Lisa Anders, PhD, RN, IBCLC

What is the Netherlands exclusive breastfeeding rate at 6 months?
Is it very low due to the very short maternity leave?
Deanna
Canada

It’s around 30.8% completely breastfed at 6 months and another 13% a combination of formula and breastfeeding.
It drops during the last couple of years, although the maternity leave is longer than before 2022 (although the extra part is partly unpaid).
Maaske

When is a great age to start bottle feeding?
Jessica
USA

For a breastfed baby, if parents also want to introduce a bottle: between the age of 4-6 weeks.
Maaske

I would like to have information for the your entire presentation as soon as it comes out in English. Thank you
Julia
USA

Please leave your address at https://www.volmondigacademy.nl/masterclass-bottlerefusal to receive updates on the course in English.

What is the time for each plan before switching to the next plan?
Plan A to Plan B to Plan C
Kendra
USA

It depends on the urgency for the parents, the age of the baby and preferences of the parents. The Masterclass Bottle Refusal takes 5 hours and will explain this in more detail.
Maaske

Do you anticipate an overall positive effect on all women being enrolled in the study as can happen in research?
Rachel
Australia

Dear Rachel,
Thank you very much for your question. I hope I have understood it correctly. When we planned the project, we focused very much on ethical concerns and the possibility that it could be distressing for the women to recount their experiences. Although it certainly was demanding for the women to tell their story, several of them also reported that it felt relieving to share their experiences, and that doing so provided them with new perspectives. I also hope that my studies can be of benefit to abused women at a societal level — for example, by raising awareness among healthcare providers so that more women get care and support.
Best wishes,
Ida

Once mother’s did open up and also understand the abuse they are actually experiencing, were there resources available to them?
Kendra
USA

Dear Kendra,
Thank you very much for your question. I am not entirely certain whether you are referring to support from public institutions or support from me as a researcher during the project, but I will do my best to address both aspects.
Most of the women that I interviewed had left the relationship long ago and reported that they were already receiving support through healthcare providers and had been in contact with the police, the justice system, and related authorities. However, their experiences of how they were met by carers while living in the relationship varied. In some cases, it took a long time to receive appropriate help.
In my role as researcher, I was prepared to identify any need for support and guide the women further within the healthcare system. This was challenging in relation to those who participated in writing, as they were completely anonymous and never had direct contact with us; however, they were provided with contact details for support organizations.
Best wishes,
Ida

Do you have a favorite technique when it comes to infant massage?
Kendra
USA

Yes. The technique I consider most comprehensive and complete is the one offered by the International Association of Infant Massage, which includes four disciplines: Indian massage, Swedish massage, Reflexology, and some Yoga exercises. It can begin as soon as the umbilical cord falls off. Thanks for your question Kendra! Greetings from Buenos Aires, Argentina.

Thank you for the lovely presentation, doc. It is lovely seeing how the baby gets stimulated to associate oral feeding with maternal touch. I wanted to ask if your unit allows mothers to feed their babies in KMC position?
Mimi
South Africa

So glad you enjoyed the presentation, Mimi!
Unfortunately, very few NICUs in our country allow this. This video was recorded in Ushuaia (the southernmost part of the country) thanks to a nurse who worked for a long time to make this possible. But even now, most NICUs don’t use this wonderful and simple technique. We still have a long way to go! Thanks, Mimi, for your question! Greetings from Buenos Aires, Argentina.

Did you practice with others before using this technique?
How long did it take for you to use it after practicing?
Euphemia
USA

Yes, I did a few ‘practice runs’. I used this technique not in my practice in the beginning, but with friends and families, for any time that they felt stuck with something and wanted to be able to move forward and make a decision.
It has definitely been a gradual process, in that I used just small aspects of it for about 6 months or so. I would drip feed it in, for example, taking one major concept and using it for a week or so, and then try to add an extra concept in until I got to the point that I felt I could easily move between them depending on what the client needed. Now I feel confident to use all of the technique, all of the time.
Warm regards,
Johanna

I absolutely loved your presentation and want to learn more! Do you have a masterclass? If not, you should. I would also love to be mentored in this technique. Any suggestions?
Stephanie
USA

