The First 1000 Days of Infant

The third edition of the Nursing and Pediatrics Congress was held in Paris from 16–19 June 2021, with the aim of contributing the experiences and reflections of relevant health professionals (pediatricians, pediatric surgeons, obstetricians, nurses, midwives, dieticians, and lactation consultants) to the knowledge of the most critical period of human life: its first 1000 days [...]

Providing effective lactation care: The Merton NHS Specialist Breastfeeding Clinic

The aim of this review was to assess the impact of an NHS specialist breastfeeding clinic staffed by International Board Certified Lactation Consultants, and to identify whether it improves breastfeeding outcomes and duration. This retrospective clinical review evaluated data from consultations at the Merton Specialist Breastfeeding Clinic. The data from each consultation forms the basis of the analysis. In the majority of cases (76%; n=56), the clinician findings differed from the mother's presenting concerns. This highlights the importance of specialist care to correctly identify issues and underlying causes. The majority (83%) of infants in this cohort were receiving some mother's own milk beyond 6 months. Women who faced complex breastfeeding challenges reached their breastfeeding goals with the support of specialist lactation care.

Friend or Frenotomy: A Single Institution’s Experience With Ankyloglossia

Introduction/AimAnkyloglossia, or ‘tongue-tie’, is a common congenital anomaly in which a short lingual frenulum or genioglossus muscle restricts tongue movement. Ankyloglossia can be graded from 1 (most severe) to 4 (least severe). The effects of ankyloglossia can include breastfeeding and articulation issues; however, many infants will have no symptoms or developmental problems. The surgical intervention for ankyloglossia is frenotomy. This can be performed in the outpatient setting in small infants. Ankyloglossia referrals in neonates and small infants necessitate an urgent referral to the ear nose and throat (ENT) clinic in order to facilitate breast feeding and weight gain. We sought to analyse the ankyloglossia service in a district general hospital setting from referral to outpatient clinic. MethodsWe retrospectively analysed a consecutive cohort of babies referred to the Ear Nose and Throat service for consideration of frenotomy over an 18 month period, We analysed data from referral including demographics and clinical information, we recorded information from the clinical consultation and procedure details if frenotomy was performed.ResultsBetween 1 January 2019 and 31 January 2021 referrals were made for consideration of frenotomy, all appointments were seen within 2 weeks. 55.3% of referrals were sent from public health nurses, 25.5% from primary care, 10.6% from lactation consultants and 8.5% from paediatric consultants. Of 47 referrals, a frenotomy was performed in 30 babies. All frenotomies were performed without complications.ConclusionInformation on ankyloglossia is varied and available information is conflicting, without any clear standardised guideline or treatment algorithm. Referral indications can be unclear and result in unnecessary clinic appointments in an already heavily burdened service. Frenotomy can be performed safely by a trained clinician in an outpatient setting with minimal equipment.

Tethered Oral Tissue Release Among Breastfed Infants: Maternal Experiences

Objectives The objective was to explore mothers’ experiences breastfeeding/chestfeeding an infant diagnosed with an issue with tethered oral tissue(s), for which surgical intervention was performed (i.e., tissue was “released”). Methods This was a cross sectional, observational survey conducted online from August to September 2020. Recruitment occurred via social media. Mothers of infants <12 months of age were eligible to participate if (1) the mother was >18 years of age, (2) they had breastfed/chestfed or were currently breastfeeding/chestfeeding their infant, and (3) the infant had >1 tethered oral tissue released. The survey included demographic and breastfeeding/chestfeeding questions as well as questions about tethered oral tissue concerns/resolution. Results Of 479 screens, 226 were eligible and 115 consented to participate. Ninety-three responses were considered valid and complete. The sample was homogeneous in terms of maternal race (95% white), marital status (94% married/cohabitating), and breastfeeding status (89% providing breastmilk at time of survey). Eighty-seven (94%) mothers reported lingual frenum release; 81 (87%) reported labial frenum release; and 16 (17%) reported buccal frenula release. Seventy-four (80%) mothers reported more than one tissue was released; most frequently, this included the lingual and labial frenula (n = 58; 62%). Most mothers felt “very confident” in their ability to identify which tissues were released: lingual (94%); labial (97%); and buccal (82%). Lactation consultants were the most frequently identified source of information about tethered oral tissues (62% of mothers) and treatment referrals (42%), while pediatric dentists were most likely to perform the intervention (66%). Nearly all participants (n = 82; 88%) reported feeding improvement, post-release. Conclusions Results indicate lactation consultants are frequently serving as both information and referral sources for release of tethered oral tissues, while pediatric dentists are most frequently performing the release. Despite limited evidence supporting release of tethered oral tissues for infant-feeding concerns, mothers in this study reported multiple tissues were released and that feeding was positively affected. Funding Sources Internal professional development funds.

