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

Interoception is a term used to describe our nervous system's awareness of the sensations from the gastrointestinal and visceral system, as well as the primary sensory part/input to baby's Autonomic Nervous System. ANS function and regulation underlay all automatic processes of the body, from heart beat to breastfeeding and digestion function, as well as maintaining a calm state in order to engage in social interaction or to transition easily in and out of sleep. More simply put, interoception is "feelings from the body". In addition to visceral information, interoceptive pathways carry information related to affective touch, itch, temperature and pain and are delivered to a separate area of the brain, the insular cortex, which also contains a map of the body, similar to the well known homunculus. Interception plays a large role in dynamic equilibrium and autonomic regulation of tissues of the body. Interoceptive information and the processing is the basis of all important activity to optimize energy utilization. This system is often compromised in babies who present with complex oral dysfunction, tethered oral tissues, postural asymmetries, fussiness, gas, reflux or other dysregulation in function. How babies feel is mirrored in how they function, compromised function equals compromised interoceptive processing. This talk covers the basics of this system and practical clinical applications for precrawling babies to optimize neurodevelopment and breastfeeding abilities.

Breast is best! We all know that; however, often parent and child struggle so much at the beginning that breastfeeding either isn’t possible or the parent becomes discouraged and gives up. When feeding challenges occur, sometimes the problem is not with the mother’s technique, but rather with the baby himself- barriers within the alignment and tone of his body causing abnormal function and preventing normal breastfeeding. There can also be tethered oral tissues present (tongue or lip ties) causing even more dysfunction. This presentation focuses on: (1) why breastfeeding is best- nutritionally and neurologically; (2) The cause of imbalance- The birth process; (3) the importance of the integrative collaboration of therapists- i.e. the LC, DDS, chiropractor and/or cranial therapist.

This presentation will discuss the difficulties that surround defining and assessing for tongue-tie. It will explore what we know about the role of the tongue in infant feeding by reviewing evidence from ultrasound studies and other research on latch and examining what this tells us about the normal functioning of the tongue. Various available assessment tools will be described along with how these may assist in differentiating between a normal and abnormal lingual frenulum. Also discussed will be other causes of tongue restriction and how to differentiate these from an abnormal lingual frenulum.

The presentation will cover current evidence of suboptimal practice in terms of fathers expereinces within maternity and neonatal services, our specific recommendations to improve practice and my development of DadPad Neonatal as a specific resource to improve experiences of fathers.
We have reviewed the literature on engaging fathers in neonatal units, with the aim of making recommendations for improving experience of fathers as well as health outcomes in neonatal practice. Fathers typically describe the opportunity to bond with their babies in glowing terms of gratitude, happiness and love. These experiences are underpinned by hormonal and neurobiological changes. We find that engagement with fathers remains sub-optimal. Fathers, also, are subject to different social expectations from mothers, which shapes how they respond to the situation and how neonatal staff treats them.
We have put forth 3 core principles and 12 practical recommendations for neonatal teams to focus on.

A growing body of work supports the lactation care provider in assessing, referring, and infant feeding after a revision of oral restrictions; far less has been said regarding ongoing lactation care when revision is not part of the plan in the short- or long-term. Whether because revision services are unavailable, inaccessible, or not desired by parents, the dyad that includes a baby with non-revised oral restrictions will require a customized plan to avoid problems of lactation related to infants with oral restrictions. This presentation will equip the lactation care provider with tools to support the identified population of dyads where the infant has or is suspected to have oral restrictions. (These tools shall include: a review of situations which might lead a dyad to be considered part of this specific population; a comprehensive understanding of the categories of potential problems of lactation associated with this population; and the creation of a lactation care plan with clinical skills specifically designed to consider and address the needs of a dyad in this population along the entire spectrum of normal lactation.) Lactation care providers in any setting and with any level of training will benefit from this review of the issue as it offers a deeper understanding of why particular tools, techniques, and routines might be required for this population as compared with other populations of dyads.

Clinical management of the breastfeeding mother and infant begins with accurate assessment of the issues that are affecting normal function. While breastfeeding is a dyadic activity, this presentation focuses on the infant. Specifically, the learner is invited to look closely at the individual baby, to observe facial tone and structure, and to identify any anomalies or restrictions in range-of-motion (such as those resulting from torticollis) that may negatively impact ability to breastfeed. Videos and photos will demonstrate both normal and abnormal presentations. Interventions will be proposed to assist infants who are unable to breastfeed so that they may continue to receive human milk, ideally from their own mothers, with an eventual goal of breastfeeding, if possible.

In biological terms, successful breastfeeding demands that the baby survives and thrives on his mother’s milk. “Not-enough-milk” (either real or perceived) has long been recognized as the most common reason why mothers abandon breastfeeding. Ways to identify for the mother whether a baby is “getting enough” are discussed. The causes of inadequate breastmilk intake include physiological/anatomical conditions in mother/baby, poor lactation management or other more obscure causes. While planning interventions to enhance breastmilk production and improve infant intake, it is important to protect the baby’s nutritional status. Simultaneously implementing strategies to increase the mothers’ breastmilk supply while caring for a high-need baby can be immensely challenging. Each client will need constant support, reassurance and re-evaluation. Turning such a difficulty around, with the goal of eventually returning to exclusive breastfeeding, can be one of the most fulfilling and rewarding situations that an IBCLC can work with.

Infants born at term following an uneventful birth generally require no breastfeeding interventions aside from a supportive environment. However, even in populations of women who are well-motivated to breastfeed, fully one third of infants demonstrate sub-optimal breastfeeding behavior in the first week postpartum. Risk factors have been identified that predict which mother-infant pairs may require extra assistance to protect the option to fully breastfeed once conditions stabilize. Careful assessment of the dyad helps identify who will need the most help. Such assessment is necessary to protect the infant from excessive weight loss and, because the calibration of milk supply is a time-sensitive event, serves to protect the potential for a full milk supply. Midwives must be familiar with new research that recommends that, in the presence of risk factors, milk expression should begin in the first hour after birth, with expressed colostrum being delivered to the infant by spoon or cup.

Research confirms that misunderstanding a baby’s behavior decreases breastfeeding duration, lowers parent confidence and increases stress and postpartum depression. Literature on “Responsive Parenting” confirms how learning to notice, understand and respond appropriately to a baby’s behavior positively impacts early parenting, breastfeeding duration and the growth and development of a baby. Midwives are uniquely positioned to enhance a family’s ability to meet their parenting and breastfeeding goals. However, other research suggest that information provided patients does not always meet the needs of today’s young families. This presentation reviews efficient, cost-effective tools, tips and techniques that foster “Responsive Parenting”, boost the confidence of new parents and help families meet their breastfeeding goals.

As opposed to being considered the optimal way to feed a baby, breastfeeding should instead be considered the norm. Human milk is the most appropriate food for all babies, even if the mother is experiencing health issues or challenging life conditions. Human milk, despite maternal conditions, is the best source of food for children. Lifestyle, maternal diet, environmental exposures, and stress, among other factors, can impact health outcomes. This leads to the question of whether these factors can also affect human milk composition. Can babies become nutritionally deficient from the composition of their mother’s milk? What is deficiency? How are those thresholds calculated? This presentation will shed light on this subject, which is undergoing a tremendous amount of new research.