I have just created a masterclass called ‘Decoding The Suck’ for babies who have issues with suck, and there is a section there on communication and creating care plans together (https://www.thelatchrevolution.com). Within the next year I will also have a counselling techniques masterclass coming out as well. With regards to mentoring, I can also suggest checking out the initial training I did (https://psychwire.com/motivational-interviewing) – it’s not specific to IBCLC, but counselling in general, and helped me to feel confident.
Warm regards,
Johanna

Do you think that more women breastfeed in Indonesia because they want to or because they need to?
Sharon
USA

Thank you for the thoughtful question. In Indonesia, the motivation to breastfeed is influenced by both desire and need. Many mothers genuinely want to breastfeed because of strong cultural norms, increasing awareness of health benefits, and supportive community programs. At the same time, economic factors and limited access to alternatives, such as formula, create a need-based motivation. Our program aims to strengthen the “want” by improving knowledge, confidence, and family support so that breastfeeding becomes an empowered choice rather than a pressured necessity.
Best wishes,
Rizka

Thank you for sharing about the program, especially about the various ways you use social media to connect with mothers.
Erin
USA

Thank you, Erin. Social media has truly become a powerful tool for reaching mothers, allowing us to provide timely education, emotional support, and a sense of community beyond physical sessions.

Is there a difference between a baby that is getting both breaatmilk and formula?
Sharon
USA

Thank you very much Sharon for your question. Yes there is a difference in breastfed, mixed fed and non-breastfed infants in their risk for severe RSV disease, pneumonia and hospitalization. This kind of relationship is called “dose-response“. Exclusive breastfeeding is the most protective against severe disease. Mixed fed babies (receiving both formula and breastmilk) have a higher risk that those fed only breastmilk. However some breastfeeding is more protective than not breastfeeding at all (exclusively formula-fed infants have the highest risk for severe outcomes or death due to RSV disease).
Thanks for listening and Happy holidays,
Melissa

How did you get around the challenge of not having bathroom facilities for both yourself and your clients?
Julie
UK

I park in locations with public bathrooms, such as parks or military visitor centers or libraries. I discuss using the bathroom with every location I park at before choosing that location.

How do you manage going state to state? Do you charge through insurance or do participants pay you upfront?
Kendra
USA

I offer both self pay and insurance covered services. My practice is in 1 state at a time. When my family moves, which we do every few years for the military, I establish my practice in that’s state. I have not lived in a state that I lived close to another state and worked in two states at once.

This mobile clinic is such a nice, portable space.
Considering the cost of the vehicle and everything, are you able to make a profit?
Marcella
USA

Yes, I am able to make a profit, but I did a lot of my the work myself to keep costs low. The vehicle and the whole build I spent $17k. Insurance is about $2,500 annually.

You did a great job in the decorating and designing the Mobile Unit. Did you say how long it took to build your clientele?
Euphemia
USA

Clientele changes as we move about every 2-3 years. I do a lot of networking before we move and start building a presents about six months before relocating. It’s one of the hardest things, building a clientele, but that’s more because of the fact we frequently move due to the military and not because of my clinic.

How do you stay safe in that region with wars and fighting continuously? How do you get to safe water when it is limited?
Euphemia
USA

Thank you so much for asking. Our team in Gaza are local healthcare workers and mothers who live this reality every day. They work inside the hospitals and clinics where they are already sheltering, and they only move when it’s safe. There’s no perfect safety in a war zone, they simply do their best to continue supporting mothers around them.
As for water, they use whatever is available: sometimes trucked water, sometimes small amounts of desalinated water, and they prioritise it for feeding and cleaning equipment. We support them remotely from the UK so they don’t have to take extra risks.
Thank you for holding them in your thoughts. Your care means a lot.

Thank you for your presentation on importance of breastfeeding support during emergencies. As a lactation consultant in the New Orleans area, support/kindness provided and received during and since Hurricane Katrina has had lifelong effects.
Marjorie
USA

Thank you so much for sharing this. The experiences from Katrina continue to teach all of us. Your words mean a lot.

Would love to get involved! I’ll check out the GINA website.
Jamie
USA

That means so much to us, thank you.
Please do have a look at our website https://www.gina.org.uk.
Our work is completely volunteer-led, and every bit of support helps us reach more mothers and babies during this incredibly difficult time.
Welcome to the GINA family already.