Exploring Plant and Behaviour on Usada Herbal Galactagogue Usage among Lactating Mothers in Bali

Background: Breastfeeding is essential for the health of newborn infants and mothers. Basic health research in 2018 shows that exclusive breastfeeding in Bali has not reached the national target. High rates of cesarean section delay breastfeeding initiation, the important predictor of continued breastfeeding. Main concern for lactating mothers about medications, increase the use of herbal galactagogue to aid lactation. The use of traditional medicinal plant in Bali is 40% higher than national average and its existence is strengthened by the issuance of Bali Governor Regulation No. 55 of 2019 concerning Traditional Balinese Health Services. Despite increasing popularity of traditional medicine, there are currently limited data available on the plant list and pattern of use herbal galactagogue. Objectives: to explore the galactagogue plants, pattern of use, perceived effectiveness of herbal galactagogues during breastfeeding among lactating mother’s in Bali. Material and Methods: This study was conducted using a questionnaires and in-depth interviews. The questionnaire and interview guideline was validated by lactation consultants and traditional health practitioners in Bali. The study was approved by Human Research Ethic Committee of Bina Usada Bali. Results: The use of herbal galaktagogue is mostly practiced by highly educated mothers, mother’s occupation as health workers and primiparous. There are 26 types of plants that are often used by lactating mothers in Bali. Majority of respondent begin to use herbal galactagogue after giving birth (82%) for approximately < 1 month. Majority of lactating mothers in Bali perceived effectiveness of herbal galactagogue usage based on breastfeeding adequacy indicators. About 95% respondents feel confidence and have self-empowerment after use herbal galactagogue, resultes in psychological benefits. Conclusions: The use of herbal galactagogue is common amongst lactating mothers in Bali, while information about efficacy and safety is lacking. Futher research is needed to give evidence-based information to support exclusive breastfeeding.

Creativity, Resilience and Resistance: Black Birthworkers’ Responses to the COVID-19 Pandemic

This article documents the experiences of Black birthworkers supporting pregnant and birthing people and new mamas during the first six months of the COVID-19 pandemic. Building on the methodology and outcomes of Battling Over Birth–a Research Justice project by and for Black women about their experiences of pregnancy and childbirth–the authors utilized a “community-based sheltered-in-place research methodology” to collect the narratives of Black birthworkers, including doulas, certified nurse-midwives (CNMs), homebirth midwives, lactation consultants, community health workers and ob/gyns. The article examines the impact of restrictions put in place by hospitals and clinics, including inadequate or inconsistent care, mandatory testing, separation from newborns, and restrictions on attendance by birth support people, including doulas. Birthworkers shared the innovative approaches that they have devised to continue to offer care and the ways that they have expanded the care they offer to make sure the needs of Black birthing people and new parents are being met during this uncertain time. The article also explores the threats to health, safety, and financial security faced by Black birthworkers as a result of the pandemic, and the overt and subtle forms of racism they had to navigate. Finally, it documents the sources of strength that Black birthworkers have found to sustain them at the frontlines of a maternal health care system in crisis.

Mothering Twins During the First Year of Life: A Metaphor Analysis

This secondary qualitative analysis identified metaphorical expressions mothers of twins used to describe their first year caring for their infants. Data from the primary grounded theory study were reanalyzed using metaphor identification procedure and revealed eight metaphors: blur, life on hold, being an orchestrator, being a juggler, being an equalizer, being a quick-change artist, being a milk factory, and open invitation. These metaphors give clinicians an insider’s view of the struggle’s mothers of twins experience during the first year after birth. Being attentive to the metaphors mothers used can provide a unique approach to helping them. Lactation consultants are key to providing much needed support for mothers who are breastfeeding twins.

