IBCLC Detailed Content Outline: Development and Nutrition Focused CERPs - Section I
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A Neuroprotective Approach to Reduce the Risk for Intraventricular Hemorrhage (IVH) In ELBW Neonates

Sandy Jose, DNP, APRN, NNP-BC is a board certified Neonatal Nurse Practitioner (NNP) in the Level IV Neonatal Intensive Care Unit (NICU) at Texas Children’s Hospital. She completed her NNP education at Rush University in Chicago and her DNP at UT Cizik School of Nursing in Houston. Her passion for quality improvement has helped improve neurodevelopmental outcomes for preterm neonates by reducing the risk for intraventricular hemorrhage (IVH) through the establishment of her “Mindful of Preemies” protocol. She was also a key stakeholder for the development of Neuro-Protective Guidelines for the Small Baby Unit (SBU) Program for Extremely Low Birth Weight (ELBW) neonates. In addition, she continues to actively participate in various QI initiatives within the NICU.
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.

Addressing Pediatric Dental Health Concerns of Breastfeeding Families

Joy MacTavish, MA, IBCLC, RLC, ICCE is an International Board Certified Lactation Consultant, Registered Lactation Consultant. She is the owner of Sound Beginnings, which provides in-home consultations and education on lactation, babywearing, and more. Her background as a birth and postpartum doula, and childbirth, newborn, and parenting educator, inform her compassionate and evidence-based support of new families in the greater Seattle area. Joy holds a Master of Arts in Cultural Studies, graduate certificate in Gender, Women and Sexuality Studies, and two Bachelors degrees from the University of Washington. She serves as adjunct faculty at the Simkin Center for Allied Birth Vocations at Bastyr University where she created the Breastfeeding for Doulas course. Joy is passionate about her family, social justice, and continuing education.
Topic: Full-Term Breastfeeding/Chestfeeding: Benefits, Considerations, and Ways to Offer Support - [View Abstract]
Topic: Mindful Breastfeeding: How Lactation Professionals Can Support Calm and Connection - [View Abstract]
Topic: Sending Reports: What’s in it for IBCLCs? - [View Abstract]
Topic: Supporting Clients Facing Fertility Treatment - [View Abstract]
Topic: Weaning: Supporting Families Stopping Lactation and/or Ending Their Breastfeeding/Chestfeeding Relationship - [View Abstract]
Dental caries are the most common chronic infectious disease of early childhood and new recommendations urge families to seek pediatric dental care at a younger age. For families who are practicing full-term breastfeeding and/or nocturnal breastfeeding (night-nursing), many are also reporting increased pressure to night-wean, wean completely, or otherwise incorporate care that is often not practical or evidence-based. A clear understanding of the research and realities of breastfeeding and the risks of dental caries, along with advocacy skills, are integral for breastfeeding families feeling confident in their breastfeeding relationship and their dental care. This presentation will compare the latest research and recommendations from the dental and lactation fields, as well as outline support strategies for assisting lactation clients as they understand the relevant information, communicate with their dental professionals, and make informed decisions about their breastfeeding relationships.

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Marion Rice, Ed.D., IBCLC is the Executive Director of the Breastfeeding Coalition of Oregon (BCO). BCO is the statewide entity that serves to build and link families, community partners and geographic and culturally specific coalitions to support, promote and protect breastfeeding in Oregon. The Breastfeeding Coalition of Oregon works to address the Surgeon General's Call to Action to Support Breastfeeding by working to provide technical assistance, support and training to 20 (and more emerging) breastfeeding coalitions throughout the state. Marion is working to understand and address the impact of racial inequity on breastfeeding support and on helping all families reach their breastfeeding goals to improve the lifelong health of their babies. She sees breastfeeding as a social justice issue, and tries to reveal and address public policy and practice that inadvertently discourage women from reaching their breastfeeding goals and helping to maintain family economic security. Marion believes breastfeeding is unifying and builds cultural bridges and personal relationships for deeper personal understanding of the commonalities of the human experience.
Kimberly Seals Allers is an award-winning journalist and a leading commentator, speaker and consultant on breastfeeding issues, with an expertise in African American women and racial disparities in breastfeeding. As a consultant and speaker, Kimberly works with organizations looking to better understand the cultural barriers and community influences that impact breastfeeding continuation rates in vulnerable communities. She is also the founder of Shift Strategies, a health communication consulting firm helping organizations increase programmatic outcomes with more effective communication strategies. Kimberly has designed and developed strategic messaging campaigns and exploratory community-based projects examining the role of “place” in breastfeeding success and pioneered the concept of “first food deserts” and “First Food Friendly” communities. She is the director of The First Food Friendly Community Initiative (3FCI), a W.K. Kellogg Foundation funded pilot program to create and accredit breastfeeding-supportive community environments. A former writer at Fortune and senior editor at Essence magazine, Kimberly is an IATP Food & Community Fellow, connecting the “first food” to the broader food movement. Kimberly was also selected as a lead commentator for the United States Breastfeeding Committee’s “Break Time for Nursing Mothers” federal campaign. Previously, she served as the editorial director of the Black Maternal Health Project of Women’s eNews. Kimberly fifth book, The Big Let Down—How Big Business, Medicine and Feminism Undermine Breastfeeding will be released in July 2016 by St. Martin’s Press.
This session will look at challenges to reducing the barriers to greater availability of banked human milk within the context of breastfeeding inequities, disparities in birth outcomes and the state of motherhood in the United States. The session will provide participants with understanding of the evidence around the inequities in preterm birth and infant mortality rates of specific cultural groups and the importance of advancing human milk banking and breastfeeding as a primary strategy for improving the health of the most vulnerable citizens, babies through an equity lens.

