For Catherine's lecture schedule, see: http://lactspeak.com/catherinewatsongenna/speaker/profile/
Available NOW! Organization of Tongue Movements Before and After Frenotomy
Research into Practice: Integrating New Latch Techniques (April 6th, 2010)
Choosing and Using Breastfeeding Tools (November 30th, 2010)
Facilitating Infant Competence: Hand Use During Latch (XL31)
Infant Oral Assessment for Breastfeeding Helpers (XL26)
Assessing for Tongue-tie
Normal breastfeeding infants use different zones of the tongue in different ways - the anterior tongue 'rides' on the mandible and the mid tongue and posterior tongue follow a wave of depression from the front of the mouth to the back, facilitating both milk removal (negative pressure) and swallowing (Elad et al, 2014). Children with posterior tongue-tie (ankyloglossia that affects the mid and/or posterior tongue) show a disorganized pattern of tongue mobility before frenotomy and a more organized wave of tongue movement after.
Not all tongue-tied infants fail to thrive. A sub-set of infants with ankyloglossia gain rapidly and are fussy during or after feeding. Some display colicky behavior and begin refusing to feed by 12-16 weeks of age. Cervical auscultation revealed disorganized sucking in a series of these infants which improved or resolved within days of frenotomy. This presentation explores the research basis for using cervical auscultation to study suck:swallow rhythms and presents the results of this case series.
Misalignment of oral structures, poor strength and coordination due to neurological problems and other biomechanical challenges can reduce sucking effectiveness. This presentation introduces the basics of biomechanics that are applicable to breastfeeding and then details specific techniques using compensatory support (touch pressure) that can improve sucking effectiveness in infants with anatomically or neurologically based feeding difficulties.
Maintaining neurobehavioral organization in dyads that are struggling with latching difficulties is a challenge for lactation professionals. Maternal interpretations of infant behavior and signs of frustration can affect her motivation to breastfeed and available psychosocial resources. This presentation explores how lactation consultants can scaffold maternal functioning by providing support, interpreting and framing normal infant behaviors, and modeling and teaching ways to scaffold the infant’s organization to improve the dyad’s ability to work through breastfeeding difficulties.
Irritable infants are commonly diagnosed with reflux, but might also be suffering from feeding related difficulties or allergy. This presentation explores the recent research on regurgitation, reflux and GERD in infants and their relationship to feeding problems. Clinical evaluation and management of breastfeeding issues that can contribute to reflux are also covered.
A review of recent research on the importance of breastfeeding to lifelong physical and emotional health, framed with breastfeeding as the biological norm.
Most breastfeeding instruction includes strategies to prevent baby’s hands from ‘getting in the way’ during positioning and latch. Careful observation reveals that infants use their hands in predictable ways that help them find, shape, and move the breast to assist attachment. This presentation focuses on these predictable behaviors and ways to work with them and when necessary modify them to assist breastfeeding dyads. The longer version includes the research base for these observations.
Many infants who present to lactation consultants with feeding difficulties have anatomical variations of the oral cavity and airway. Issues such as micrognathia, ankyloglossia, and macroglossia can lead to persistent feeding difficulties, and greatly increase the risk of early weaning and/or failure to thrive. Respiratory disorders like laryngomalacia can increase the risk of failure to thrive. Through the use of clinical photographs and videos, participants will gain an understanding of how these anatomical variations impact sucking and breastfeeding skills, and learn some initial measures to help mothers and infants compensate.
Sensory processing is important for successful breastfeeding, and is less developed in infants. This lecture gives a brief overview of sensory integration theory, explains how dysfunctional sensory integration can make breastfeeding challenging, and gives strategies for working with infants and mothers with these issues. Normal infants will also benefit from the information (illustrated by clinical photographs and videos) on infant state, stress cues, and methods of helping infants re-organize.
