MoreThanReflexes.org is an educational resource for professionals on the cognitive neuroscience of learning, forgetting, and relearning, as well as the science of motor learning, motor forgetting, and motor relearning of infant milk-feeding skills, with a focus on breastfeeding skill acquisition. 

Our infant mammalian selves receive early learning support for milk-feeding skills in the form of pre-adapted movements termed the primitive survival reflexes (crawl, search/rooting, oral grasp or latch, suck, swallow, and cough), but the exquisite presence of these reflexes does not guarantee the oral grasp and effective suckling for all infant milk-feeding methods in all babies all the time.  There is a widely known but poorly understood universal phenomenon of observable infant breastfeeding difficulties that often follow the use of an artificial nipple, and a wealth of data correlates the use of an artificial nipple with shorter duration of exclusive breastfeeding, as well as early termination of the entire breastfeeding course.  Similarly, bottle-fed infants are frequently observed to struggle with - and often refuse - a novel style of artificial nipple, regardless of whether the bottled milk contains expressed mother's milk, human donor milk, artificial infant milk, or a blend of any of these milks.  

Infant breastfeeding difficulties that follow the use of an artificial nipple are often observed as a recency effect, i.e., the primitive reflexes are often more heavily weighted toward the more recently learned feeding method, rather than equal weighting of these reflexive feeding movements for all infant milk-feeding methods all the time.  A further aspect of the phenomenon is that infant breastfeeding difficulties are less likely to occur when the use of an artificial nipple is avoided entirely or for a sustained period of time, particularly during the early learning period for breastfeeding skill acquisition.   In 1989, in response to this universal phenomenon, the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) first began advising that artificial nipples, including pacifiers, should not be given to breastfeeding infants.  This well-known formal recommendation is listed in WHO/UNICEF’s Ten Steps to Successful Breastfeeding as Step 9: “Give no pacifiers or artificial nipples to breastfeeding infants." The Ten Steps to Successful Breastfeeding has long been part of the criteria for the prestigious WHO designation of Baby Friendly Hospital. 

Motor learning is a complex process across the lifespan, and learning how to switch between tasks that are similar yet different (task-switching) is also a time-consuming process as we learn how to discern and differentiate between movements that are appropriate as well as inappropriate for performing various tasks.  Exclusively bottle-fed infants often display greater skill with an originally used artificial nipple, and often refuse a novel artificial nipple that is different in size, contour, and/or length.  When babies have learned to breastfeed as well as bottle-feed, parents often report that their infant will only accept a certain style of bottle nipple.  When babies and children are given pacifiers (soothers), there are often observable displays of refusal for a different style of pacifier, as well as displays of acceptance for a previously learned style of pacifier. 

In the world of sport and other performances, task-switching is considered costly, and thus practice should be specific to the task for learning to be most effective.  Switch costs often follow task-switching efforts, and these switch costs can be readily observed and formally studied as slower speed of movement and less accuracy in performing the task, with human movement measured in milliseconds (ms) for reaction time (RT) to stimuli, movement time (MT) for completion of the movement, and response time for the sequence from onset of the stimuli to completion of the movement.  In addition, the inhibition of return is measureable - - the delay in responding to previously cued (orienting) stimuli.  Consider the professional musician who is preparing to audition for a prestigious position in a symphony orchestra:  when one’s instrument is the clarinet, the musician would never choose to rehearse for the audition using an oboe, due to the tremendous differences in the oral grasp for each mouthpiece.  Similarly, the elite athlete would never choose to practice with a softball in preparing for the World Series in baseball, due to the expected and subsequent change in baseball performance following the adaptation of the manual grasp to the softball.  More practice that is specific to the task (practice specificity) can once again build stronger performance for accuracy and speed of movement, although switch costs are considered far too costly to many performers, and task-switching between similar but different tasks is frequently, intentionally, and intuitively avoided. 

Much research has been conducted over the past five decades in the area of infant long-term memory, beginning with the seminal work of Carolyn Rovee-Collier.  Infants display the greatest difficulty during task-switching studies in all ages studied, with a distinct progression in task-switching abilities as we move from infancy toward adulthood.  Children display less difficulty than infants in task-switching studies, and adolescents display greater ability than children in task-switching.  Even though switch costs continue into adulthood, adults display the least difficulty in task-switching studies as compared to their younger counterparts.  

Although lactation consultants are extensively educated and trained in breastfeeding and lactation management, much of the clinician’s workday is spent providing verbal and manual guidance to mothers in motor learning for positioning the baby to feed, as well as manual guidance to the baby for motor learning the oral grasp of the maternal nipple-areolar complex (the latch), and clinicians further provide manual guidance to the infant in learning how to effectively suckle for adequate transfer of milk.  Like other professionals who provide hands-on care, lactation consultants are not born knowing how to provide such assistance, and thus we each have our own motor learning curve toward increasingly greater motor control during the acquisition of our clinical skills, as we progress from the novice stage to greater expertise.   To date, precepts from the fields of motor learning, developmental psychology, and cognitive neuroscience have been little discussed in the field of breastfeeding and human lactation, and similarly, the fields of developmental psychology, cognitive neuroscience, and kinesiology have placed little to no focus on the acquisition, skill decay, and reacquisition of infant milk-feeding skills.   Integrating precepts from these related sciences can only provide greater insights into the acquisition of the earliest of our skills.  

MoreThanReflexes.org provides professional education on sensory-perceptual-motor learning, motor forgetting, and motor relearning, in support of robust motor memory for the earliest of infant feeding skills.   Toward this goal, many precepts are integrated from the fields of breastfeeding science, developmental psychology, developmental cognitive neuroscience, and kinesiology – the study of human movement, motor learning, and motor control. 


MoreThanReflexes.org is a professional educational website by Debra Swank, RN BSN IBCLC.  Ms. Swank is a graduate of Davis & Elkins College, and began her health care career serving infants, children, and young adults with genetic and other chronic health concerns.  An International Board Certified Lactation Consultant (IBCLC) since 1998, Ms. Swank has provided care in both rural and large urban settings to over 15,000 nursing families from many walks of life.  In addition to her professional interests in sensory-perceptual-motor learning for the acquisition of infant breastfeeding skills, Ms. Swank is also interested in Tronick's Mutual Regulation Model (MRM).