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Ratih Ayu Wulandari, MD, IBCLC is a breastfeeding mother of two. She applied baby led weaning method for her two babies while continue breastfeeding and get many benefits from the method. As lactation consultant she gives breastfeeding counseling and complimentary feeding either with spoon feeding or baby led weaning approach for family who wish to know more and practice it. Experienced breastfeeding her two tongue-tied babies, helped her understand the pain and support early frenotomy. She is now practicing frenotomy for tongue-tie and lip-tie. She believes attachment parenting is the best way to nurture a child and shares her thoughts on her blog http://www.menjadiibu.com.
Complementary feeding is a process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants and therefore other foods and liquids are needed along with breast milk typically covers the period from 6 - 24 months of age. Baby-Led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. The BLW infant also shares family food and mealtimes and is offered milk (ideally breast milk) on demand until they self-wean. In Indonesia, this method of feeding has becoming popular lately and be a controversy in Indonesian traditional spoon feeding culture. This presentation will present 10 cases of BLW in Indonesia with different settings. It shows baby who was breastfed, have a well educated and stayed at home mother will be more successful in this method of feeding.

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Beyond Baby Friendly, Thinking Outside the Box

Dr. Jane Morton has had a long, fulfilling career as a general pediatrician, She has also had a long-standing interest in breastfeeding, from understanding its clinical benefits to practical solutions for mothers having difficulty in providing breastmilk to their infants. Over the years, she has conducted research on human milk and breastfeeding and has designed and implemented systems and policies to help breastfeeding mothers. She produced award winning videos on this topic, including “Breastfeeding: A Guide to Getting Started”, “A Preemie Needs His Mother: Breastfeeding a Premature Baby” and “Making Enough Milk, the Key to Successful Breastfeeding”. These have been translated and widely used in thousands of hospitals to train both staff and new mothers. As an executive board member of both the Academy of Breastfeeding Medicine and the American Academy of Pediatrics Section on Breastfeeding, she enjoyed working to enlarge the footprint of breastfeeding, both nationally and internationally.
For a 5 year period, she joined the neonatology clinical faculty at Stanford to develop the Breastfeeding Medicine Program. In that position, she had the opportunity to design a nationally recognized educational program, conduct and publish original research on milk production and composition in mothers of very low birth weight infants, and publish a study with the AAP on the efficacy of a breastfeeding curriculum for physician residents in training. She was an advisor to the California Perinatal Quality Care Collaborative, and was a key author of the toolkit “Nutritional Support for the Very Low Birth Weight Infant”. She co-authored the book Best Medicine: Human Milk in the NICU. She has published extensively and presented her original research and educational workshops internationally. She continues to teach at Stanford where she is an Adjunct Clinical Professor of Pediatrics, Emerita.
Topic: First Touch, First Food, First Hour …in a mother’s hands - [View Abstract]
Complications of insufficient milk production and suboptimal intake account for delayed discharge, readmission, potentially serious medical complications and a sharp drop off in any breastfeeding before 1 month. Reframing lactation support based on prevention, accessibility and sustainability, we could logically reduce these complications, while increasing exclusive breastfeeding rates for both low and at-risk infants. Recent science supports the importance of beginning this support for all mothers in the first post delivery hour, to prevent what might be called, “the lost first hour syndrome”.

