in January of 2011. He obtained a diploma in clinical epidemiology during his time in Toronto. He is the recipient of several national and international research awards, with international peer reviewed publications and keynote presentations and the lead for cardiovascular research, supervising several post graduate PhD candidates.
Topic: Mother's Own Milk Versus Donor Human Milk in the NICU: Practical Recommendations for Individualized Care - [View Abstract]
Premature infants have impaired cardiovascular function that persists into adulthood. Preterm infants exhibit impaired systolic and diastolic dysfunction that is intolerant of the adverse loading conditions experienced during the early neonatal period. Young adults born premature demonstrate a unique cardiac phenotype characterized by reduced biventricular volume, relatively lower systolic and diastolic function, and a disproportionate increase in muscle mass. This may clinically manifest by an increased risk of cardiovascular incidents, hypertension, and reduced exercise tolerance. Those consequences appear to result from early postnatal cardiac remodelling due to premature birth and associated comorbidities. Recent evidence suggests that early exposure to breast milk slows down or even arrests those pathophysiological changes, thereby mitigating the long-term adverse effects of premature birth on cardiovascular health. In this presentation, I aim to demonstrate the vital role of early breast milk exposure in preventing cardiovascular disease in preterm infants. We will explore the emerging evidence and examine the possible mechanistic pathways mediating this phenomenon.
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Nim Tottenham, PhD is a Professor of Psychology at Columbia University and Director of the Developmental Affective Neuroscience Laboratory. Her research examines brain development underlying emotional behavior in humans. In particular, her laboratory investigates the interplay between brain development and caregiving experienced by humans. Her research has highlighted fundamental changes in brain circuitry across development and the powerful role that early experiences, such as caregiving and stress, have on the construction of these circuits. She has authored over 130 journal articles and book chapters. She is a frequent lecturer both nationally and internationally on human brain and emotional development. She is a Fellow of the Association for Psychological Science and of the Society for Experimental Psychologists, and her scientific contributions have been recognized by the National Institute of Mental Health BRAINS Award, the American Psychological Association’s Distinguished Scientific Award for Early Career Contribution to Psychology, and most recently by the National Academy of Sciences Troland Research Award and the Flux Congress Linda Spear Award.
Human brain development is very slow, but there is value to this slow pace. This pace maximizes the chances for learning from developmental experiences (for example, caregiving by parents) and by doing so, developing highly sophisticated emotional behaviors by adulthood. Brain circuitry involving the amygdala and medial prefrontal cortex (mPFC) support fundamental aspects of emotional behavior (learning about, responding to, and regulating emotions), and in this talk, I will present studies that describe their development, including functional magnetic resonance imaging data showing age-related changes in amygdala-mPFC circuitry. I argue that the development of this circuitry in humans is intimately associated with caregiving, such that parents exert significant and enduring neural modulation during development.
The findings presented are highly consistent with the animal literature showing both large changes in amygdala-mPFC circuitry throughout development, as well as the large influence of parental care in shaping this neural circuitry. This talk will focus on both typical development as well as development following caregiving-related stress showing that early life environments may influence development through learning and modification of developmental trajectories. These age-related changes will be discussed in terms of potential developmental sensitive periods for environmental influence.
