On-Demand Webinars with CERPs!

More Than Reflexes

Learning, Forgetting, and Relearning Infant Breastfeeding Skills

Integrating precepts from breastfeeding science and the cognitive sciences

with emphasis on kinesiology,

the study of human movement, motor learning, and motor control

Following a learning experience with an artificial nipple, why do so many infants display skill decay for breastfeeding skills, i.e., decreased speed and accuracy for the oral grasp and/or effective suckling at the breast? 

Why do so many bottle-fed infants display difficulty in learning the oral grasp of an artificial nipple that differs from a previously learned artificial nipple in contour, length, width, and/or texture?

When older infants have learned to drink from a sippee-cup and are subsequently offered a different style of sippee-cup, there is often a behavioral display of difficulty in learning that novel style of sippee-cup.  Why do such observable difficulties occur in infants around the world, particularly but not only during early learning?  

Please join us for this 3-hour intensive course on:

  • motor skill acquisition (motor learning toward motor control)

  • skill decay (motor forgetting)

  • reacquisition of infant breastfeeding skills 

This groundbreaking content provides a wealth of readily teachable precepts integrated from breastfeeding science and the cognitive sciences, with emphasis on kinesiology - the study of human movement, motor learning, and motor control.

IBLCE Verification Number C1881306

CERPs: 3.0 L-CERPs

Presenter Debra Swank, RN BSN IBCLC

Key Terms  motor learning, motor forgetting, motor control, motor memory, learning constraints, coordination, feedback, expected sensory consequences, learning specificity, specificity of practice, task-switching, switch costs, skill decay, primacy effect, recency effect, proactive interference, retroactive interference, perseverance, performance plateau, transfer of learning, consolidation of memory, automaticity, reaction time, response time, movement time, inhibition of return.

Course Description The presence of the primitive survival reflexes does not guarantee the oral grasp and effective suckling in all babies all the time.  There is a well-known but poorly understood universal phenomenon of 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 cessation of the entire breastfeeding course.  For decades, the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) advised childbearing facilities to avoid the use of pacifiers and artificial nipples in breastfeeding infants, as part of the Ten Steps to Successful Breastfeeding.  Current language in the Ten Steps advises childbearing facilities to counsel mothers on the use and risks of feeding bottles, teats, and pacifiers. In order for childbearing facilities to receive the prestigious designation of Baby Friendly Hospital, observation of the Ten Steps is part of the WHO criteria set forth in the Baby Friendly Hospital Initiative (BFHI).  As of this writing, fewer than 26% of all childbearing facilities in the U.S. currently hold the WHO designation of Baby Friendly Hospital.

  Infant breastfeeding difficulties that follow the use of an artificial nipple are often observed as a recency effect, i.e., the primitive survival 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.  Following the use of an artificial nipple, newly acquired difficulties with latch and/or suckling are often observed, while other infants are able to latch but display a new technique of shallow latching, a requisite technique for using an artificial nipple, but one that is correlated with nipple pain and visible nipple damage when the infant feeds at the breast.  These breastfeeding difficulties are particularly prevalent during early learning, prior to the achievement of robust motor memory or consolidation of motor memory for breastfeeding skills.  

     We adults have much in common with our former infant selves, in that learning is most effective when practice is specific to the task.  Motor learning is a complex process, and task-switching between tasks that are similar yet different requires enough rehearsal time to learn how to discern and differentiate which movements are appropriate and inappropriate for correctly performing a specific task.  After learning a similar but different task and subsequently returning to the original task, switch costs are often observed, and these switch costs are measurable in regard to decreased speed of movement as well as decreased accuracy in performing the task.  Task-switching and switch costs have been studied for decades by comparing measurements in reaction time (RT) to stimuli; movement time (MT) for the achievement of a movement or a series of coordinated movements in completing a task or skill; response time; and inhibition of return (IOR), a delay in responding to a previously cued (orienting) stimulus. 