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Beyond the Basics of Latch: Support Strategies for Helping Babies when the Basics Aren’t Enough

Melissa Cole is a board-certified lactation consultant, neonatal oral-motor assessment professional and clinical herbalist in private practice. Melissa is passionate about providing comprehensive, holistic lactation support and improving the level of clinical lactation skills for health professional. She enjoys teaching, researching and writing about wellness and lactation-related topics. Her bachelor’s degree is in maternal/child health and lactation and her master’s degree is in therapeutic herbalism. Before pursuing her current path, Melissa’s background was in education and cultural arts, which has served her well in her work as a lactation consultant and healthcare educator. She loves living, working and playing in the beautiful Pacific Northwest with her 3 children.
Topic: Beyond Fenugreek: An Individualized Approach to Dietary and Herbal Galactagogues - [View Abstract]
Topic: Beyond the Basics of Latch: Support Strategies for Helping Babies when the Basics Aren’t Enough - [View Abstract]
Topic: Common Infant Digestive Health Concerns and Useful Support Strategies - [View Abstract]
Topic: Connection and Care: Virtual Support for Tongue-Tied Infants - [View Abstract]
Topic: Infant Oral Assessment: Exploring Anatomy and Function Beyond the Frenulum - [View Abstract]
Topic: Low Milk Production Detective Work: Assessment and Care Plan Considerations - [View Abstract]
Topic: New Thoughts on Infant Pre and Post-Frenotomy Care - [View Abstract]
Topic: Thinking Critically About the Use of Clinical Lactation Tools - [View Abstract]
Topic: Will it hurt? Frenotomy aftercare strategies to optimize healing outcomes for the newborn - [View Abstract]
In a perfect world, every baby would latch beautifully right after delivery and breastfeed happily ever after. In reality what we often see is that most moms and babies need a little help to get breastfeeding off to a good start. Many dyads need a lot of help. And a few mother/baby pairs need a miracle to breastfeed successfully. How can we best help those tough cases? There are many reasons babies struggle to latch and feed well. Some issues may include structural issues, physical discomfort, respiratory concerns, medical issues, digestive issues, poor feeding tool choices, prematurity, etc. Many providers are frustrated when they are unable to help a dyad latch and feed successfully. This presentation will covers some reasons why babies struggle to latch and breastfeed well. We will go over cases that portray challenging situations and the assessment techniques and care plan strategies that helped. This session is designed to help providers implement critical thinking skills in order to think outside the box when it comes to difficult cases.

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Biomechanics of milk extraction during breast-feeding

David Elad is a Professor of Biomedical Engineering at Tel Aviv University since 1985. He received his B.Sc. in Mechanical Engineering on 1973, M.Sc. and D.Sc. in Biomedical Engineering on 1978 and 1982, all from the Technion, Haifa, Israel. He was then awarded the Rothschild and Bantrell post-doctoral fellowships at Imperial College London and M.I.T.
David pioneered computational studies of biofluid transport phenomena in the nasal cavity in the late 80's. In the early 90's he established a comprehensive research program in bioengineering of human reproduction, both at Tel Aviv University. He developed his expertise in the fields of Respiratory Biomechanics and Reproductive Bioengineering, from complete organs all the way to the cellular levels. The respiratory studies included integrative assessment of respiratory muscles, transport phenomena in the human nose, objective noninvasive evaluation of nasal function and mechano-transduction of nasal epithelial cells cultured under air-liquid interface conditions, including effects of air-pollution. The reproductive studies included the role of uterine peristalsis in early human life, pre-implantation embryo transport after IVF, feto-maternal blood circulations in the placenta, transport of nutrition, pharmaceuticals and carcinogenic materials across a tissue engineered placental barrier, mechano-transduction of cultured ovarian cancer cells and biomechanics of infant breastfeeding. He published over 120 articles in peer-review journals and was the leading editor of 5 special journal issues in reproductive bioengineering, respiratory biomechanics and biofluid mechanics.
David has been a visiting scholar at Imperial College London, Massachusetts Institute of Technology, Northwestern University, Nagoya Institute of Technology, Drexel University, Georgia Institute of Technology, University of Toronto, City College New York and Columbia University. He is a member of the World Council for Biomechanics (2002-14) and a fellow of the American Institute for Medical and Biological Engineering (2004), the Biomedical Engineering Society, USA (2005) and the International Academy of Medical and Biological Engineering (2013).
Dr. Elad is currently on sabbatical leave from Tel Aviv University and affiliated with the Department of Biomedical Engineering of Columbia University.
The physical mechanisms executed by the infant during breastfeeding have been intriguing topics that lead to a long scientific controversy; whether it is sucking of the milk or mouthing of the nipple/areola. We developed a dynamic analysis of ultrasound video clips acquired during breastfeeding in order to explore the kinematics of the tongue. Then, we have developed a three-dimensional biophysical model of the breast and lactiferous tubes that enabled mimicking latch-on and the dynamic characteristics of the tongue and nipple observed in ultrasound imaging during breastfeeding. Then, we simulated breastfeeding and explored the biomechanical aspects of breastfeeding. We demonstrated that latch-on to draw the nipple/areola into the infant mouth, as well as milk extraction during breastfeeding, require development of time varying sub-atmospheric pressures within the infant's oral cavity. Analysis of infant tongue motility was compared between breast and bottle feeding. The presentation will also include discussion of oral pressure measurements.