Do you think that a baby with sensory defects and thus doesn’t really touch mom breast contributes to the mother producing less milk?
Sharon
USA

I don’t think we should generalize that this could be due to sensory differences, but maybe if baby doesn’t spend enough time at the breast, definitively can impact the supply. Although maybe, mum has low milk supply, affecting the baby and unable to be there for long?
Usually babies will Prefer to held by mum. In terms of the support we could give, no matter the source of the problem, is increasing the demand. Ideal with baby effectively removing milk, improve pumping, etc.

My second child has sensory differences, I recall the difficulty I had trying to keep him calm and relaxed despite baby wearing and having him close to me almost all the time. How do we get early interventions if Dr just tells you they are a needy baby?
Tiffany
USA

So hard. Breastfeeding is always hard, and usually many HCP do not have a good recommendation to improve the feeds or that for baby to calm down. There aren’t evidence based interventions (first months of life for example) that will change prognosis, so what’s needed is support around parenting, breastfeeding, support from other therapies (physio, osteopathy, craneosacraltherapy) in case tension, etc. breastfeeding that’s why is the first great regulator. We need more doctor understanding baby behaviours (normal AND abnormal).

Did the return to birth weight change from 2 weeks to 21 days?
Donna
USA

Hi Donna,
Thank you for your question. The majority of breastfed infants return to birth weight by about 2 weeks (mean 8.3 days) and some may take a bit longer. Practically all breastfed infants (97.5%) have regained birth weight by 21 days (I’m guessing this is the statement that may have caused confusion for you; it simply means that though we expect them to regain weight by two weeks, some outliers may take longer but most all babies will have done it by 21 days).
In newborns that are gaining a bit slower than expected, the important thing is that you take into account not only weight gain but other signs (like type of birth, stool output, milk transfer at the breast, baby´s behavior and so on).
Hope that helps to clarify!
Cheers,
Kika

Do you follow the long held recommendations of 5.5-8.5 ozs/wk (155-240 grams/wk) for 0-4 months; 3.5-5.5/wk (100 – 155 grams/wk) for 4-6 months; 1.75-2.5 ounces/wk (50 – 70 grams/wk) for 6-12 months (or another slightly different variation?)
Jill
USA

Hi Jill,
Thank you for your question. There are several recommendations of this type, they are mostly pretty close to each other… I think working with WHO charts is the easiest way to “get it right” – they also have growth speed charts, which are more accurate for a given child. In any case, remember these recommendations you mention, as well as the charts, are only one of the things we have to look at when we are working with babies… the important thing is that you take into account not only weight gain but other signs (like type of birth, stool output, milk transfer at the breast, baby´s behavior and so on).
Hope that helps to clarify!
Cheers,
Kika

Do you work with the pediatricians during these times? How do you build that relationship of trust so they do not push the mother to go straight formula?
Kendra
USA

Hi Kendra,
Thank you for your question… there is no easy answer since circumstances can be so different (for example, if you are part of a pediatric team in which you are valued, vs you work solo and have no relation to any pediatrician except thru the mother/parents). I think the way to build trust is little by little, making a good reputation for yourself by working with excellence and giving your clients good clinical reports that they can share with their peds, as well as assuring your client that you are open to consulting with their doctor.

This article may help you understand what your clients feel and give you some tips:
https://www.zocdoc.com/blog/how-to-handle-conflicting-advice-from-healthcare-providers

And this one was helpful for me also, in dealing with difficult professional interactions:
https://www.medicalprotection.org/ireland/resources-training/articles/view/dealing-with-difficult-interactions

Hope it all helps!
Cheers,
Kika

To check the weight of a wet nappy by using spoonfuls of liquid on a dry nappy, what size are the spoons?
Kirsten
Australia

Hi Kirsten!
Thank you for your question. We would use tablespoons (about 15 ml); generally each pee after the first week contains about 30 to 45 ml of urine. The urine is clear and odourless.
Hope that answers you!
Cheers,
Kika

Are there contraceptives that you know that have lowered the estrogen levels? or was this a change made across all combo contraceptives?
Kendra
USA

Modern contraceptives have lower estrogen doses than older formulations. Typical combined contraceptives now have 10-35mcg of ethinyl estradiol.

Do you think that the different types of contraceptives affect the milk supply?
Sharon
USA

They may, and there are certainly case reports of this. However, we do not currently have large studies showing significant impact. It is important to keep in mind that all patients are individuals and need tailored care and counseling.

