Archive | November, 2011

The Science Behind It…Primer Guide to Research

26 Nov

In our field of practice, IBCLCs continually strive to gain respect from the community and other health care professionals. We seek to accomplish this by allowing the research to guide our practice.  This is called evidence-based practice (EBP).  As we care for mother/baby dyads, we develop plans by integrating clinical experience (ours and that of other respected IBCLCs), the values of the mother, and the best current external evidence (research) we can find.*

A great deal of time goes into reading a study, analyzing it, and applying it to practice.  There are several elements we look for to determine if the research is truly going to benefit mothers and babies.  This is called generalization…can we take the results from a study that uses a cross- section of breastfeeding mothers and apply it to all breastfeeding mothers?

Some questions we ask to determine the “health” of a study are:

  • How many participants were there?  Was it enough?
  • Did the researches design the study correctly?
  • Were the proper tools used?
  • Was the outcome of the study related to the bias of the researchers? (for example, were the researchers “obligated” to find a certain result due to funding?)  Or was the outcome achieved without any bias?
  • And will this work in the general population?

It is exciting to see more and more research being done in the field of lactation; however, more is needed as IBCLC’s continue to establish themselves as respected members of the healthcare team.  Will you be the next study participant?  Maybe….

At the Children’s Nutrition Research Center…

Lactation Study: Production of Milk Sugars & Triglycerides

Are you 18 to 35 years old, healthy, and exclusively breastfeeding? Is your baby LESS THAN 10 WEEKS OLD? If so, you are needed for a study investigating factors that affect breast milk production. The study includes a 24 hour stay at Texas Children’s Hospital with your baby. Financial compensation provided.  Click here for more information: http://www.bcm.edu/cnrc/studies

*Evidence-Based Lactation Management, Texas Department of State Health Services, February 2011.
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Does my baby have Oral Motor Hypotonia?

26 Nov

Oral-Motor Hypotonia and the Role of the Speech Pathologist

by Leah Jolly, BA, IBCLC, RLC 

I never thought a speech pathologist would be in my circle of breastfeeding support, but just a few days after the birth of my first son, we were referred to one. At our first appointment with the speech pathologist, Ellen Carlin, we discovered through thorough hands-on testing that our son had oral motor hypotonia, a condition of weakened muscles of the mouth. We were quite surprised when our second son was born a few years later and had the same latch difficulties, so we headed back to Ellen Carlin and received the same diagnosis. Both boys had weekly therapy with Ms. Carlin and a home therapy program we learned at our visits. When I tell other Leaders and breastfeeding professionals about our experiences with speech pathology and breastfeeding there is always a list of questions. The following questions and answers are from an interview with Ellen Carlin and will be helpful to others in understanding how speech pathologists play a role in breastfeeding help and support. Ellen Carlin is a speech pathologist practicing in The Woodlands, a suburb north of Houston. 

What training/background does a speech pathologist need to work with breastfeeding babies?

 A speech pathologist must have an interest in working with infants and obtaining additional trainings in oral motor function and intervention techniques. The speech pathologist should be a master’s level therapist, ASHA Certified and have a Certificate of Clinical Competency. Oral motor training is the key and the Beckman Techniques for evaluation and exercises, as well as Susan Evans Morris feeding training are very comprehensive trainings for oral motor evaluations of infants. Speech pathologists working with breastfeeding babies should have hands-on experience in these evaluation and therapy techniques. Additional training in sensory systems and head/neck and trunk support as well as knowledge of a variety of oral motor techniques and theories are also recommended.

What types of conditions do you most often diagnose and treat for breastfeeding babies? 

Most often babies are referred by doctors or lactation consultants when positioning attempts have been unsuccessful, the infant presents with an unsuccessful latch, for suck/swallow coordination issues, leaking of milk during feeding, and general feeding difficulties that are not responding to normal courses of treatment/support. Upon evaluation infants may be diagnosed with oral motor hypotonia, coordination disorders and/or feeding difficulties and mismanagement. 

What types of therapies/treatment are available with speech pathologists?

Treatment for infants who have been found to have feeding difficulties begins with a thorough hands-on evaluation. By testing range of motion and reflexes of the mouth, tongue, cheeks, palate and jaw, the speech pathologist can determine what exercises are needed to improve strength and range of motion for appropriate function of the muscles.  The parents are trained to use their infant’s individual exercise program and encouraged to use the exercises on a daily basis.

 In your practice, how does breastfeeding impact the outcome of oral motor conditions?

