On Practice

In order to build robust motor memory, the repetition of effective practice must take place during sensory-perceptual-motor learning, or more simply, motor learning. The Specificity Principle refers to practice specificity and learning specificity, in that practice must be specific to the task in order for learning to be effective.  When practice is indeed task-specific, and with the repetition of this specificity of practice, we can expect our performance to improve in the acquisition of all feeding skills and so many other skills across the lifespan.

The Specificity Principle is reflected in the Ten Steps to Successful Breastfeeding, a set of recommendations from the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF).  Step 9 of the Ten Steps advises, "Give no pacifiers or artificial nipples to breastfeeding infants."  The Baby-Friendly Hospital Initiative (BFHI) has long supported the Ten Steps to Successful Breastfeeding, and in childbearing facilities where the Ten Steps are followed, longer rates of breastfeeding duration result (see Appendices I - VI in the Resources section of this website).  

Here in the U.S., college basketball is nearing the end of its season, and the final men's game will take place on Monday night between Villanova and Michigan.  As the daughter of a high school coach in boys' basketball and baseball, I have so many positive memories of watching my late father, Wlbur Swank, coach athletes in his highly positive, high-energy style.  With these happy memories in mind, here are some favorite quotes about the importance of practice.  

Practice does not make perfect. Only perfect practice makes perfect. - Vince Lombardi

Practice doesn't make perfect. Practice reduces the imperfection. - Toba Beta

Everything is practice. - Pele

The way anything is developed is through practice practice practice practice practice practice practice practice practice and more practice. - Joyce Meyer

I used to practice at the hockey ground on synthetic surface while I was in the sports hostel, so Test cricket is certainly going to be a challenge for me. - Suresh Raina

Failure happens all the time. It happens every day in practice. What makes you better is how you react to it. - Mia Hamm

Champions keep playing until they get it right. - Billie Jean King

I've always really just liked football, and I've always devoted a lot of time to it. When I was a kid, my friends would call me to go out with them, but I would stay home because I had practice the next day. - Lionel Messi

Do it again. Play it again. Sing it again. Read it again. Write it again. Sketch it again. Rehearse it again. Run it again. Try it again. Because again is practice, and practice is improvement, and improvement only leads to perfection. - Richelle E. Goodrich

The same way that I practiced the violin, the same way that I practiced my dance moves, I decided that I was going to practice being positive and practice loving myself. - Lindsey Stirling

If I don't practice one day, I know it; two days, the critics know it; three days, the public knows it. - Jascha Heifetz

If you don't practice, you don't deserve to win. - Andre Agassi

Why should I practice running slow? I already know how to run slow. I want to learn to run fast. - Emil Zatopek

We learn by practice. Whether it means to learn to dance by practicing dancing or to learn to live by practicing living, the principles are the same. One becomes in some area an athlete of God. - Martha Graham

There is something comforting about going into a practice room, putting your sheet music on a stand and playing Bach over and over again. - Andrew Bird

First you study photography, then you practice photography, then you serve photography, and finally one becomes photography. - Ralph Gibson

Pastry school is great for a foundation and introducing you to basic techniques, but it is really up to the chefs to practice, practice, practice and refine their techniques. - Johnny Iuzzini

I'm a person who gets better with practice. Getting older is awesome - because you get more practice. - Zooey Deschanel

In the end, it's about the teaching, and what I always loved about coaching was the practices. Not the games, not the tournaments, not the alumni stuff. But teaching the players during practice was what coaching was all about to me. - John Wooden

