IBCLC Detailed Content Outline: Pathology Focused CERPs - Section III

Although pain is not a normal part of nursing, many mothers experience this difficulty at some point in their breastfeeding journey. It is one of the main reasons for breastfeeding consultations, and an important cause of early, undesired weaning, especially if the infant is not thriving. Assessment of pain during lactation differs significantly from other types because it is a system we must explore – not a single patient but the interaction between the mother and her infant (that is, the dyad). In this talk, an ecosystemic overview of the evaluation and management of breast and nipple pain is offered, based on current research and clinical practice. With appropriate support, the vast majority of dyads are able to breastfeed comfortably and effectively.

Deep breast pain and milk stasis are often blamed on back pressure on milk ducts, incomplete emptying and fungal infection. Although these issues can be attributed to backpressure in the case of milk stasis, or "not likely to be related to" in the case of fungal infection inside the breast, the forgotten role that structural integrity plays in breast health can explain those problems that develop and persist despite proper milk removal and general health care of the breast. This presentation covers the anatomy and physiology of rib and vertebral subluxation and myofascial trigger points in generating deep breast pain and milk stasis. Several case reports illustrate the concept; proper care for resolution of these issues is covered.

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.

Appropriate care of artificial airways is an important part of clinical care in the NICU. This presentation will demonstrate how to provide ongoing care to newborns with an endotracheal tube or a tracheostomy tube. Indications, and contraindications of endotracheal tube management. A variety of securing methods will be reviewed for endotracheal tubes. A review of a variety of chronic conditions that may warrant a tracheostomy tube. The procedure for securing a tracheostomy tube will be reviewed. Cleaning and maintaining a tracheostomy will be discussed. Education with the staff caring for newborns with an artificial airway will be reviewed along with parent education.

Craniofacial anomalies (CFA) are a common anatomical malformation that affects the craniofacial region; they present either as cleft lip (CL), cleft palate (CP), or cleft lip and palate (CL/P) with varying degrees of severity. The incidence depends on the population’s ethnicity and geography. Infants with CFA can experience feeding difficulties either at the breast or at the bottle because they can have issues with their suck, swallow, breathe sequence and milk transfer.

This presentation will provide an overview of the anatomy of CFA. Techniques on how best to support families with CFA infants who wish either to breastfeed, maintain lactation or transition towards breastfeeding post-surgery will be discussed. Health care professionals involved in the care sometimes lack the expertise of supporting breastfeeding and often only recommend maternal pumping and specialised bottles. There is limited research about feeding infants with CL/P directly at the breast. A clinical case will be presented to illustrate clinical techniques and sequence of care.

There is scientific research that says that breastfeeding duration shortens when parents experience their baby as a baby who cries a lot. There are all kinds of medical reasons why a baby is crying. Crying is a way of communication for a baby. It's a cry for help.

But what if there are no obvious medical reasons for a baby's crying behavior? This lecture explains sociological and anthropological factors that can influence crying behavior in babies.

Sometimes parents have false expectations about parenting and baby behavior. Sometimes cultural assumptions make parents believe they have a crying baby when they actually haven't. And some cultural or anthropological parameters can strengthen the crying behaviour in a baby. Learn more about normal newborn crying behaviour and how to help parents understand their newborn.

IBCLCs assess chest/breast and bottle feeding skills and infant’s oral and body anatomy, and the motions that contribute to, or inhibit, the process of feeding as well as post-feeding comfort (digestion and elimination for infant, breast comfort for parent). When infants present with feeding dysfunction, the root of the issue could be from a variety of sources - effects of in utero positioning, prematurity, effects of birth interventions, tight frenulum (ties), asymmetric/tense muscles/fascia, neurological/ reflexive issues, low/high muscular tone, or suckling discoordination, suck-swallow-breathe discoordination, laryngomalacia, compensations for low supply, cleft lip/palate, and more. IBCLCs help families navigate the differential assessment of feeding dysfunction, and at the same time support the family’s feeding and milk supply choices.

This presentation will examine the role of the IBCLC when suckling dysfunction is occurring - for example aiding with latch and bottle feeding, oral/body exercises, referrals for oral evaluations and/or bodywork, or help with frenotomy pre/post work if needed. IBCLCs adjust the care plan as the infant’s feeding skills and parents’ goals grow and change. Developing the skills to aid oral function, and coordinate with specialized practitioners to aid this process, is crucial in order to determine the best course of clinical care, meet the families needs, and allow for the best possible outcome.

We propose a talk that outlines the anatomy and physiology of normal infant feeding. Our talk will cover the basic functions of infant muscle groups recruited for latching, sucking, swallowing, and drinking human or artificial milk. We believe that if lactation professionals understand normal physiology as it pertains to muscle groups, they will better be able to educate and help the families our profession serves. At the end of this talk, the lactation professional will be able to establish a baseline for normal muscle function when evaluating the breastfed infant. We will use multiple learning modalities to outline and explain the essentials of muscle function in the breastfed infant.

A common misconception among care providers and families is that babies born with an oral cleft cannot breastfeed/chestfeed. This presentation corrects that misconception by exploring cleft types and their expected breastfeeding/chestfeeding outcomes and sharing tools that lactation specialists can use to more effectively support parents when their baby is born with a cleft lip/palate. In particular, during the neonatal period, the lactation specialist is uniquely positioned to support parents to make informed decisions about their feeding choices and create a going home care plan to help them achieve their breastfeeding/chestfeeding goals in the long term.