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From:
Laura Wasielewski <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 17 Mar 2012 01:49:01 -0400
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Wow Jamie,

What an awesome opportunity. Most SLPs get very little on infant feeding & nothing on breastfeeding in their graduate curriculum. I think I would stress first & foremost that feeding at the breast is *nearly always* safer than bottle feeding & that human milk is almost certainly safer/more easy for the body to break down & deal with if aspirated than human milk substitutes/formula are (compare it to the Frazier Free Water Protocol for adults). You cannot stress enough that a videoflouroscopic swallow study (aka Modified Barium Swallow study or Oral Pharyngeal Motility study) done with a bottle is probably not an accurate representation of what that baby's swallowing looks like at breast. All of the available research indicates that babies have a more coordinated suck swallow breathe pattern at breast vs feeding w/ a bottle. A baby who aspirates with a bottle may be perfectly safe at breast.

Most SLPs that deal with infant or pediatric feeding and swallowing will either be working NICU or doing early intervention feeding therapy in the 0-3 population. So think about the dilemmas they face & what in regards to breastfeeding would make them more effective at helping babies & families. They really need to understand how critical human milk & feeding at breast is in the high risk populations they will be working with.

Other topics to consider:
-necessity of human milk as medicine for medically compromised infants (& option of donor milk)    
-strongly encourage any SLPs interested in working w/ babies to at minimum get that 5 day lactation counselor certification
-strongly encourage them to network w/ IBCLCs & attend relevant IBCLC cont ed courses or join their local BF coalition 
-tongue tie, especially posterior tt. MOST SLP grad programs will teach how to ID standard tt but the general consensus in the field is that tt rarely impacts speech. They need to be aware that the research does indicate tt can significantly negatively impact breastfeeding & the indicators for clipping. They may or may not have ever even heard of posterior tt. 
-how to promote & protect breastfeeding in the preterm or hospitalized infant, including kangaroo care.
-kangaroo care!!! And all the myriad of benefits thereof.
-the gut brain connection, there are neurons in the gut & what you put in it has a dramatic impact on the brain. 
-the connection between formula feeding & picky eaters.
-difficulty/draw backs of thickening breast milk & feeding via bottle vs. feeding directly at breast. Types of thickeners currently used & risks of each.
-alternative feeding methods (besides bottles)
-how feeding at breast vs. via bottle impacts orofacial development & musculature, maybe that they should include this as a question when they're doing an evaluation on a young child with an articulation or motor speech disorder. Did the child breastfeed AT BREAST? If so for how long? 
-when to refer to an IBCLC
-how to create a bf'ing support group for medically fragile children or where a local one is to refer to
-world wide age of weaning, necessity & rationale of breastfeeding beyond the first year
-that they can still be breastfeeding advocates even if they didn't nurse their own babies or don't have children yet 

Tell them all they need to buy Cathy Genna's "Supporting Sucking Skills..."!!! :-) No financial interest, I just love that book. It's written in their language. They'll get it & it will help them more than the other available breastfeeding texts.

Maybe Cathy Genna or Lisa Sandora will weigh in on this conversation?

I'm sure I could come up with more & I think I just gave you two semesters worth of material to cover so I'll quit while I'm ahead! I *wish* I had an IBCLC teach me 18 hours of breastfeeding related curriculum when I was a grad student. My training gave me a lot of nice framework to build upon but most of my lactation education was way after I finished grad school. I'm jealous of your students!

-Laura Wasielewski MS, CCC=SLP, IBCLC
Los Angeles, CA 

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