Optimized for medical personnel in the delivery and postpartum unit, this presentation explores newborn neurobehavioral programming for breastfeeding and how it is affected by birth interventions and separation from the mother. The development of hospital feeding practices is briefly traced, and evidence-based strategies to assist non-latching infants and their mothers are detailed and illustrated with clinical photographs. Supporting milk supply, preventing hypoglycemia and hyperbilirubinemia, and post-discharge planning are included.
One of the biggest challenges of lactation consultant practice is the non-latching infant. Designed for mixed groups of hospital and private practice lactation consultants and health care providers, this presentation provides equal emphasis on in patient and out patient issues for non-latching infants. Advanced strategies for helping infants who don’t latch are covered in the final half of the presentation. This presentation is copiously illustrated with clinical photos and video.
The understanding of infant sucking has burgeoned in recent years with the continued development of cineradiographic and ultrasound techniques. A clear understanding of how infants use the tongue during breastfeeding as well as triggers for infant feeding behaviors helps the lactation consultant understand how to optimize attachment for each mother-baby pair. A wide variety of approaches to both mother and infant led attachment are illustrated by video clips from lactation consultations. Extensive clinical photos illustrate the subtle signs of suboptimal vs. optimal attachment. The longer version includes latching to bottle nipples to support breastfeeding skills, optimizing attachment when using at-breast supplementers, and latching to nipple shields in a way that promotes direct breastfeeding in the future.
How does the lactation consultant choose between the various supplementers, nipple shields, cups and bottle nipples? Infants differ in their skills and needs, and mothers differ in their capabilities and resources. A strategy for clinical observation and decision-making is detailed, using case vignettes, clinical photographs, and videos to show how different devices are used in individualized feeding goals.
This presentation is intended for an audience of IBCLCs. Most infants suck correctly given normal anatomy, an optimal latch and normal milk flow. This presentation focuses on some strategies to assist infants who do not. It builds on the information given in Anatomical Contributions to Infant Sucking Skills. The function of each oral and pharyngeal structure in sucking is reviewed, potential issues with each structure are discussed, and strategies to help improve sucking function are presented. Clinical photographs and video illustrate the techniques taught.
Infants who can’t breathe well can’t feed well. Breastfeeding is generally easier for these infants than other feeding methods, especially if modifications are made to accommodate their reduced stamina and ability to manage flow. The most common developmental respiratory difficulties (laryngomalacia, tracheomalacia, transient tachypnea of the newborn) and malformations (velopharyngeal insufficiency, subglottic stenosis) are discussed, along with ways to optimize breastfeeding for each condition. Clinical photos and videos illustrate the conditions and techniques covered.
The control of milk synthesis depends on a complex interaction of autocrine and endocrine factors. The contributions of these two systems are continually being clarified by research. This presentation explains the two systems, their interactions, and what this means for the advice we give to mothers. Should an engorged mother pump? How do we best help a mother increase milk supply? How do we control oversupply without increasing the risk of mastitis? The scientific background is clearly delineated in understandable language, and these quandaries discussed.
The tongue is the major player in sucking, and even subtle variations in tongue attachment can cause suckling difficulties. This presentation covers normal tongue movements and normal sucking, effects of different degrees of tongue restriction on tongue mobility, sucking compensations in tongue tied infants, and strategies to preserve breastfeeding. Richly illustrated with clinical photographs and videos, this presentation is suitable for health care professionals as well as lactation consultants.
Infants communicate through facial expressions, motor activity, autonomic responses and vocalizations to indicate their needs to caregivers. Infant communication is explored with the goal of supporting responsive parenting. Infant state, hunger cues, feeding behaviors, entrainment vs. avoidance signals, satiety cues, and normal neurobehavioral modulation are all included in a framework that highlights to competence of human infants. Includes a brief introduction to conditions that might impact breastfeeding through the lens of infant facial expressions and motor responses.
This talk presents the nuances of fingerfeeding as both an alternative feeding method to help preserve breastfeeding behaviors and as a way to facilitate sucking skills in infants currently incapable of breastfeeding adequately. Theoretical justification is briefly reviewed, and then specific devices and techniques are discussed and illustrated along with indications and contraindications for each. The techniques are presented in case context, with clinical video of each technique in use.
