Lactation-Feeding Clinic, an Innovative Model of Care

In this post, I would like to highlight the Lactation-Feeding clinic at UNC Hospitals. Lillian Scott, M.S., CCC-SLP, IBCLC and Cambria Stephens BSN, RN, IBCLC have developed a wonderful model of care for infants and mothers who are breast feeding or desire using human milk. This clinic has been a needed adjunct to the feeding team and has allowed us to provide better support for our breast feeding mothers and families. Please read about this clinic and check out their webinar info at the end of the post.

1. Can you describe your Lactation Feeding Clinic and talk about the types of infants you treat?

Our SLP & Lactation Clinic follows infants discharging from the NICU and referrals from the community. The infants have feeding difficulties including cleft palate, prematurity, genetic differences, nasogastric and gastric feeding tubes, GI etiologies, etc. The parents have a desire to offer human milk and/or breastfeed/chestfeed.

2. Can you talk about why a clinic like this was needed and describe your roles and treatment philosophy? 

Our SLP & Lactation Clinic was started with a vision to better support breastfeeding/chestfeeding for infant’s with complex needs after they leave the NICU or post-partum floors. We know that breastfeeding/chestfeeding rates decline in the first 10 days a family is home from the hospital. Some of this is due to limited follow up care and support. The managers of the Lactation Department and Speech-Language Pathology agreed that this was a need and understood the value of having two providers in one appointment.

Lillian: Am a SLP and IBCLC, I identify that I am not as strong in lactation at understanding and treating challenges on the maternal side of things compared to the infant side. This is much like in speech-language pathology I am skilled in dysphagia but my skills are weak in child language development.  Also, SLP and IBCLC are two separate fields therefore it is extremely challenging to cover all of that by one provider in one appointment.  I enjoy the team approach as we can treat the full dyad (lactating parent and dyad).

Cambria: From the Lactation perspective, Lactation Consultants are often the “first responders” when it comes to evaluating breastfeeding/chestfeeding difficulties.  Lactation consultants are in a unique role as providers because they provide care to both the mother/lactating parent and the baby.  Since breastfeeding/chestfeeding involves the mother/lactating parent and baby as a dyad, it is important to identify factors impacting the situation from both the mother and the infant’s perspective in order to provide optimal care and help families meet their goals.  Milk supply can impact latch and an ineffective latch can impact milk supply so identifying root causes of feeding issues can be challenging. Quite often there are multiple factors impacting feeding from both sides of the dyad.  Lactation Consultants do not have the training of the SLP to identify specific issues with tongue/swallow function or dysphagia but often can identify when there is lack of milk transfer and/or something abnormal or ineffective related to the way the baby is feeding or sucking.  In the speech/lactation clinic we use an interdisciplinary approach to address issues and help families achieve their goals. 

3. Where do you get your referrals?

Our referrals come from all over the region.  UNC’s inpatient medical teams (NICU and pediatric hospital), UNC outpatient Lactation providers, UNC Feeding Team, WIC peer supporters and breastfeeding counselors, community SLPs and IBCLCs, pediatrician, and pediatric dentists who focus on Tethered Oral Tissues.

4. UNC also has a feeding team, how do you interface with the feeding team?

We love working with UNC’s Feeding team! We often talk with the team and space our appointments for to provide good support and progress. UNC Feeding team’s assessment and treatment of gastroenterology issues, and guidance for growth allows the SLP & Lactation Clinic to make progress in breastfeeding/chestfeeding or offering exclusive human milk. The team also helps us get referrals for physical therapy and consult other providers (ENT, pulmonology) as needed.  UNC Feeding Team’s registered dietitians (RDs) are great about coming to us when we need help calculating an estimate about how much human milk an infant is getting from breastfeeding/chestfeeding. We enjoy working with the RDs to reduce any formula supplementation, fortification, or tube feedings to help the family meet their goals. UNC Feeding Team’s SLP are great at supporting breastfeeding/chestfeeding by identifying the family’s goal, assessing swallow function, and getting them connected with the SLP & Lactation Clinic. The gastroenterology nurse practitioners are proactive in treating GI concerns that might be impacting feeding and supporting human milk and breastfeeding/chestfeeding. We enjoy have this open dialog as each team member brings important knowledge and perspective to the case.

Cambria: Working with the outpatient feeding team is a new experience for me as a Lactation Consultant and I have learned so much from this collaborative, multidisciplinary approach.  Being followed by multiple teams can put families at risk for confusion about recommendations as well as create burdens to financial and time resources.  Being able to work closely with the feeding team helps us to promote a cohesive feeding plan and optimize support for our families. 

5) What are your goals moving forward, how do you see this clinic as it grows?

We would like to continue to build our capacity to serve more families. 

Lillian: I would love to see this model of care happen in more communities around North Carolina, the United States, and the world to help all families achieve their lactation and infant feeding goals. 

I want to continue to strive to reduce barriers to healthcare and increase accessibility.  Our clinic is hospital based such that we accept Medicaid and most insurance. However, barriers to healthcare including distance from a family’s home, co-pays, time off work to attend appointments, and childcare for other children are still present.

Cambria: From the lactation side, I agree that that goals for our clinic moving forward are to build our capacity to provide care to families, reduce barriers to care and to protect breastfeeding.  Most of our families know the benefits of breastmilk but often need education, guidance and empowerment to reach their goals amidst the numerous barriers not only in health care but in our culture.  I believe that this team approach really honors mothers and babies as dyads which is necessary to fully support breastfeeding goals and achieve successful outcomes.  

6) Could you describe one of your cases?

We have so many great case studies but we feel typing out one will be long and not fully depict the teamwork. Our presentation with USLCA on September 1 has several case studies including ones that collaborate with UNC Feeding Team. If you cannot attend the live session, it will be available in recorded format.

When Milk is Hard to Swallow: An SLP and IBCLC Collaborative Approach

September 1, 2020 *, 90 minutes – 12:00 pm Eastern (11:00 am Central, 10:00 am Mountain, 9:00 am Pacific)

Here is the link:https://uslca.org/education-resources/live-webinars#!event/2020/9/1/when-milk-is-hard-to-swallow-an-slp-and-ibclc-collaborative-approach