Short description of work and background:

Kim Fleischer Michaelsen, MD. DrMedSci, is professor emeritus in Paediatric Nutrition at Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen. He has established the research group: Paediatric and International Nutrition at the department. The group has projects in Denmark, Ethiopia, Tanzania and Uganda. The focus of his research include effects of breastfeeding and complementary feeding on growth, development and risks of diseases later in life, both in high and low-income countries. He is advisor to the Danish Health Authority on infant and young child feeding (IYCF) and has been temporary advisor and consultant for WHO. He is the PI of the Danish part of the international MILQ study including breastfeeding mother-infant dyads with the aim of providing reference values for nutrients in breastmilk and explore how they relate to growth. The project is funded by Bill and Melinda Gates Foundation and includes also cohorts in Bangladesh, The Gambia and Brazil.

Abstract with the content of the speak:

Short description of work and background:

RN, PhD, IBCLC. Clinical nursing researcher and clinical nurse specialist in the neonatal intensive care unit at Rigshospitalet, Copenhagen.

Has special interest in breastfeeding of preterm infants, skin-to-skin contact and Baby-friendly Hospital Initiative for Neonatal wards (Neo-BFHI). Member of the Nordic and Quebec working group that developed the Neo-BFHI and one of the principal investigators of the Neo-BFHI Survey.

Abstract with the content of the speak:

”Compliance with the ”Baby-friendly Hospital Initiative for neonatal wards” in 36 countries”

In 2012, the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross-sectional survey aimed to measure compliance on a global level with the Neo-BFHI’s expanded Ten steps to Successful Breastfeeding and three Guiding Principles in neonatal wards. In 2017 the Neo-BFHI Self-Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country and international levels. A total of 917 neonatal wards from 36 low, middle and high-income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Steps 3 (antenatal information) and 7 (rooming-in) had the lowest scores, 63 and 67, respectively. High-income countries had significantly higher scores for Guiding principle 2 (family-centered care), Step 4 (skin-to-skin contact) and Step 5. Neonatal wards in hospitals ever-designated Baby-friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo-BFHI designation. Currently, Neo-BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby-friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.

Short description of work and background:

Dr. Gill Thomson is a Reader (Associate Professor) in Perinatal Health at the University of Central Lancashire, UK. Gill’s research interests relate to psychosocial influences and impact of perinatal care, with a particular focus on factors that impact upon maternal wellbeing.

Abstract with the content of the speak:

“Shame if you do, shame if you don’t: Women’s experiences of infant feeding.”
In this presentation I draw on the sociological underpinnings of shame to highlight how irrespective of how women feed their infants, they can face judgement and blame during interactions with health professionals and within community contexts, leading to feelings of failure, inadequacy and isolation. Strategies and support that address personal, cultural, ideological and structural constraints of infant feeding are highlighted.

Short description of work and background:

RN, MSA, PhD, IBCLC, chief consultant in The Danish Committee for Health Education, Copenhagen, Denmark.

Ingrid has been running a 90-hours breastfeeding course for health professionals in Denmark since 2004, aimed to prepare participants for the IBLCE exam. Is the main author during 16 years of the official Danish Handbook in Breastfeeding for Health professionals and facilitate professional networks on breastfeeding for health professionals in all Regions in Denmark. Research focus on breastfeeding in the early postpartum period.

Abstract with the content of the speak: 

“Father’s Involvement in Breastfeeding Counselling”

Ingrid Nilsson, PhD, IBCLC1; Sisse Hulsbæk, MSc, IBCLC2; Marianne Busck-Rasmussen, MPH, IBCLC1; Hanne Kronborg, PhD3 

1 Danish Committee for Health Education, Copenhagen, Denmark
2 Department of Obstetrics and Gynecology , Slagelse Hospital, Slagelse, Denmark
3 Aarhus University, Department of Public Health, Section for Nursing, Aarhus, Denmark 

Contact email: in@sundkom.dk 

Background: Recently, the involvement of the father in breastfeeding counselling has been in focus in several research studies within the breastfeeding fields. Many fathers want to be part of the breastfeeding and the literature also shows that the father has an impact on breastfeeding duration. However, the mother, the father and the health professionals are in doubt of the optimal way of involving the father, which might result in the father not being part of the breastfeeding counselling. This study is part of a National Clinical Guideline. 

