IBCLC Detailed Content Outline: Pathology / Infant Focused CERPs - Section III A

Cranial Nerve Dsyfunction, CND, is a term used to describe a disruption, dysregulation or dysfunction in one or more cranial nerves in the precrawling period. Cranial Nerves are twelve, paired nerves, ten of which originate in the brainstem. They mediate all incoming sensory input and also help regulate, move and maintain the health of the muscles of the face, head, neck, jaw, tongue and throat. From sensing mother’s smell, touch, taste to rooting, latching and coordinating suck/swallow/breathe patterns, optimal cranial nerve function is paramount. Lactation consultants need to be able to identify CND, identify a couple of treatment interventions and know when to refer to appropriate health care professional such as OT, PT, Speech, or Manual Therapist/Bodyworker. CND explains how many tongue/lip tied babies who have had a frenotomy continue to struggle significantly with the activities and movements of optimal breastfeeding. Michelle will cover the basics of CND, a simple classification system, and her 4 Principle Functional Movement Protocol, which she states can optimize cranial nerve function in the precrawling baby and improve breastfeeding outcomes.

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.

Colic and allergy symptoms are problems commonly encountered in newborns exclusively receiving human milk, and are thought to be triggered by inflammatory responses in the gut. Maternal diet, especially cow’s milk intake, has been associated with infantile colic and allergies, but no previous studies have examined the effect of a Mediterranean diet. Thus, this new research aims to investigate whether maternal adherence to a dairy-free Mediterranean diet, known for its anti-inflammatory properties, reduces colic and allergy symptoms in infants exclusively fed human milk. This presentation will discuss the methodology of this recent study and present the results of the Mediterranean diet on allergy symptoms and average daily crying of infants.

Intraventricular hemorrhage (IVH) is a devastating and debilitating diagnosis commonly seen in premature neonates. Statistics indicate that 45% of extremely premature infants with very low birth weight develop IVH within the first week of life. IVH is associated with numerous acute and long-term neurologic and psychiatric complications. Additionally, it has led to a progressive increase in hospital costs and length of hospitalization.

IVH is multifactorial, but it is primarily attributed to the intrinsic fragility of the germinal matrix vasculature from prematurity and disturbances in the cerebral blood flow (CBF) from commonly seen complications in premature neonates. Seminal research studies support neurodevelopmental positioning (NDP) of high-risk preterm infants as a postnatal preventive approach to reduce the risk for IVH. Hospitals with low IVH rates utilize NDP.

This session will focus on functional assessment and treatment of tethered oral tissue in the breastfeeding infant. Participants will understand the importance of task analysis of the motor skills to support sucking, prior to referring an infant for a release. Post op treatment has focused on active wound management (Ghaheri, B. 2017) rather than neuromuscular re-education. This approach multidisciplinary approach encourages lactation consultants to partner with body works specialists and speech pathologists to develop the underlying motor skills to support sucking.

Advanced Breastfeeding Case Reports will cover 4 unusual situations in a format that will allow you to use your skills to discover the ultimate outcome. One part of the excitement of our field is being detectives. These 4 cases will challenge your detective skills.

This study aims to show a correlation between aerophagia in infants with tethered oral tissues (TOT’s) consisting of ankyloglossia and shortened maxillary labial frenula (tongue and lip-tie) and reflux. Currently there is little to no data on aerophagia as a possible cause of reflux in infants. Infants with tongue and possibly lip tie often have a poor latch in which there is often an inadequate seal around the breast and inefficient transfer of milk. As a result many of these infants swallow air during breastfeeding. Many of these infants suffer from symptoms of reflux. This study and results to demonstrate a correlation of ankyloglossia and shortened maxillary labial frenula with aerophagia and reflux.Treatment of these infants with a relatively simple frentomy procedure may reduce or eliminate reflux in this population.

Oral ties are often diagnosed and released during infancy to improve the breastfeeding relationship between mother and baby. But what happens if ties go undiagnosed? This course will review tethered oral tissues and their relationship in a breastfeeding dyad and the neurodevelopment of an infant and beyond. We will explore the implications of oral restrictions on the myofascial system throughout the body. Movement patterns, posture, and primitive reflex integration can all be affected by oral ties. Signs, symptoms, assessment tools, and strategies for co-management between IBCLC and bodyworkers will be discussed. Attendees will also learn neuro-biomechanical implications of TOTs beyond breastfeeding. Several case studies will be discussed and how successful management can be achieved with a team approach.

Ankyloglossia is an embryologic variation of the lingual frenulum, which causes a significant restriction in the mobility of the tongue. As such, an altered lingual function is always an essential consideration when faced with breastfeeding challenges. On some occasions however, other anatomic or functional alterations in the babies’ orofacial region can cause breastfeeding problems, similar to those seen in tongue-tie babies. They can be the root of latch difficulties, nipple trauma and/or suction and deglutition issues. In these cases, frenotomy does not solve those problems and therefore, the misdiagnosis and posterior surgical treatment can frustrate parents. From a pediatric dentist perspective, retrognathia (recessed chin) and hypotonia are two common differential diagnosis of tongue tie, which can affect a babies’ suction at the breast. The aim of this talk is to present normal and abnormal orofacial structures so as to differentiate ankyloglossia from two problems that can be part of a “faux tie”, in order to aid breastfeeding consultants, and broaden their perspective on breastfeeding difficulties.

Early- and late-onset sepsis is a significant cause of morbidity and mortality in neonates. However, prolonged antibiotic administration alters the microbiome and increases the risk of necrotizing enterocolitis, sepsis, and death in very low birth weight infants and in late preterm and term infants adverse effects include ototoxicity, nephrotoxicity, increased bacterial resistance, and unnecessary costs. Empiric antibiotic therapy for early-onset sepsis and routine Vancomycin usage for late-onset sepsis was a common practice for neonates at this neonatal intensive care unit. Also, antibiotic stewardship in early- and late-onset sepsis management in the NICU posed unique challenges due to variability in provider practices. In this presentation the Model for Improvement quality improvement methodology and three quality improvement projects with a global aim to reduce antibiotic usage will be presented.