Bradley is one of the few basketball players who have ever been appreciatively cheered by a disinterested away-from-home crowd while warming up. This curious event occurred last March, just before Princeton eliminated the Virginia Military Institute, the year's Southern Conference champion, from the NCAA championships. The game was played in Philadelphia and was the last of a tripleheader. The people there were worn out, because most of them were emotionally committed to either Villanova or Temple - two local teams that had just been involved in enervating battles with Providence and Connecticut, respectively, scrambling for a chance at the rest of the country. A group of Princeton players shooting basketballs miscellaneously in preparation for still another game hardly promised to be a high point of the evening, but Bradley, whose routine in the warmup time is a gradual crescendo of activity, is more interesting to watch before a game than most players are in play. In Philadelphia that night, what he did was, for him, anything but unusual. As he does before all games, he began by shooting set shots close to the basket, gradually moving back until he was shooting long sets from 20 feet out, and nearly all of them dropped into the net with an almost mechanical rhythm of accuracy. Then he began a series of expandingly difficult jump shots, and one jumper after another went cleanly through the basket with so few exceptions that the crowd began to murmur. Then he started to perform whirling reverse moves before another cadence of almost steadily accurate jump shots, and the murmur increased. Then he began to sweep hook shots into the air. He moved in a semicircle around the court. First with his right hand, then with his left, he tried seven of these long, graceful shots - the most difficult ones in the orthodoxy of basketball - and ambidextrously made them all. The game had not even begun, but the presumably unimpressible Philadelphians were applauding like an audience at an opera.            - John McPhee, A Sense of Where You Are:  Bill Bradley at Princeton

Quote of the Day

It always seems impossible until it's done. 

- Nelson Mandela (1918 - 2013) 

Noggin Bloggin

A link follows to Noggin Bloggin, a new favorite blog on "building networks in the community through neuroscience education and art".   Their most recent blog post,  "Why Art? Noggins Go To Washington", contains photos of many beautiful pieces of art on display during the recent Society for Neuroscience Conference held in D.C.  Of course the elegant drawings of neurons and synapses by neuroscientist and pathologist, Santiago Ramon y Cajal (1852 - 1934), were included in the exhibit.  The Noggins team also visited Sidwell Friends School in D.C. and Turner Elementary in Anacostia, where lucky students had the opportunity to make art, inspired by the inner workings of the brain.

http://nwnoggin.org/2017/12/23/why-art-noggins-go-to-washington/

An Untested Hypothesis

The learning of all feeding and drinking skills across the lifespan are forms of reward-based learning and reinforcement learning, both of which have been studied in the cognitive sciences for many decades. 

There are indeed some babies who display little difficulty in task-switching between breastfeeding and bottle-feeding, and the minimal difficulty is often displayed as minimal but nevertheless prolonged rooting (sensory processing in identifying the stimulus/stimuli, followed by action planning) prior to achieving the oral grasp for either or both feeding methods. This can be measured in milliseconds as response time, which is comprised of both reaction time and movement time for achieving the task, as in achieving and sustaining the oral grasp for milk-feeding. 

Task-switching has long been studied in the cognitive sciences, and today's PubMed search using the term task switching has yielded 2,888 results.  However, if using the term with a hyphen as task-switching, the search yielded only 1,321 results.  Switch costs of task-switching are measured as decreased speed and accuracy for the task, measured in milliseconds.  Infant feeding specialists, such as IBCLCs and others, are often called upon to provide manual guidance to the infant toward re-learning the oral grasp and/or effective suckling after a learning experience with an artificial nipple.  

I have an untested two-part hypothesis in regard to why a number of babies are able to successfully switch back and forth from breast to bottle and back to breast again, given that so very many infants display challenges ranging from mild to moderate to pronounced difficulties in correctly performing such task-switching skills, particularly during early learning, but not only during early learning.  This hypothesis applies to conditions of learning in the absence of learning constraints, such as complete cleft of the lip and palate; non-protractile nipple anatomy; and pronounced breast engorgement, however transient.  

Part 1 of the hypothesis: By following Step 9 of the Ten Steps and thereby building motor memory for the oral grasp and effective suckling at the breast, babies are able to strengthen motor memories for latch and suckling at the breast to a more robust state of motor memory.  Step 9 of the Ten Steps to Successful Breastfeeding encourages this accommodation for infants who are just beginning to learn, by advising, "Give no pacifiers or artificial nipples to breastfeeding infants."

