IBCLC Detailed Content Outline: Pathology Focused CERPs - Section III
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Breast Cancer During Breastfeeding and Breastfeeding After Breast Cancer

Fedro Peccatori is a medical and gynecologic oncologist whose clinical activities mainly include diagnosis and treatment of breast cancer, gynecological malignancies and tumors of young adults. He is Director of the Fertility and Procreation Unit within the Division of Gynecologic Oncology at the European Institute of Oncology, Milan, Italy.
His research projects deal with fertility preservation and counselling in young oncological patients, pregnancy associated cancers, pharmacological protection of ovarian function during chemotherapy, molecular characterization breast and gynecological malignancies.
He’s part of the ESMO task force Adolescent and Young Adult and ESMO faculty member for breast cancer. At present, he acts as Scientific Director at the European School of Oncology (ESO), where he’s in charge of organizing and supervising international courses and masterclasses on different oncological issues.
He has been interested in breastfeeding in cancer patients since 2009 and has published a number of papers on this issue.
Breast cancer is the most frequent malignant tumor during reproductive age.
Around 1/10000 nursing mothers are diagnosed with breast cancer every year. In this rare and difficult situation, patients and healthcare providers should be knowledgeable about the prognostic and practical implications of such an event. Chemotherapy may pass into the milk and breastfeeding is usually contraindicated during chemotherapy. Weaning should be gradual, to avoid breast inflammation and mastitis. A thorough psychological support should be given to the nursing mother to help her into the oncological trajectory.
On the other hand, the number of young breast cancer survivors is increasing and more and more patients enquire about the possibility of subsequent pregnancies and breastfeeding. The breast treated with conservative surgery and subsequent radiation is less responsive to hormonal stimulation, with reduced glandular hyperplasia and hypertrophy. Milk production is usually decreased in the previously affected breast and surgery may affect duct integrity. Nonetheless, each breast has the capability to self regulate milk production according to the baby’s suckling habits, and many evidences support the notion that one breast is enough. Specific education programs should focus on adequate baby positioning, correct latching and reinforcement of the advantages of on demand breastfeeding. Data from our group demonstrate the feasibility of breastfeeding after breast cancer, but qualified lactation counseling to support patients and caregivers is needed.

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Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study

Bobby Ghaheri, MD is a board certified ear, nose and throat specialist with The Oregon Clinic in Portland, OR. His interest in treating children with tongue and lip-tie stems from his ardent support of breastfeeding and was furthered by his personal experiences, as his youngest child benefited from treatment for it. He enjoys working with children and has an interest in traditional and non-traditional approaches to pediatric pain control. To communicate with him, feel free to email him at [email protected] or follow him on Twitter at @DrGhaheri.
Topic: Diagnosis and Management of Tongue Tie and Lip Tie in Breastfeeding - [View Abstract]
Numerous symptoms may arise which prevent mother-infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments which positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality.
Surgical release of tongue/lip-tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1-week postoperatively) and continue to improve through 1-month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue-tie and less obvious posterior tongue-tie. This study identifies a previously under-recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist.

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Veronique Darmangeat has a private practice as a certified Lactation Consultant in Paris, France. She proposes both home visits and office consultations. She also offers continuing education sessions for IBCLC Lactation Consultants, is part of a team offering initial lactation consultant training for candidates for the IBLCE exam, and does training in hospitals. She has in addition created “Lactissima”, a consulting service for businesses which proposes breastfeeding support programs for their employees returning from their maternity leave. She is the author of two books: L'Allaitement Malin and Allaiter et reprendre le travail.
The gag reflex is usually situated far back in the infant’s mouth to allow them to bring the nipple almost to the junction of hard palate and soft palate. However, certain babies present a very sensitive and hyperactive gag reflex and which causes gagging more easily. For these babies, a good, deep latch can stimulate this gag reflex. In order to avoid gagging, infants will develop a shallow latch taking less breast tissue into the mouth. This can result in low milk transfer, painful feedings for the mother and a possible decline in milk supply. This presentation will assist the lactation professional in utilizing various approaches to avoid undesired consequences of hyperactive gag reflex in a breastfed infant, and will ensure that they have the skills necessary to work with families facing this feeding challenge. Veronique will explain methods of desensitizing the gag reflex, using modified position and latch techniques, and maintaining milk supply. As part of this presentation, Veronique will take the listener through relevant case studies encountered in her work as a private practice IBCLC.