Aim: The aim of the study was to evaluate the effects of father’s involvement in breastfeeding counselling on breastfeeding duration, infant weight loss more than 10% of the birth weight, and readmission of the infant due to nutritional problems in order to make a graded national evidence-based recommendation. Secondly, to describe the elements in the effective interventions. 

Method: A literature review was made using the GRADE method. Studies were included if the parents had a full-term, single infant, delivered vaginally or by cesarean section, and the mother and infant did not have any diseases or other problems, which would make breastfeeding difficult. The interventions should be performed during the first month postpartum and the studies published in year 2000-2017. Subsequently, a meta-analysis was performed for each identified outcome measure and the effective interventions in the studies were shortly described. 

Results: Nine studies fulfilled the inclusion criteria. The meta-analysis showed a significant effect of the involvement of the father on exclusive breastfeeding 4-6 weeks postpartum (pp)(1.14, CI 95% 1.03-1.25), any breastfeeding 4-6 weeks pp (1.09, CI 95% 1.03-1.16), exclusive breastfeeding 3-4 months pp (1.56, CI 95% 1.18-2.05), and exclusive breastfeeding 6 months pp (2.10, CI 95% 1.42-3.09). We found no studies describing the effect on weight loss and readmission of the infant. The effective interventions were characterized by including counselling about: the benefits of breastfeeding; the importance of father’s involvement; how the involvement could practically be done; knowledge of common breastfeeding problems and how they could be solved. 

Conclusion: A strong recommendation for giving the father/partner the opportunity to be involved in the breastfeeding counselling was the outcome of this national clinical guideline. 

Short description of work and background:

Marion Hetherington is Professor of Biopsychology at the University of Leeds.
She is an experimental psychologist with more than 30 years’ experience of conducting research on appetite across the lifespan.  Her recent interests include the ways in which infants communicate hunger, appetite and satiety as well as the ways in which mothers respond to these signals.   She is also a trustee of the charity Give A Child A Hope which partners with the Revival Centre in Matugga, Uganda to provide education, shelter and support to disadvantaged children.  She conducts research in Uganda investigating infant feeding practices.

Abstract: (Look at Netalies abstract)

Short description of work and background:

Dr. Netalie Shloim is a Lecturer in Counselling and Psychotherapy in the School of Healthcare. She is a trained psychologist and counsellor with more than 17 years’ experience of supporting clients with eating disorders, addictions, trauma and obesity. Her educational and research interest are in maternal well-being, body image and self-esteem, eating behaviours/eating disorders, attachment and mother-infant mealtime interactions. Prior to moving to the UK (2010), she was the creator and manager of an obesity prevention intervention in one of the largest hospitals in Israel (The Chaim Sheba Medical Center at Tel HaShomer) and studied obesity in Jewish Orthodox and non-Orthodox populations. She is continuing her scholarship work in Israel and is interested in international research.

Abstract with the content of the speak:
“Towards responsive feeding – using observational methods to understand how infants communicate hunger, appetite and satiety”, Shloim N, Hetherington MM. University of Leeds, Leeds, LS2 9JT, UK.

Background: To promote optimal growth and health in early life, mothers are encouraged to be responsive to their infants’ needs. Responsive feeding involves a bidirectional exchange between mothers and infant during mealtimes. Mothers who are able to “tune in” to their infant’s hunger, appetite and satiation cues and respond accurately and promptly to these cues are said to be responsive.

Aims and objectives: 1) to provide an overview of observational methods in assessing responsive feeding; 2) to assess stability and change in infant hunger and satiety cues across the first 2 years of life; 3) to characterise expression of appetite cues during the course of a meal.

