Lactation: Evidence, Innovation, Care

Milk removal drives milk production and feeds the baby. The ability to remove milk from the breast depends strongly on the milk ejection or letdown reflex. While normally robust, a number of factors can influence it, some more obvious than others. When milk flow suddenly becomes an issue, the rush is on to determine why and what to do about it. This session will take a deeper look at how this reflex works, factors that can affect it positively or negatively, and potential strategies to help.

1.5 L Cerp (II, III, IV, VII) 

• II Physiology and Endocrinology
• III Pathology
• IV Pharmacology & Toxicology
• VII Clinical Skills

Skillful lactation consulting requires the ability to interpret sucking speed, suck:swallow ratios, and coordination of swallowing and breathing. This session presents recent research on normal sucking rhythms of breastfeeding infants. Compensatory strategies used by infants with prematurity and cardiorespiratory anomalies are discussed, and are illustrated with clinical videos. Cervical auscultation (listening with a stethoscope over the baby’s neck or chin during feeding) is a useful tool for lactation consultants in assessing suck:swallow:breathe rhythms. Inaudible swallowing sounds become audible, and difficulties coordinating swallowing and breathing are more easily identified. This advanced practice presentation uses recorded sound files of cervical auscultation of breastfeeding infants to illustrate difficulties that can be identified using this method. Use of this information in clinical problem solving is stressed.

1.5 L Cerp (I, III, VI)
I Development & Nutrition
III Pathology
VI Techniques

Insufficient milk output has many causes; one of the least understood is mammary hypoplasia, under and/or abnormal development of the lactating tissue. In some cases the etiology appears to be genetically predetermined, while in others it is acquired due to environmental, hormonal or other insults prior to or during critical windows of development. It is important to differentiate these causes and their risk markers from incomplete breast changes during pregnancy due to transient external factors that may not repeat during another lactation cycle. This information, along with an understanding of the parent’s infant feeding goals, life situation and emotions, will assist the lactation clinician in developing a supportive and optimized care plan.

1.5 L Cerp (I, VII) 

I Development & Nutrition
VII Clinical Skills

Many infants with unilateral breast refusal and asymmetrical tongue movements have a tight neck muscle from their intrauterine position. This presentation discusses torticollis and related craniofacial asymmetries and the effect on breastfeeding, as well as creative ways to position babies at the breast and support normal feeding.

1.5 L Cerp (I, III, VI, VII)

I Development & Nutrition
III Pathology
VI Techniques
VII Clinical Skills

Polycystic Ovary Syndrome (PCOS) emerged as a potential risk factor for lactation over 25 years ago. Validating research has been mixed, with some studies showing modest correlations while others cast doubt on any correlations, despite clinical experiences and observations. Investigations extending to potential treatments for lactation problems in PCOS patients have been equally disappointing. One glaring omission to much of the research is the lack of recognition that PCOS is a syndrome with varying presentations rather than a disease with a distinct specific set of causes and symptoms. Current trends in PCOS research are focusing on the phenotypes with an eye towards a more effective, individualized approach to therapy rather than assuming that one treatment is appropriate for anyone with the PCOS diagnosis. Understanding these phenotypes may help lactation helpers as well to zero in on potential treatment strategies that have a higher likelihood of helping related lactation problems.

1 L Cerp (IV, VII)
IV Pharmacology & Toxicology
VII Clinical Skills

Tongue tie treatment is increasingly common but still controversial, partially because objective selection of infants for frenotomy is lacking. Our research collaborative assessed the organization of tongue movements in space and time using ultrasound during breastfeeding in infants with tongue-tie and other conditions that impact feeding efficiency as the culmination of years of progressive studies. This session shares some of our published (Genna, 2021) and not yet published results. Ultrasound is a useful tool in our quest to understand both normal sucking and breastfeeding impairments. Research depends on both accurate classification of subjects and breastfeeding best practices. This session merges findings from our studies of tongue kinematics during breastfeeding using an objective methodology and cervical auscultation with clinical work on tongue-tie and confounding conditions, highlighting the learning process from research results of one’s own and other teams, and how those impact the design of further studies. This illustrates the scientific process of discovery through hypothesis testing.

1.5 L Cerp (I, III, VI, VII)
I Development and Nutrition
III Pathology
VI Techniques
VII Clinical Skills

The connection between the thyroid gland and milk production has not been well-recognized or appreciated. The good news is that new animal research is providing us with insights into the possible effects of thyroid dysfunction. This talk takes a detailed look at hypothyroidism, hyperthyroidism, postpartum thyroiditis and thyroid cancer and the unique challenges each presents for lactation, and then discusses treatment strategies and interfacing with the health care team.

1.5 L Cerp (II, III)

II Physiology and Endocrinology
III Pathology

Many breastfeeding parents attribute infant symptoms to allergy and undertake elimination diets. This talk reviews recent evidence on the risk factors and management of infant allergy to help guide feeding decisions and reduce unnecessary dietary restrictions, which may backfire in protecting the infant and lead to untimely weaning.

1.5 L Cerp (I, II, IV, V, VII)
I Development & Nutrition
II Physiology & Endocrinology
IV Pharmacology & Toxicology
V Psychology, Sociology & Anthropology
VII Clinical Skills

It has long been understood in the animal lactation world that milk production quickly transitions from hormonal to local control in the days and weeks after birth. The mechanism of this control was believed to involve a why protein- FIL. Subsequent research shows a much larger, encompassing picture: homeostatic regulation. This session reviews the progression of this research and the factors likely involved in human mammary homeostasis.

1 L Cerp (II)
II Physiology & Endocrinology

Infant breastfeeding efficiency, safety and comfort is highly dependent on body position, stability and depth of latch, particularly in those with medical or biomechanical challenges. Infants with Down Syndrome, Prematurity, Congenital Muscular Torticollis, Laryngomalacia/Tracheomalacia, Congenital Heart Disease, Cleft Lip, and Micrognathia can benefit from specific positioning and supportive strategies during breastfeeding. This presentation discusses specific feeding needs of these infants, and positioning, latch, and stabilizing strategies to optimize their breastfeeding abilities.

1.25 L Cerp (III, VI)
III Pathology
VI Techniques