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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Case Studies of Missed Tongue Ties and Subsequent Consequences

As a little girl, Melanie had the opportunity to watch her OBGYN dad deliver babies and it was such an incredible process to be a part of, she knew she wanted to help babies when she grew up. She received her bachelor’s degree in Family Science from Brigham Young University and worked in adoption until she had her first of six children, which included twins, all of which she was able to exclusively breastfeed. She struggled with postpartum depression which has helped her to be all the more compassionate towards the mothers she works with. Once all 6 children were in school, she became a certified postpartum doula and focused on guiding families mainly with multiples. Given her personal experience, she felt called to serve breastfeeding mothers, so she went back to school to become an IBCLC. She has a passion for helping breastfeeding dyads and also loves educating others about the importance of treating ties. She feels very blessed to have trained with some of the top in the tongue tie field and hopes to continue to spread the word to help increase breastfeeding success.
Improve your investigation skills as we walk through case studies of infants with tongue ties that were initially missed and the subsequent consequences. We will then review once the ties were found how a frenectomy with complete release improved or completely resolved their symptoms. We will examine studies that involve infants with Down syndrome, G tube, NG tubes, and failure to thrive. Learners will be empowered to assess with more accuracy by relying on their knowledge of symptoms and function in addition to standard anatomical assessments. This will improve outcomes for breastfeeding dyads allowing more tongue-ties to be found earlier on.

Clinical Assessment and Management of Low Milk Production

Barbara D. Robertson, IBCLC, has been involved in education for over 34 years. She received a Bachelor’s degree in Elementary Education in 1988 and her Master’s in Education in 1995. Barbara left teaching elementary students in 1995 to raise her two children. Barbara is now the Director of The Breastfeeding Center of Ann Arbor and of the brand new business LactaLearning. The Breastfeeding Center of Ann Arbor will still continue to serve breast/chestfeeding families and now LactaLearning will be dedicated to all of Barbara’s professional lactation trainings. Barbara has developed two 95 hour professional lactation training, a group training and a completely self study training with Nancy Mohrbacher. Barbara’s idea of creating professional book groups has exploded with her hosting Making More Milk with Lisa Marasco, Supporting Sucking Skills with Cathy Watson Genna, Breastfeeding Answers, 2nd Edition with Nancy Mohrbacher, and new for the fall, Safe Infant Sleep with Dr. James McKenna. Barbara will be hosting a one day online conference in the fall with Lisa Marasco and Cathy Watson Genna using all of her tech savvy skills to make this a one of a kind experience. Barbara is also a speaker for hire on a wide variety of topics including Motivational Interviewing. Barbara volunteered for the United States Lactation Consultation Association as the Director of Professional Development for 4.5 years. She just retired as Associate Editor for Clinical Lactation, a journal she helped create for USLCA. Barbara has free podcasts, a blog, and Youtube videos which can all be found on her websites lactalearning.com and bfcaa.com. She has written many articles as well. She loves working with parents and babies, helping them with breast/chestfeeding problems in whatever way she can.
Topic: Breastfeeding: Baby’s First Milestone - [View Abstract]
Topic: Clinical Assessment and Management of Low Milk Production - [View Abstract]
Topic: Deconstructing Online Messaging: Ethical Considerations - [View Abstract]
Topic: The Baby's Not Gaining Weight! Now What? - [View Abstract]
Topic: The Great Nipple Shield Debate - [View Abstract]

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Compensatory vs Novel Movements: 3 Keys for Babies With Tongue, Lip and Buccal Restrictions

Michelle has been a pediatric neurodevelopmental Occupational therapist specializing in precrawling infants for over 26 years. She has specialty certifications and training in lactation, manual therapy, and pre and peri natal psychology. Michelle has specialized in optimal cranial nerve function and oral restrictions, with an emphasis on infant movement, innate biological imperatives and human potential, providing novel curriculums, support and resources for both professionals and parents. She enjoys collaborating and working in teams for babies and families going through the tethered oral tissues release process.
Topic: Breastfeeding and Cranial Nerve Dysfunction – the what, who and why of Cranial Nerve Dysfunction in the newborn to precrawling baby - [View Abstract]
Topic: Compensatory vs Novel Movements: 3 Keys for Babies With Tongue, Lip and Buccal Restrictions - [View Abstract]
Topic: Interoception: Beyond the Homunculus....The Real Sixth Sense and Its Primary Function as Sensory Input to the Autonomic Nervous System - [View Abstract]
Topic: The Vagus Nerve: Branchial Motor / Special Visceral Efferents: The Pharynx, Larynx, Soft Palate and one tiny tongue muscle - [View Abstract]
Topic: TummyTime!™ : A Therapeutic Strategy for Parents and Babies - [View Abstract]
Babies with tongue, lip and buccal ties commonly present with altered or compensatory movements of the tongue, lips, face, mandible, neck and whole body. These compensations are secondary to restrictions and subsequent oral dysfunction that results from not having full range of motion and movement of the tongue, a vital organizational organ of the body. While these compensatory strategies have been somewhat functional prior to release, once the ties are released, babies need novel movements to emerge for function to improve and breastfeeding to experience a positive shift. The difficulty is that novel movements often do not spontaneously arise, requiring therapeutic intervention. In this talk, Michelle will discuss 3 keys to eliciting and strengthening novel and more competent oral patterns and feeding abilities after release while making compensatory strategies obsolete.