Consolidation is the building and strengthening of memory into a robust state, and this includes the consolidation of motor memory. Early memories are fragile, and require the repetition of practice as well as sleep in building robust memory. Aside from the fragility of early motor memories, consider the fragility of other early memories, such as the difficulty in remembering a new computer password until more frequent use (the repetition of task-specific practice) builds increasingly robust memory for that new password. 

The second part of my untested hypothesis follows in regard to why some babies are able to switch back and forth between breast and bottle with only minimal delays in achieving the oral grasp following a moment or two of prolonged rooting. 

When babies are able to both breast and bottle-feed with no greater difficulty during task-switching other than minimal rooting prior to achieving and sustaining the oral grasp, I suspect and hypothesize that these babies are at a particular breast (and brain!) that is being stimulated for a far more rapid onset of the initial MER than average, which is a rapid reward to the infant in reinforcing what is being learned (rapid onset of the initial MER is not to be confused with an overactive MER that lasts throughout most or much of a feed).  This hypothesis is not a new lightning bolt of realization, but an integration of precepts from breastfeeding science and the cognitive sciences.  Clinicians have long discussed flow confusion and flow preferences, in addition to nipple confusion, nipple preference, suck confusion, and suck preference.       

When babies learn how to bottle-feed, regardless of whether the bottled milk is their own mother's milk, human donor milk, or artificial infant milk, the positive reinforcement to the infant of learning how to use correct bottle-feeding movements is the infant's ability to obtain milk with the very first suck via gravity flow, even when paced bottle-feeding is ideally used for a bottled feed.  The Milk Ejection Reflex (MER) is not stimulated by gravity, which is ideal from the milk-giver's point of view.  While lactating, who would wish to constantly release milk via gravity, except when adopting a supine position ?      

When we’re no longer at the breast and have transitioned to meals at the family table, the acquisition of all other feeding and drinking skills involves the reward and reinforcement of food or liquid with the very first correct eating and drinking movements, in spite of the awkward nature of feeding and drinking movements during earliest skill acquisition.  How we move, and the sensory consequences of our movements, inform us of so much.

New Study on Inhibition

Following the motor learning experience with an artificial nipple, the speed and accuracy of the infant's reflexive lunge toward the breast often becomes inhibited, particularly during early learning but not only during early learning. When an infant learns to bottle-feed, the opposite movement is learned, in that the bottle is moved toward the baby, rather than the baby being moved toward the bottle.  When an infant is subsequently returned to the breast, decreased speed and accuracy are often observed for the infant's latch, and such difficulties may be mild, moderate, or profound.  In many such instances, there are also observable decreases in speed and accuracy for organized, effective suckling.  The term skill decay is defined as decreased speed and accuracy for the task.  

Following a learning experience with an artificial nipple, the infant's reflexive oral gape is often inhibited to a more shallow gape as well (a "shallow latch"), even when an infant is able to achieve and sustain the oral grasp at the breast.  

Inhibition has been heavily studied in the cognitive sciences for decades. Today's PubMed search using the term "cognitive inhibition" yielded 11,580 search results, with newest studies published this month.

How has inhibition been traditionally studied in the cognitive sciences?

Researchers often compare reaction time, movement time, response time, and inhibition of return - - parameters that are measured in milliseconds. Inhibition of return (IOR), the delay in a previously orienting response, is considered significant when the delay is at least 200 to 500 milliseconds in duration. Although the comparison of these measurement parameters is not yet an area of formal study in the field of infant feeding for lactation consultants, the clinician often observes dramatic changes in these parameters over the course of a career, particularly in non-Baby Friendly hospital settings.  IBCLCs are educated and trained in many aspects of human lactation and infant feeding, and much of the clinician's workday is spent providing skilled guidance to both members of the dyad for the infant's oral grasp and/or effective suckling.  Varying levels of manual guidance are often needed by the infant in the acquisition and re-acquisition of infant milk-feeding skills, particularly when interference takes place during a baby's learning.  Neifert, Lawrence, and Seacat (1995) cited interference in their discussion on the first formal definition of the phenomenon of nipple confusion.  