Methods: A series of studies involved video recording mealtimes to assess the ways in which infants communicate hunger, appetite and satiation. Films have been coded for communication cues including the frequency and time at which each cue appeared within a meal, as well as how these change with development.

Results: Women who breastfed provided fewer distractions during the meal, a more ideal feeding environment and fed more responsively than those who did not. Following complimentary feeding the frequency of hunger and satiety cues increased with development. Infants were more likely to communicate potent engagement cues such as babbling, mutual gaze and looking at mother with age with time. Some cues such as gazing at food or gazing at the caregiver decline over the course of a meal, and exploratory gaze increases, suggesting that gaze is an important indicator of attention and interest in food.

Discussion: These studies provide sample evidence that infants are capable of communicating hunger, appetite and satiation. However, mothers may vary in their ability to identify and respond to these cues.

Conclusion: Raising awareness of feeding cues may encourage more responsive mealtime interactions. Future research is needed to examine the unique contribution of parental and child factors, to better integrate knowledge and to provide further insight into the complex mechanisms involved in children’s eating behaviour and appetite regulation.

Short description of work and background:

Dr. Solveig Thorp Holmsen graduated from University of Oslo, Faculty of Medicine in 1997. She obtained a Masters degree in Public Health from Johns Hopkins University in 1998. Surgical residency and continuing work in the Oslo Emergency Room a department of Oslo University Hospital since 2001 where she is currently working as a Consultant Doctor. Solveig wanted to offer better treatment to mothers suffering from lactational mastitis in her clinic and to work with the health system to prevent this condition among mothers. She started as a medical advisor in the Norwegian National Advisory Unit on Breastfeeding in 2011 and she is currently specializing in community medicine. She is working on a National level to increase the knowledge on breastfeeding and prevention and treatment of lactational mastitis. She has experience in evaluating and treatment of medical conditions that can be a challenge for breastfeeding. Observing the association between tongue ties and lactational mastitis in her daily practice she started addressing this problem. She is organizing the work developing a knowledge based National guidance document on the diagnosis and treatment of tongue-tie among infants in Norway. She has also received funding for research on tongue-ties in Norwegian infants.

Abstract with the content of the speak:

Solveig Thorp Holmsen MD, MPH.  
Tongue tie in infants may cause breastfeeding problems. The lecture will present an overview of the literature and the evidence for treatment. How a tongue tie can affect breastfeeding and suckling adversely.  Diagnosis of tongue tie in infants with breastfeeding and nutritional problems and treatment on right indication and timing is of importance as well as multidisciplinary treatment and support of the breastfeeding dyad.  Breastfeeding support in dyads with tongue tie complicating the feeding will be discussed.

Short description of work and background:

Charlotte Giuliani, BSc, Chiro, MSc APP in Paediatric Musculoskeletal Health, Denmark

Charlotte has practiced in private practice in Holland and Denmark since she graduated from Anglo European College of Chiropractic (AECC) in 1994. Since she completed her Master in Pediatric Musculoskeletal Health at Bournemouth University in 2014, she has build-up an interdisciplinary pediatric clinic receiving more than 1000 new paediatric patients a year. Inspired by the work carried out at the Interdisciplinary Midwifery and Chiropractic Newborn Breastfeeding Clinic at AECC/ Bournemouth University, she has set up an interdisciplinary clinic “Din ammeklinik” receiving mother-infants dyads with suboptimal feeding issues. Charlotte is a frequent guest lecturer on the subject Paediatric Oral Motor Dysfunction and she is currently participating in the development of interdisciplinary National Clinical Guidelines on “Examination and Treatment of Tongue Tie in Breastfeeding Infants” in Denmark.

Abstract with the content of the speak:

Research has shown, that not all infants with tongue tie have breastfeeding problems and that not all infants with breastfeeding problems and tongue tie, respond to frenectomy. Research has also shown that a large percentage of infants with suboptimal suckling techniques respond well to manual treatment. So when is frenectomy indicated and when is manual treatment appropriate? Presentation of a research evidenced based clinical approach to suboptimal feeding and empirical considerations about clinical indications for frenulotomy.