  Across the lifespan, examples abound for switch costs that often follow task-switching.  At approximately six months of age, the older baby begins to learn to drink from a sippee-cup, but weeks to months are required for the achievement of basic skills in sippee-cup drinking.  During early skill acquisition, the baby will not display any ease in switching to a similar but different sippee-cup, and a novel sippee-cup is often refused by infants in favor of an originally learned sippee-cup.  The toddler begins to learn how to use a spoon and a fork, and during early practice sessions, often displays spoon-like movements when using the fork, and fork-like movements when using the spoon.  The professional musician who is preparing for an important performance on the clarinet will not rehearse with an oboe, as there is a world of difference in the oral grasp of the clarinet mouthpiece and the oral grasp of the oboe reed.  The elite athlete will never rehearse for the World Series in baseball by practicing with a softball or a non-regulation sized baseball, and so on. 

   Toward greater understanding of sensory-perceptual-motor learning in the acquisition of infant breastfeeding skills, this intensive presentation integrates precepts from the fields of breastfeeding science and the cognitive sciences, with emphasis on kinesiology - the study of human movement, motor learning, and motor control.  Utilizing these integrated precepts, prioritized clinical interventions are discussed in regard to observable skill decay for infant breastfeeding skills that often follows the use of an artificial nipple.  Research opportunities are also discussed in regard to motor skill acquisition for infant breastfeeding skills.   

About the Speaker Debra Swank, RN BSN IBCLC is the Owner and Program Director of More Than Reflexes Education, a Registered Nurse, and International Board Certified Lactation Consultant (IBCLC) who specializes in maternal-child health and infant feeding, with a focus on breastfeeding and human lactation.  Ms. Swank began her RN career serving infants, children, and young adults with genetic and other chronic health problems.  An IBCLC since 1998, she has provided infant feeding and lactation care in inpatient and outpatient settings in both rural and urban areas, serving well over 15,000 families from many walks of life.  Ms. Swank’s current professional focus is the integration of the cognitive sciences toward greater understanding of learning within the context of the primitive survival reflexes, with emphasis on skill acquisition (motor learning toward motor control), skill decay or motor forgetting, and relearning infant breastfeeding skills.  In addition to her professional interests in sensory-perceptual-motor learning for the acquisition of infant breastfeeding skills, Ms. Swank is also interested in Edward Z. Tronick’s Mutual Regulation Model (MRM).

Conflict of interest statement:  The speaker declares no current or potential conflicts of interest.


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Group rates are available.  Please contact us for more information!

Upcoming Webinars

Developmental Science and Breastfeeding Skill Acquisition addresses learning, forgetting, and relearning in the context of the developmental progression of task-switching abilities (cognitive flexibility) from infancy to adulthood, with emphasis on the earliest of skills to be learned.  A historical overview of early research on sucking in puppies and rat pups is presented, including seminal work by Dr. Walter C. Stanley (1922 - 2015) and by Dr. William P. Smotherman (1946 - 2008). Groundbreaking work by Dr. Carolyn Rovee-Collier (1942 - 2014), the founder of infant long-term memory research in humans, is a centerpiece of this discussion.  Rovee-Collier's master's thesis was on sucking in puppies.  

Looking on the Inside:  Neural Analogs of Learning and Forgetting discusses how the brain changes as we learn, forget, and adapt.  A historical overview on cognitive neuroscience is given, and precepts from breastfeeding science and associative learning are integrated, with emphasis on excitatory and inhibitory processes.  Across the lifespan, sleep is critical for the consolidation of memory - the strengthening of memory toward a robust state.  As new memory traces are first encoded, there is a fragility of the new memory, but over time - with the repetition of practice followed by rest and sleep - new memories become more robust, and this robust state is termed consolidation.  Following the use of an artificial nipple, the infant's reflexive breastfeeding movements are often subsequently inhibited at the breast, particularly during early learning.  Inhibition is a dynamic area of study in the cognitive sciences, including the inhibition of reflexes, when reflexive behavior is altered during the learning process.