In their new study published on December 4, 2017, Johns Hopkins researchers K.Z. Xu and colleagues used fMRI (functional magnetic resonance imaging) to study response inhibition.  Prior to this study, inhibition of planned behavior was thought to be governed by a single brain system.  In their current study, Xu and colleagues concluded that inhibition of a planned behavior "depends on two distinct neural processes involving different sub-regions of the rVLPFC [right ventrolateral prefrontal cortex] and their interactions with other motor-related brain regions." 

Title: Neural Basis of Cognitive Control over Movement Inhibition: Human fMRI and Primate Electrophysiology Evidence.

In: Neuron 2017 Dec 4. pii: S0896-6273(17)31063-2. doi: 10.1016/j.neuron.2017.11.010. [Epub ahead of print]   https://www.ncbi.nlm.nih.gov/pubmed/2922472

 Authors: Xu KZ, Anderson BA, Emeric EE, Sali AW, Stuphorn V, Yantis S, Courtney SM.  

Quote of the Day

I discovered what I could not do today, I could do tomorrow.   It's very important to know that what you cannot do today, you will do it tomorrow . . . . Each one of us is unique. 

                                     - Francois Rabbath, double bassist and composer,                                          speaking to students on learning to play the instrument

On Credentials: Discerning and Differentiating Between Those That Are Similar Yet Different

From a cognitive science point of view, discerning and differentiating between things that are similar yet different is cognitively demanding, and these cognitive demands range from mild to moderate to pronounced. 

We can quickly relate to this in our field of infant feeding when we observe the common difficulties that so many infants display when task-switching between the breast and a learning experience with an artificial nipple, particularly during early learning but not only during early learning. Similarly, families as well as hospital nursery staff often report that bottle-fed babies frequently "do better" with one style of artificial nipple versus another, and such observations are also made when infants are given different styles of soothers/pacifiers. We can expect the older baby as well as the toddler to reject one style of sippee-cup in favor of another, rather than task-switching between the two different styles with ease.   

In addition to the cognitive demands in learning motor skills, other forms of learning are often cognitively demanding from a task-switching perspective, including language. In our field of infant learning for milk-feeding skills, we are rightly concerned that the general public will have cognitive demands in discerning and differentiating between similar but different credentials of the infant feeding specialist. In these examples of job titles from our own field as well as other fields, consider the cognitive demands in learning how to accurately differentiate these professional titles, either with little difficulty, moderate difficulty, or marked difficulty: 

Teacher versus Teacher's Aide

Manager vs. Assistant Manager

Nurse vs. Nursing Assistant

Licensed Practical Nurse (LPN) vs. Registered Nurse (RN) vs. Nurse Practitioner (NP) 

Doctor/physician vs. Physician's Assistant

Optician vs. Optometrist vs. Ophthalmologist

International Board Certified Lactation Consultant vs. Certified Lactation Specialist vs. Certified Breastfeeding Specialist vs. Certified Lactation Counselor vs. Certified Lactation Educator Counselor vs. Breastfeeding Counselor vs. Breastfeeding Peer Counselor vs. Lactation Educator vs. Certified Lactation Educator vs. Community Breastfeeding Educator vs. Certified Clinical Lactationist, and so on.   

We clinicians are often asked by new parents about the differences between breastpumps, and we are educated and trained to teach these differences in pump technology, in order that parents may be best educated to discern which pump will meet their needs. In the U.S., prenatal breastfeeding classes typically include a segment on various pumps, with detailed instruction in how one type of pump varies from another, and such teaching is also provided at the hospital bedside and in home settings.

The eminent psychologist, William James (1842 - 1910), discussed the cognitive challenges in discernment and differentiation, using the examples of discerning between different red wines, and differentiating one twin from another. The cognitive demands of task-switching (and the subsequent switch costs of decreased speed and accuracy for the task) have been heavily studied in the cognitive sciences for decades, and these areas continue to be heavily studied. Today's PubMed search using the term "task switching" yielded 2,873 results. 