Debbie Fraser is an Associate Professor, Faculty of Health Disciplines, Athabasca University and a neonatal nurse practitioner in the NICU at St Boniface Hospital in Winnipeg Manitoba. She is the editor-in-chief of Neonatal Network and is the Executive Director of the Academy of Neonatal Nursing. Debbie has published three textbooks and over 70 book chapters and peer reviewed articles on topics related to high-risk newborns.
Topic: Late Preterm Infants: Not as Grown up as they look! - [View Abstract]
Topic: Not always a safe place: Intrauterine Infections - [View Abstract]
We think of the fetus as living in an impenetrable environment, protected from the outside elements. While most bacteria are too large to cross the placental barrier or infiltrate the amniotic membranes, some bacteria, viruses and parasites are capable of reaching the fetus and causing intrauterine infections. Over the years, the list of organisms responsible for these infections has grown with the addition of pathogens such HIV and West Nile Virus. Most recently, a resurgence of congenital syphilis has been identified in newborns born to women with an active infection in pregnancy. This session will review pathogens responsible for intrauterine infection with particular attention to congenital syphilis. A review of the effects of these infections will be accompanied by a discussion of the diagnosis, management and prognosis of intrauterine infections.

Counseling and Anticipatory Guidance to Reduce Perceived Insufficient Milk Production

Tameka Jackson-Dyer is an International Board-Certified Lactation Consultant (IBCLC) and Community Health Worker whose passion is community outreach. She holds a Bachelor of Applied Science in Health Studies from Siena Heights University, several lactation certifications and has been in the field for almost 20 years- honing her counseling and clinical skills in WIC agencies, OB/Gyn offices and Baby Friendly hospitals throughout the metro Detroit area. Her work as Manager of Community Collaboration with Coffective and consulting work with the EMU Center for Health Disparities, Innovations & Studies on their CDC/REACH and NACCHO grants- allows her to provide a voice for the populations who are historically underrepresented in conversations about breastfeeding support. To ensure she reaches as many families in her community as she can, the wife and mother of three owns a private practice, Crazymilklady Lactation Support Services, LLC, serves as Chair of the Metro Detroit/ Wayne County Breastfeeding Coalition, is a co-founder of the Southeast Michigan IBCLC’s of Color and volunteers as a Sisterfriend mentor with the Detroit Birthing Project.

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Sarah is a Registered General Nurse, Health Visitor, International Board Certified Lactation Consultant and Tongue-tie Practitioner with a busy private practice based in Cambridgeshire, UK. Sarah worked as a volunteer breastfeeding counsellor for the Association of Breastfeeding Mothers for several years and continues to run a weekly breastfeeding support group as a volunteer. Sarah is a founder member and former Chair of The Association of Tongue-tie Practitioners in the UK and is the author of the book, ‘Why Tongue-tie Matters’. She offers an online course in tongue-tie and infant feeding in association with Babyem and provides education on infant feeding and tongue-tie for healthcare professionals and breastfeeding supporters in the public, private and volunteer sectors.
Topic: Is This a Tongue-Tie: How Do We Decide? - [View Abstract]
Topic: The Elephant In The Room - Bleeding Post Tongue-Tie Division - [View Abstract]
This presentation will examine the impact Covid 19 had on infant feeding and in particular the provision of tongue-tie services in the UK and other parts of the world during the period March to September 2020. It will look at the impact changes in provision had on the infant feeding experiences of families. It will also explore how practitioners managed services during the pandemic and what the lasting effects on those services have been. Specific concerns around transmission of Covid 19 during oral procedures will also be considered. Consideration to lessons learned will be given.