Once the infant is able to efficiently breastfeed, the oral exercise program may be weaned. Normal use and function of the oral muscles needed for breastfeeding, will keep the muscles toned in a typical developing infant. What I find in my practice is that once the infant’s oral motor strength improves and normal function is regained, feeding skills and speech/language skills will also develop normally. Keep in mind that children with other neurological difficulties may need additional support throughout development.

What is an oral motor evaluation?

The oral motor evaluation consists of two evaluation sessions. During the first session medical history is obtained and the mother discusses problems the baby is having. This is important because difficulties may not be occurring at every feeding and the mother can describe sensations or pain she is having during the feedings. A thorough history is taken to evaluate if birth traumas or other complications of pregnancy or birth may have contributed to the feeding difficulties. Next, the oral reflexes are evaluated to determine where muscle weaknesses exist and a feeding observation of the infant is obtained. The speech pathologist looks at the latch, jaw motions, tongue placement, lip seal, suck/swallow/breathe pattern and overall feeding behavior.

The reflexes are tested by stimulating different regions of the mouth with the finger while looking for tongue movement reflexes, suck reflexes, suck/swallow/breath patterns and jaw motion reflexes. This helps determine where weakness/dysfunction are occurring and which exercise will be helpful.  The areas of oral strength ranging between 79% and 0% are identified, and an exercise program is initiated. Parents are trained to use the exercises and are instructed to use the exercise program daily. The second evaluation session is scheduled following a week of exercise use. The infant’s oral strength is reassessed and parent information is collected regarding feeding progress to determine if additional exercises are needed. Typically the exercise program is a ten week program.

What “red flags’ would a Lactation Consultant or doctor be looking for when referring an infant to speech pathologist?

*Absence of a gag reflex – infants should have a strong gag reflex, which is protective in nature.

*Reflux diagnosed – may signal difficulty with suck/swallow/breath triad. (The infant is getting too much air in tummy during feedings.)

*Multiple apnea and /or bradycardia episodes

*Difficulty with grasping the nipple after 35 wks GA – they don’t have the strength to produce a good latch on.

*Length of time to feed (2 oz. in 20 min is too long)

*Absence of 1:1:1 ratio for suck/swallow/breath denotes disorganization of oral musculature.

*Infants with a poor lip-seal, leakage of milk around lips (bib soakers) or milk coming out of nose.

*Snack and snoozers – mom’s report that the infant is always eating because he can’t stay awake to finish a feeding. (Infant doesn’t have the muscle strength to finish a feeding then wakes up hungry – falls asleep- wakes up hungry….)

*Infants who are loud feeders – they display inconsistent tongue suction during feedings

*Infants who clamp down on the nipple causing nipple pain, trying to stop the milk flow due to difficulty managing it.

*Infants who refuse the breast and will only drink from a bottle-may start and stop crying at the breast.

*Infants that require maximum flow nipples or cross cut nipples

*Poor non-nutritive sucking patterns

*Infants for which positioning techniques do not help with feedings.

Meet the BABE IBCLCs…Misti Ryan

22 Nov

For as long as I can remember (early childhood), I have been fascinated with mommas and babies.  My earliest memory of this fascination is when I was about 4 years old after I must have seen a mom breastfeed…I tucked myself in a little corner of our living room with a blanket and my baby doll and proceeded to nurse my doll!

These early experiences fostered a desire to help mommas and babies in my adult years as I attended nursing school and specialized in obstetrics after I graduated.  My career was my passion.  Once I had my foot in the door, though, I plunged head long into my primary goal in life: getting married and having a family of my own!

My wonderful husband and I were married in 1999…baby number one was born the summer of 2001.  My sweet little daughter was born at home with the assistance of my now life long friend and midwife, Jackie Griggs.  She nursed right away.  I was in mommy heaven!  Then, day #3 hit…the challenges!  Nothing was going to keep me from nursing my baby, so I persisted through, and by 6 weeks we were nursing comfortably, and it was pure bliss!

As a labor and delivery nurse, I knew that after my own personal breastfeeding experience I was in a unique position to help moms avoid the problems I had in the beginning of my breastfeeding journey.  I took the childbirth educator position when it became available and added a breastfeeding class to the repertoire soon after.  My job evolved, and I gradually began counseling inpatient breastfeeding moms as an educator.  I made it my personal mission to educate myself on all things breastfeeding and the dream of becoming a lactation consultant was born.