The extraordinary growth of the lactation consulting profession has been nurtured and supported by the credentialing body, the International Board of Lactation Consultant Examiners (IBLCE).  For decades, this credentialing body has promoted the International Board Certified Lactation Consultant (IBCLC) as "The Gold Standard" in specialized knowledge and clinical expertise in breastfeeding and human lactation. 

IBLCE offered the first board certification exam in 1986, and since that time, the lactation consulting profession has grown to over 28,000 IBCLCs from 105 countries, with over 15,000 IBCLCs in the United States alone.  In the short timespan of the profession's 31-year history, the dramatic growth in the number of IBCLCs is a remarkable testament to the care of the dyad by skilled clinicians.  The growth of our profession is also a testament to the decades of support from the IBLCE in promoting the education and training of the IBCLC as "The Gold Standard" in caring for the dyad. 

Parents who seek skilled infant feeding and lactation care are best served by appropriately credentialed clinicians. As parents seek information about various credentials for lactation and infant feeding specialists, this search should not be so cognitively demanding as to require the expenditure of hours by sleep-deprived new parents.  When parents can readily access concise information about the credentialing of lactation clinicians, parents should then be able to accurately discern and differentiate one credential from another, in order to meet their own health care needs and the health care needs of their infant.

At Least 2.33 Million Reasons

The skilled support of the IBCLC is critical in the health of the dyad, and there are at least 2.33 million reasons why.  

A 2017 study looked at expanding Medicaid coverage for lactation services, breastfeeding duration rates, and cost-effectiveness of IBCLC support.  This study was conducted in North Carolina, finding that when breastfeeding support resources are available state-wide, such high-density IBCLC support is associated with increased breastfeeding by low-income mothers.  Furthermore, this study found that such high-density IBCLC services are cost-effective:  Medicaid reimbursement of IBCLCs showed an estimated annual cost savings of $2.33 million.    https://www.ncbi.nlm.nih.gov/pubmed/27535132

New Study: The Significance of Breastfeeding Duration on Maternal Cardiovascular Disease

This new prospective study of 300,000 Chinese women found that breastfeeding reduced the risk of maternal CVD (cardiovascular disease) later in life, particularly with greater duration of breastfeeding.  Of note is the decreased risk of maternal heart attack and stroke with greater breastfeeding duration.                                                                                                                                                                                                                                                            The press release:  https://www.medpagetoday.com/cardiology/strokes/66168

The open access article:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669201/pdf/JAH3-6-e006081.pdf

Quote of the Day

It's all connected,

because the way babies move determines what they see,

and what they see determines what they learn.  

                                                   - Linda Smith PhD (2013)                                                                                                             

Smith is Distinguished Professor and Chancellor's Professor of Psychological and Brain Sciences at Indiana University.  http://www.indiana.edu/~cogdev/

Psy Talks Episode 1:  Movement and babies' learning development  https://www.youtube.com/watch?v=yMyn8j8sMjA

New Study: Examining Delivery Method and Infant Feeding Intentions Between Women and Traditional and Non-Traditional Prenatal Care

In this new study, researchers found that women who were enrolled in group prenatal care (CenteringPregnancy), in contrast to those receiving traditional prenatal care, had fewer planned cesarean section births and high rates of breastfeeding initiation. 

From the abstract:  "The purpose of the study is to evaluate delivery method and breastfeeding initiation in women enrolled in group prenatal care (CenteringPregnancy) and in traditional prenatal care.  Methods:  Data were obtained from medical records of a hospital-based midwifery practice in south central Connecticut that offered both types of prenatal care programs.  Medical information from 307 women enrolled in this practice was included in the analysis. Out of the 307, 80 were enrolled in group prenatal care. Socio-demographic, lifestyle, and previous and current obstetrical information from medical records formed the basis of comparison. Bivariate and logistic regression analyses were carried out.  Results: Women in Centering had fewer planned cesarean sections (1.3 vs. 12.8%) and had a higher breastfeeding initiation (88.7 vs. 80.0%).  However, Centering women were found to have a higher portion of unplanned cesarean sections (27.5 vs. 11.0%). Both the unadjusted and the adjusted odds ratios of having a cesarean planned delivery were lower in the group care. Women in Centering had 2.44 (95% CI 1.05, 5.66) times the odds of breastfeeding initiation compared to the odds for women in traditional prenatal care after adjusting for maternal age, smoking status, gestation, and race. Discussion: CenteringPregnancy can have a positive impact for the woman and baby. This program implementation saw lower rates of elective cesarean sections and increased breastfeeding compared to women in traditional care."    https://www.ncbi.nlm.nih.gov/pubmed/29124626