Your study did not see differences in supply and type of contraceptive. I work more with the NICU mothers. Do you think having given birth early would change anything?
Shelley
USA

It certainly could. We are lacking data looking at the impact of postpartum contraception on more vulnerable/higher risk populations.

Thank you,
Cheryl

How do you protect the people working on revealing code violations from aggressive multinational companies? Are they ever worried about their safety?
Rachel
Australia

Thanks for your question and interest. Regarding people who report violations to official agencies or watchdog organizations, it is a standard practice that those who receive info about violations would never disclose personal information of the monitor/reporter. Sometimes, agencies/organizations tasked with Code monitoring need to clarify information pertaining to a reported violation, therefore contact info (or personal info) is helpful. But if reporters/monitors feel they are more comfortable with reporting anonymously, that option should always be available. As for those who REVEAL the violations, personally I have not experienced or heard of any risks involving personal safety. Companies sometimes do come back to “argue” and try to water-down the seriousness of the extent of violations published in public reports and journal articles etc. In those cases, presenting solid evidence and sound and firm explanations have always sufficed. Important to note, in those cases, the response to companies is usually published to public, and we also avoid getting into “back and forth” arguments.
Best,
Constance

Do you think microbiome research will change how we understand caries risk in breastfed children?
Naegia
Libya

Thank you for your question Naegia
Absolutely!! We are gaining understanding of the complexity of the microorganism communities present in various body surfaces and the relationship of when there is health (symbiosis) and disease (dysbiosis) in lots of different diseases including dental and oral health. It seems to me that the substrates (food) present in the mouth encourages the microorganisms that like to consume it and gives them the “upper hand” in colonising the space. (There’s another more recent concept that inflammation, the body’s response, provides the environment for dysbiosis. I am not so sure about that in ECC….the acid demineralises the teeth, they aren’t decayed by inflammation IMO so I did not venture into that concept in my talk!) (5)
(There’s another more recent concept that inflammation, the body’s response, provides the environment for dysbiosis. I am not so sure about that in ECC….the acid demineralises the teeth, they aren’t decayed by inflammation/hyperglycaemia in my opinion so I did not venture into that concept in my talk!) (6)

=sugars -> bacteria that ferment these carbs to make acid -> acid environment they can survive in -> dysbiotic environment that is incompatible to the “good guys” that don’t decay teeth and allows the proliferation of other pathogenic microorganisms that survive in the acid….the acid then demineralises and breaks down the tooth. So not just one bacteria is doing the damage but a dysbiotic microbiome, complex mix of them.

The new genetic ways of detecting which microorganisms are present will give pictures of these microbiomes in health and disease. The important next step is then in manipulating the microbiome back to health ie not wiping out all microorganisms with antiseptics but encouraging the symbiotic ones with what people eat (not have the fermentable sugars, not feed our kids with them), teeth cleaning products that neutralise acidity, removal plaque etc. I think alcohol-based antiseptic mouthwashes will be a thing of the past! Breastfeeding and fresh breast milk will be (eventually) seen as promoting normal (protective, symbiotic) microbiome. Components of milk are already being produced and promoted as therapeutic agents in oral health products. (3&4)

Kind regards
from Alison

1. Wang Yuan, Wang Sa, Wu Chunyan, Chen Xi, Duan Zhuhui, Xu Qian, et al. Oral Microbiome Alterations Associated with Early Childhood Caries Highlight the Importance of Carbohydrate Metabolic Activities. mSystems [Internet]. 2019 Nov 5 [cited 2025 July 15];4(6):10.1128/msystems.00450-19. Available from: https://doi.org/10.1128/msystems.00450-19

2. Zhang J, Chu CH, Yu O. Oral Microbiome and Dental Caries Development. Dent J [Internet]. 2022;10(10). Available from: https://www.mdpi.com/2304-6767/10/10/184

3. imutis W. Bioactive properties of milk proteins with particular focus on anticariogenesis. J Nutr [Internet]. 2004;134(4):989S-995S. Available from: https://www.sciencedirect.com/science/article/pii/S0022316623027475?via%3Dihub