Diana West is an IBCLC in private practice. She is the co-author of “Sweet Sleep: Naptime and Nighttime Strategies for the Breastfeeding Family,” the 8th edition of La Leche League International’s “The Womanly Art of Breastfeeding,” “The Breastfeeding Mother’s Guide to Making More Milk,” the clinical monograph “Breastfeeding After Breast and Nipple Procedures,” and ILCA’s popular “Clinician’s Breastfeeding Triage Tool.” She is the author of the “Defining Your Own Success: Breastfeeding After Breast Reduction Surgery.” She is on the Editorial Review Board for the “Journal of Clinical Lactation,” a La Leche League Leader and the Director of Media Relations for La Leche League International. She has a bachelor’s degree in psychology and is the administrator of the popular BFAR.org, LowMilkSupply.org, and LactSpeak.com websites. She lives with her three sons and one husband in the picturesque mountains of western New Jersey in the United States.
Topic: Mothers Speak Out: Top Five Traits of a Great Lactation Consultant - [View Abstract]
Topic: Postpartum Nipple Pain: Causes, Treatments, and Empathy - [View Abstract]
Topic: Sweet Sleep: Bedsharing for Breastfeeding Mothers and Babies - [View Abstract]
This session presents a detailed discussion of breast assessment techniques and criteria, with photos contributed by colleagues around the world.

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Breast Milk and Sleep: Circadian Rhythms in Human Milk

Briana Tillman received her undergraduate degree in International Relations from the United States Military Academy at West Point. She has been a La Leche League Leader for 9 years and is a board certified lactation consultant. After spending 10 years as a stay-at-home mom, she is currently attending medical school at Rocky Vista University College of Osteopathic Medicine in Parker, Colorado. She loves spending time with her husband and three elementary-school-aged children—as a family they like to play board games, go camping, and play bluegrass and chamber music.
Topic: Breast Milk and the Microbiome - [View Abstract]
Many of us are aware of human milk’s amazing ability to provide for our infants’ changing nutritional needs with age. Recent research suggests that its composition shifts in synch with mom’s circadian rhythms as well, giving breastfed babies a leg up in neurological development, chrononutrition and sleep patterns. This presentation discusses the diurnal cycles of the following breast milk components: wakefulness vs. sleep-inducing amino acids, hormones (such as melatonin), trace elements, and even some nucleotides. Clinical implications include improving use of pumped breast milk. The presentation concludes with a brief look at other factors related to breastfeeding and infant sleep, including SIDS rates, skin-to-skin, and room sharing.

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Breastfeeding Medically Complex Infants in the Neonatal ICU

Amber Valentine Forston is a Speech-Language Pathologist who graduated from the University of Kentucky with her MS in Communication Disorders. She is a Board Certified Specialist in Swallowing and Swallowing Disorders and an International Board Certified Lactation Consultant, as well as a Certified Neonatal Therapist (CNT). She worked for Baptist Health Systems, Inc for 8 years before moving to Florida where she worked for Wolfsons Children’s Hospital and Mayo Florida. She is now back in Kentucky working for Baptist Health Lexington. She has experience in adults and pediatrics with feeding and swallowing difficulties including: bedside swallow evaluations, Modified Barium Swallow studies, FEES, and pediatric feeding evaluations including NICU. She has experience with head and neck cancer patient including evaluation and treatment of swallowing difficulties, PMV use, and voice after total laryngectomy including TEP. She has provided guest lectures for the University of Kentucky, Eastern Kentucky University, and the University of Louisville on feeding and swallowing topics. She has presented at the hospital, local, state, national, and international levels on pediatric feeding/swallowing and breastfeeding.
Topic: Breastfeeding Medically Complex Infants in the Neonatal ICU - [View Abstract]
Feeding is the most complex task of infancy, even in term babies with no complications. There are many diagnoses, conditions, syndromes, and co-morbidities that can impact feeding in neonates and infants. This talk will briefly highlight many of those, but we will focus on three specific populations of interest –Cleft lip and palate, Infants of Diabetic Mothers, and Down Syndrome. We will discuss the specific implications these conditions can have on feeding, why these infants may have difficulty, and the classic symptoms one could expect to see. The differences between delayed and disordered feeding will also be addressed. Strategies and adaptions for both breast and bottle feeding will be discussed. Positioning, nipple flow rate, and external strategies will be explained. Case studies will be shared at the end of the presentation.

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