New Study: Associations Between Breastfeeding and Maltreatment in Childhood

In this new study in Breastfeeding Medicine, researchers Kremer & Kremer looked at whether breastfeeding practices impact childhood maltreatment in regard to neglect, inadequate supervision, physical abuse, and sexual abuse. After controlling for covariates, the study found that compared with adolescents who were never breastfed, adolescents who were breastfed 9 months or longer had REDUCED ODDS of having experienced neglect and sexual abuse. Study conclusions: "Breastfeeding duration is significantly and inversely associated with childhood neglect and sexual abuse."  https://www.ncbi.nlm.nih.gov/pubmed/?term=associations+between+breastfeeding+and+maltreatment+in+childhood

The Dynamic Study of Task-Switching, Switch Costs, and Inhibition

As a registered nurse and IBCLC (International Board Certified Lactation Consultant) specializing in infant feeding and human lactation, I love studying kinesiology and other cognitive sciences on task-switching, switch costs of decreased speed and accuracy, and inhibition. These areas have all been heavily studied for many decades, and three new studies (among many new studies in these areas) are shared below.    

From time to time, lactation consultants are asked about the use of cannabis during lactation, and we frequently utilize three well-known resources in the field:  Lactmed, part of the toxicology database at the National Institutes of Health; Dr. Thomas Hale's invaluable reference handbook, Medications and Mothers' Milk (2017); and the InfantRisk Center.  

The first of three new studies mentioned here looked at vigilant attention, inhibitory control, top-down attentional control, and cognitive flexibility (aspects of executive functioning) in cannabis users and non-cannabis users.  Researchers measured salivary cortisol to assess these areas, finding altered attentional control among cannabis users compared to non-cannabis users.  These results are relevant to parenting, in that responsible parenting requires prolonged periods of alert attentiveness.  The cannabis study citation:  

Nusbaum AT, Whitney P, Cuttler C, Hinson JM, McLaughlin RJ.  Altered attentional control strategies but spared executive functioning in chronic cannabis users.  Drug and Alcohol Dependence 2017 Oct 12;181:116-123.  DOI: 10.1016/j.drugalcdep.2017.09.019. [Epub ahead of print]

Another interesting task-switching study just out:  

H. Freyja Ólafsdóttir, Francis Carpenter, Caswell Barry. Task Demands Predict a Dynamic Switch in the Content of Awake Hippocampal Replay. Neuron 2017; DOI: 10.1016/j.neuron.2017.09.035

And the third new study on task-switching and switch costs, which is by no means the very last of new studies in this fascinating area: 

Swainson R, Martin D, Prosser L.  Task-switch costs subsequent to cue-only trials.  The Quarterly Journal of Experimental Psychology 2017 Aug;70(8):1453-1470.  DOI: 10.1080/17470218.2016.1188321  

Today's PubMed search results using the term "task-switching":  1,295

Today's PubMed search results using the term "cognitive flexibility":  4,144

Today's PubMed search results using the term "cognitive inhibition": 11,362

Infant cognition labs in graduate psychology programs often study cognitive flexibility and task-switching in infants and children, with Piaget's A-not-B Task as one of the seminal task-switching studies in the field of developmental psychology, the study of learning across the lifespan.  Going well beyond Piaget's work, the late Carolyn Rovee-Collier (1942 - 2014) was the founder of the field of infant long-term memory research.  Please see a listing of infant learning labs under the Resources section of this website.  These infant learning labs are just part of Rovee-Collier's legacy.    