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

Abstract Background Lactation consultants frequently advise adjustments to fit and hold (or positioning and attachment) with the aim of optimising intra-oral nipple placement. However, approaches to fit and hold interventions vary widely, with little evidence of benefits, and effects of fit and hold on infant tongue movement have not been examined. The aim of this preliminary study was to investigate whether a gestalt breastfeeding intervention alters tongue movement, using measurements from ultrasound imaging to determine nipple placement and intra-oral nipple and breast tissue dimensions. Methods Ultrasound measurements were conducted in five breastfeeding dyads, infants aged between four and 20 weeks, while feeding in their usual or ‘standard’ position and again after brief application of gestalt principles of fit and hold. Four of the mother-baby pairs, who had received comprehensive lactation support, reported persisting nipple pain. Three of these infants had difficulty latching and fussed at the breast; three had been diagnosed with oral ties. A fifth pair was breastfeeding successfully. Results Ultrasound demonstrated that the distance from nipple tip to junction of the hard and soft palate decreased, intra-oral nipple and breast tissue dimensions increased, and nipple slide decreased after a brief gestalt intervention. Conclusion These preliminary findings suggest that changes in fit and hold impact on infant tongue movement. Further research investigating short-and long-term outcomes of a gestalt breastfeeding intervention in larger cohorts is required.

Increasing Diversity in the Field of Lactation: An Interview With the Directors of Pathway 2 IBCLC Programs at Historically Black Colleges and Universities

In this issue’s Lactation Newsmakers: Documenting our History, we are featuring two emerging leaders in the field of lactation. Rachel Davis and Janiya Williams are both International Board Certified Lactation Consultants and hold positions as directors for the only two Pathway 2 Lactation Consultant Training Programs in Historically Black Colleges / Universities. Rachel is Program Director for the Lactation Consultant Training Program at Johnson C. Smith University in Charlotte, North Carolina, while Janiya directs the Human Lactation Training Program at North Carolina Agricultural and Technical State University an hour and a half away in Greensboro, North Carolina. While their backgrounds are quite different, both women care passionately about increasing diversity and equity in the field of lactation support, as well as normalizing nursing for Black and brown families transitioning into parenthood. In this interview they speak to relationships they have developed with their students, their students have developed with each other, and the strength of community created within and between their programs. They describe the difficulties their students encounter with institutional racism within the medical system, and the additional preparation they receive to navigate it. Both programs experience high volumes of applicants—almost 350 for the 12 positions at Johnson C. Smith University—demonstrating the significant need for this curriculum in Historically Black Universities/Colleges. The importance of this model in diversifying the field of lactation cannot be underestimated, and the outspoken women doing this work will be influencers in this field for years to come. (RD = Rachel Davis; JW = Janiya Williams; EC = Ellen Chetwynd).

Lactation Support Case Study During COVID-19

ObjectiveTo highlight a new format, a newborn clinic is providing lactation care during the pandemic. COVID-19 is affecting many families, and lactation consultants can adapt during these times. Families are staying isolated in their homes to reduce exposure to the virus, but problems concerning lactation still exist, and in-person appointments are discouraged.MethodsFamilies continue to get lactation advice and care through scheduled telephone appointments and simultaneous viewing of Global Health Media breastfeeding videos sent through secure message emails. The contents of the videos are discussed, and questions answered. The no-cost telephone appointments continue until the family reaches their goals. The videos are multicultural, translated into many languages, easy to use, and provide a visual demonstration for the families. The families can watch the videos and practice breastfeeding as well as get all their questions answered during the telephone call.ConclusionsInfant- and mother-related lactation problems continue to exist during the pandemic, but because of in-person restrictions, families are not able to attend clinic appointments. The scheduled telephone appointments and the simultaneous video viewing addresses many lactation problems with great success and satisfaction among the families.