4. Rousseaux A, Brosseau C, Le Gall S, Piloquet H, Barbarot S, Bodinier M. Human Milk Oligosaccharides: Their Effects on the Host and Their Potential as Therapeutic Agents. Front Immunol Sec Nutr Immunol [Internet]. 2021;12. Available from: https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.680911/full

5. Lavigne SE. The evolution of plaque hypotheses: The past, present, and future. Can J Dent Hyg [Internet]. 2023;57(2):75–7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10351492

6. Nyvad, B., & Takahashi, N. (2020). Integrated hypothesis of dental caries and periodontal diseases. Journal of Oral Microbiology, 12(1). https://doi.org/10.1080/20002297.2019.1710953

How can we provide this information to dentists all around the world?
Goretti
México

Where are you going to present these important findings?
Rachel
Australia

Thank you for your questions Goretti and Rachel
Indeed!!! I have informed our Australian dental colleges that I have a “comprehensive talk on BF and ECC”. Their response was that they “did not need education on this topic as they have already covered it before”…… 🙁
Someone suggested I attend a conference in Europe for paediatric dentists….would have cost me $7000 (airfares, accom, conference registration, meals, transfers etc). I have done all this research in my own time. It has taken literally hundreds of hours….I don’t have a spare $7K…
I am just getting a bit weary doing this largely as a volunteer (yes my 2 hr talk was remunerated by iLactation for which I am very grateful)….it really needs some paid professor somewhere to take it on that already has kudos in world of dentistry and research……….

But I am open to suggestions!!
This online conference was an International start!
I am trying to convert this info into a journal article…in my spare time….
I think it will take having a paediatric dentist see this info and then have them promoting the concepts to their colleagues.

In fact I just asked Claude.AI and it gave me this answer:

“Getting evidence-based information to dentists internationally who may be skeptical requires a strategic approach that respects their expertise while positioning your insights as complementary. Here are some effective strategies:

Meet them in their professional spaces:

• Submit proposals to major international conferences: International Association for Dental Research (IADR), International Association of Paediatric Dentistry (IAPD), FDI World Dental Congress
• Pitch articles to high-impact dental journals like Pediatric Dentistry, Journal of Dental Research, Community Dentistry and Oral Epidemiology, or International Journal of Paediatric Dentistry
• Offer presentations through webinar platforms that reach multiple countries simultaneously
• Connect with CPD providers in different countries – dentists everywhere need continuing education credits

From your Australian base:

• Start with Australian Dental Association conferences and the Australian and New Zealand Society of Paediatric Dentistry (ANZSPD) to build credibility locally
• Publish in the Australian Dental Journal first, then use that publication to pitch international venues
• Leverage Australia’s strong reputation in evidence-based healthcare and public health research

Frame it as collaboration, not correction: Instead of positioning this as “what dentists are getting wrong,” frame it as “emerging evidence that bridges lactation science and dental health.” Dentists are more receptive when they see you’re filling knowledge gaps rather than challenging their clinical judgment. Lead with curiosity about their observations and questions.

Leverage influential allies:

• Partner with pediatric/paediatric dentists who already see nuance in the breastfeeding-caries relationship
• Work with dental researchers publishing in this area who could co-present or co-author
• Connect with the Academy of Breastfeeding Medicine, which has international reach and credibility with medical professionals
• Reach out to WHO or UNICEF Baby-Friendly Hospital Initiative coordinators who work with healthcare teams

Lead with the evidence they value: Open with systematic reviews, meta-analyses, and mechanism-based explanations. Dentists respond to biological plausibility and high-quality research. Address confounding factors (nighttime bottles, juice consumption, oral hygiene practices, socioeconomic factors, sugar exposure timing) head-on with data.

Create shareable resources:

• Develop a peer-reviewed publication that becomes the reference point
• Create visual abstracts and infographics for social media (LinkedIn is particularly effective for reaching health professionals)
• Consider a podcast interview on dental or paediatric health podcasts
• Develop an online course module that offers CPD/CE credits

Address the “why should I listen” question upfront: Dentists see the clinical outcomes daily. Acknowledge what they observe (caries in breastfed children), validate their concern for child oral health, then present the evidence on mechanisms, confounders, and what the research actually shows about exclusive vs. mixed feeding, nocturnal feeding patterns, and the complex etiology of early childhood caries.”
I will have to think about what to do next
probably try to publish in the Aust dental journal or international ones….??

kind regards
from Alison