Quote of the Day

What do we live for, if it is not to make life less difficult for each other? 

 - George Eliot (1819 - 1880) 

Quote of the Day

Behavior reeks of purpose.

- Psychologist Edward Tolman (1886 - 1959) 

http://www.npr.org/sections/13.7/2013/02/11/171578224/of-rats-and-men-edward-c-tolman

http://www.apadivisions.org/division-1/publications/newsletters/general/2015/04/tolman.aspx

Quote of the Day

We have a brain for one reason and one reason only -- and that’s to produce adaptable and complex movements. Movement is the only way we have of affecting the world around us . . . I believe that to understand movement is to understand the whole brain. And therefore it’s important to remember when you are studying memory, cognition, sensory processing, they’re there for a reason, and that reason is action.

- Neuroscientist Daniel Wolpert (b. 1963)

http://www.neuroscience.cam.ac.uk/directory/profile.php?wolpert

https://www.ted.com/talks/daniel_wolpert_the_real_reason_for_brains

Quote of the Day

Immediately after learning, the motor memory is fragile.  In particular, it is vulnerable to disruption by learning of something similar.  However, if there is no disruption, with the passage of time, the memory becomes more robust. It is this process, of becoming more and more robust with time, that is designated consolidation.

- Kinesiologist Mark Hallett PhD (2006) https://neuroscience.nih.gov/ninds/Faculty/Profile/mark-hallett.aspx

Motor Learning Terms of the Day

For many decades, the impact of artificial nipple use on feeding skills in breastfeeding infants has been measured in studies on breastfeeding duration, measuring rates of exclusive breastfeeding duration and/or the duration of the entire breastfeeding course (see Appendices 1 - 6 in the Resources section of this website).  Skill acquisition, skill decay, and re-acquisition of infant breastfeeding skills can also be studied and measured in real time, i.e., in milliseconds (ms), utilizing the parameters below during direct observation of infant feeding behaviors.  

Similarly, in bottle-feeding populations - regardless of whether the milk is expressed mother's milk, human donor milk, or artificial infant milk - the acquisition of bottle-feeding skills, skill decay, and the re-acquisition of infant bottle-feeding skills can also be measured in regard to task-switching between different styles of artificial nipples that vary in diameter, length, texture, shape/contour, scent, and taste.  Task-switching between similar yet different pacifiers/dummies can be studied as well.  Task-switching is much studied in the cognitive sciences, including the subsequent and frequent switch costs of decreased speed and accuracy for the task. 

Reaction time (RT):   the interval between the presentation of a stimulus and the initiation of a response, measured in milliseconds (ms).  After a newborn’s learning experience with an artificial nipple and subsequent return to the maternal breast, a delay in the infant's reaction time to the maternal stimuli (nipple-areolar complex) is often observed.   

Movement time (MT): the interval of time between the initiation of a movement and its completion, also measured in milliseconds.  Following an infant's learning experience with an artificial nipple and subsequent return to the maternal breast, the infant’s movement time for achievement of the oral grasp and/or effective suckling at the breast is often prolonged.  

Response time:  the interval from the presentation of a stimulus to the completion of a movement; the sum of reaction time (RT) and movement time (MT).  

The equation:  RT + MT = response time.  

Inhibition of return (IOR): the phenomenon of the delay or impairment in responding
to a previously cued (orienting) stimulus (by 500 - 3000 milliseconds [ms] or more).
*1 second (s) = 1000 milliseconds (ms)

The above learning terms can also be utilized to further define infant feeding confusions and preferences, expanding on the first formal definition of nipple confusion provided by Neifert, Lawrence, and Seacat (1995).  

Quote of the Day

Humans come with preadapted motor behaviors that are built into the central nervous system. But even reflexes, such as the sucking and grasp reflexes, are quickly modified by the infant’s experiences in the world. For the species’ survival, these early experiences open a dialogue between the newborn and its new stimulus-rich world. This dialogue provides a cycle of perception and action with consequences.  

                    - Kinesiologist Jane E. Clark  https://sph.umd.edu/people/jane-e-clark