Ultrasound is a non-invasive tool for studying tongue and swallowing function during breastfeeding. Infants with tongue tie are unable to perform normal wavelike tongue movements, and use compensatory and less efficient strategies to transfer milk from the breast. Ultrasound videos show these strategies in action, and are correlated with clinical video of infants using the same compensations. Normalization of sucking motions and rhythms is documented after treatment.
Posterior tongue tie is a frequent cause of oral motor dysfunction and is frequently missed by even experienced physicians and lactation consultants. Extensive clinical photos and video demonstrate evaluation and simple frenotomy for posterior and submucosal tongue tie. Ultrasound videos document the changes in tongue function produced by this treatment.
Case studies of infants with multiple diagnoses illustrate the planning, prioritizing, creative problem solving, and emotional support that help mothers of infants whose ability to ever breastfeed is in doubt.
How do breastfeeding helpers distinguish between harmless temporary issues during lactation and signs and symptoms of serious conditions that require immediate referral to a health professional? This presentation illustrates maternal and infant red flags and helps differentiate those that are transient from those that may become dangerous.
There are few resources for a detailed assessment of infant breastfeeding competency. This presentation will provide a framework for systematic evaluation of breastfeeding, including:
Clinical photos and videos will detail how the use of treatment probes (brief application of facilitative or compensatory strategies) can increase the validity of the assessment and guide the formulation of an effective care plan.
Subtle difference in tongue attachment can cause feeding difficulties in infants. Traditional guidelines such as requiring a heart-shaped tongue-tip or complete inability to extend the tongue over the gum ridge miss these more subtle cases of ankyloglossia. This presentation uses extensive clinical photography to illustrate a systematic assessment strategy that examines tongue mobility and tongue attachment in light of recent research.
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.
Normal human variation can sometimes be difficult to distinguish from minor anomalies that can impact feeding ability. This presentation uses clinical photographs to illustrate a systematic assessment of infant anatomy for optimal breastfeeding. Minor oral anomalies that may affect breastfeeding are highlighted, including tongue-tie, mandibular asymmetry due to torticollis, natal teeth, hemangioma, and palatal problems. Minor conditions are differentiated from those that might put infants at risk for significant feeding difficulties.
Infants with orofacial clefts are challenging to feed. Babies with cleft palate may be unable to create negative pressure to remove milk from the breast. In-utero motor patterning of tongue movements and swallowing is often altered. Lactation consultants can help mothers protect milk production and assist the infant in being as active a participant in feeding as possible. Some families may choose special bottles, others may use modified supplementers to feed their infant at breast to promote normal breastfeeding after repair. This presentation reviews strategies and tools to promote normal tongue and swallowing function in infants with clefts.
The ten steps to successful breastfeeding of the baby friendly hospital initiative form the backbone of evidence-based care for breastfeeding dyads. This presentation provides practical strategies for nurses and student nurses to use to facilitate optimal breastfeeding in the context of the 10 steps, as well as basic breastfeeding assessment skills to allow identification of dyads who may require additional support.
There are usually several ways to resolve a breastfeeding problem. This series of case studies provides an entrée to discussion of evaluation and clinical decision making around lactation difficulties. The interventions and outcomes used are revealed after the audience discusses what strategies they might try, and alternative approaches are validated. Conference Committee: The cases are those more typically seen in a lactation consultant practice than those in In for the Long Haul, which are more complex cases.
Recent research has revolutionized our understanding of breast anatomy, the physiology of the control of milk synthesis, optimal positioning, and the infant’s contribution to breastfeeding success. This presentation highlights new findings that affect how we support and assist mothers in learning to breastfeed their infants.
Transitioning to breastfeeding ideally begins in the NICU and continues after discharge. This presentation explores what can be done to transition ill and preterm babies to direct breastfeeding. It explores common challenges and strategies to overcome them.