IBCLC Detailed Content Outline: Development and Nutrition Focused CERPs - Section I

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.

Preterm infants are at increased risk for impaired neurodevelopmental outcomes (Stoll et al, 2010). There is evidence supporting the differences in outcomes related to how we provide care to preterm infants and the effects of the environment in which the care takes place. One of the most effective ways to reduce impaired infant outcomes is inviting parents to actively participate in care activities and provide Kangaroo Care (Boundy et al., 2016; Charpak et al., 2017). Despite international recommendations, empirical evidence, and an implementation science project focused on strengthening Kangaroo Care in neonatal intensive care units in British Columbia, Canada, implementation has been slow due to various barriers to uptake (Charpak et al., 2020; Coutts et al., 2021; WHO, 2020). A ‘one size fits all’ approach cannot guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers. The uptake of Kangaroo Care relies on the involvement of parents and healthcare providers and their understanding and commitment to the evolving paradigm shift in neonatal care. This transition requires environmental and social supports, systems level change of philosophies of care, and assistance for healthcare providers to recognize their changing role.

This session focuses on supporting parents who are breastfeeding/chestfeeding beyond 12 months. Many of us live in countries where breastfeeding beyond 12 months is not the norm. When it does happen, it may not happen openly. Parents are often feeling increasingly isolated and may be dealing with lack of support from family and friends. There can be further challenges such as new issues with positioning and attachment, conversations with employers and health professionals, dealing with family break-up and thinking about new pregnancies. Parents continuing to feed older children may not always feel able to reach out to local breastfeeding support services that often focus on the newborn period. You will be encouraged to reflect on your personal approach to supporting feeding older children and whether you have any unconscious or conscious bias that may affect your work. The session will give you confidence to discuss the value of continuing to breastfeed with families and colleagues and be able to offer a variety of support.

Long NICU stays, invasive oral procedures, chronic lung disease, and gastrointestinal complications can contribute to a complex oral feeding journey for premature infants. Frequently, the NICU journey prioritizes bottle feeding over breast feeding. Breastmilk supply and transfer are challenging for mothers and infants born very premature. At the time of NICU discharge, most very premature infants remain fragile oral feeders with weak breast-feeding and bottle-feeding skills, and some require tube feeding support. Community-based breastfeeding support is often lacking, and breastmilk intake and direct breastfeeding diminish beyond discharge. The authors will highlight four remarkable case studies of very premature newborns who were discharged home on nasogastric tube feeding. All four babies had a complex oral feeding journey in the NICU with minimal opportunity to develop breastfeeding skills. Parent comments will be shared, including barriers and facilitators for breastfeeding. Take away messages will focus on helpful strategies to support families taking home a fragile feeder and progressing toward positive, enjoyable oral feedings and more importantly, weaning from tube support and advancing breastfeeding.

Many preterm infants remain vulnerable following discharge from the neonatal intensive care unit (NICU). Health challenges persist beyond the NICU including respiratory illness, breastfeeding progression, bottle feeding incoordination, behavior and development issues, impaired growth, infrequent stooling, and gastroesophageal reflux. Preterm infants are up to two times more likely than full term infants to be hospitalized in the first year of life. Parents are challenged to transition their premature baby home and to keep them home!

Community-based, specialized follow-up services following NICU discharge have a powerful impact. The Neonatal Transition Team in Calgary, Alberta, Canada provides post-NICU follow-up for very-low-birth-weight infants and their families. The team consists of community health registered nurses with advanced skill in premature infant outcomes, feeding and neurodevelopmental assessment, and a consultation partnership with nutritional and feeding specialists. While home visits have been the backbone of this service, the team questioned the feasibility and acceptance of virtual care and completed a three month quality improvement pilot. This virtual care pilot demonstrated optimization of health-care resources by providing safe, high-quality care at a reduced operational cost. The pilot was instrumental in the team’s management during the SARS-COVID-19 pandemic. Virtual care has been fully operationalized into the service delivery model and expanded to serve other newborns with feeding or growth challenges.