La Leche League played a big role in my breastfeeding success as well as my dream.  I became a leader shortly after the birth of my 2nd daughter in 2004 and have been co-leading the Pasadena group since then.

My family grew rapidly, a son in 2003, another daughter in 2004, third daughter in 2006, and a surprise daughter in 2009…all natural births and all breastfed.  Needless to say, I stayed busy, and each year that passed I patiently postponed making the commitment to apply for the IBCLC exam.  Then, in the fall of 2010 I met Leah Jolly while working on our La Leche League groups’ treasuries.  The rest is history, and here I sit…my dream realized.

I believe mommas are strong.  I believe babies are smart.   I believe birth is a dance.   I believe breastfeeding is natural.  And I am so excited to be a part.  Let the adventure begin!

Meet the BABE IBCLCs…Leah Jolly

22 Nov

My journey towards Lactation consultant work started with my love for science. I grew up thrilled with anything science and nature. I explored my world with the eyes of a scientist. I was so interested in the natural course of life and as I moved through my school aged years my interest grew and I was drawn into science as a career path in college.  I began college sure I wanted to work with animals but after a year of veterinary nursing school I was not so sure, I found my self more drawn to human life and sciences. So I transferred to University of Houston Clear-Lake and acquired a degree in Biology.

In my last year of college I met and married my husband. We started our family a year later. My first breastfeeding experience came when my first son arrived and due to his oral motor hypotonia, we struggled a great deal and with a lack of support to continue through the struggles, we only had 4 weeks of breastfeeding. I was devastated and determined to have a different experience the next time. When my second arrive, in 2003, after a very traumatic birth, breastfeeding started on another difficult path. Determined to not give up, I sought the support of my local La Leche League group and this is where it all began.  Even though we still had a very difficult time breastfeeding, the support and encouragement made it all so much easier! After a year with the group, I began my work to become a leader.

We had two more children, in 2005 and 2009 and with each one my breastfeeding experiences became more and more positive and less difficult.  I continued my work with La Leche League and loved helping moms achieve their breastfeeding goals. I was so reward to give back what was given to me! In the fall of 2010 I decided I want to be able to help moms even more and made plans to sit for the 2011 IBCLC exam.  I met Misti through our La Leche League work and we decided to become study partners…..well the rest is history!! My dreams have come true beyond measure! I absolutely love working as an IBCLC. I love empowering moms to listen to their own voice and their baby. It is a joy to be part of such a special part of the mothering journey! Daily, I am amazed at the strength and perseverance of mothers. I look forward to many years of working with moms and babies!

When to call a Lactation Consultant (IBCLC)

22 Nov

Breastfeeding should be an enjoyable experience for both mom and baby! Although breastfeeding is natural many factors play into the ease to which mom and baby learn and adapt to these new skills. Lactation Consultants are trained medical professionals who can evaluate the source of your breastfeeding challenges and offer ways to improve the outcome for both you and your baby.  Below is a list of common issues lactation consultants can assist with:

A mom who:

v Has Sore nipples

v Has Mastitis or plugged ducts

v Is Engorged

v Has flat or inverted nipples

v Is Ill or needs surgery

v Has a low milk supply

v Wishes to breastfeed an adopted baby

v Needs to take a medication while breastfeeding

v Plans to return to work

v Experiencing stress about breastfeeding

Or a baby who:

v Refuses to latch on

v Is jaundice

v Is not gaining weight well

v Is fussy at the breast or between feedings

v Is premature or is a late preterm

v Spits up frequently

v Has physical challenges that impair breastfeeding

Or anytime you feel breastfeeding is not going well!

Up and Running……

15 Nov

Bay Area Breastfeeding and Education is up and running!! Misti and Leah passed our IBCLC exam with flying colors and are thrilled to be now serving moms in the Bay Area. Since our test results came in just 3 weeks ago, we have helped several moms and babies and Misti and I are feeling so blessed to be in such a rewarding career!! It is awesome to see a mom feel empowered with knowledge and able to overcome their breastfeeding challenges! The motherhood journey is so powerful and it is so exciting to be a part of reminding moms of their ability and instincts!! Our first few cases were challenging and Misit and I love the detective work involved in some of the not so “run of mill’ cases! We are putting all our hours of intense studying to good use and loving every minute of it!!

Our next goal is to reach out to local physicians and other healthcare providers that work closely with moms, to give them information about our services so that we can reach more mothers and babies! For all those following us here….we hope to use this blog to let you know about BABE news and breastfeeding information! Stay tuned…..we have so much to come……