CONFERENCE REFLECTION
Translating Evidence into Individualised Care

Dr Sonya Quinn, IBCLC

I was delighted to attend the GOLD Lactation Online Conference 2026, supported by an ALCI bursary that part-funded my registration costs. The conference offered an extensive programme exploring current research, emerging technologies and evolving approaches to complex lactation care. I also completed two specialist recording packages: The Art & Science of Complex Breast and Nipple Care and Breastfeeding Biomechanics: Functional Approaches to Oral Coordination.

The ALCI bursary made this continuing professional development more affordable and accessible. It is a wonderful opportunity for ALCI members who wish to expand their knowledge while managing the considerable costs associated with maintaining and developing professional competence. I would strongly encourage other members to consider applying for future bursaries.

A particular highlight was Seizing the Day: Supporting Women with Epilepsy to Breastfeed, presented by Irish IBCLC and ALCI member Pauline McLoughlin. It was especially rewarding to see an Irish colleague contributing her expertise to an international conference programme.

Pauline's presentation explored the additional considerations faced by women with epilepsy during pregnancy, birth and breastfeeding. Anti-seizure medication may require dose adjustments during pregnancy, while the immediate postpartum period can bring an increased risk of seizures. Sleep deprivation, disrupted medication routines and the physiological changes following birth may all contribute to this vulnerability.

The presentation highlighted the importance of planning and multidisciplinary support. Parents need individualised information about their medication, seizure control and infant-feeding goals. Rather than assuming that epilepsy or anti-seizure medication automatically prevents breastfeeding, professionals should consider the specific medicine, dosage, available safety evidence and any appropriate monitoring of the infant. Practical support from family members and healthcare professionals can also help reduce sleep deprivation and support medication adherence. Pauline's session demonstrated how informed, collaborative care can help women with epilepsy breastfeed while protecting both maternal and infant wellbeing.

Across the wider conference, one of the strongest themes was the importance of looking beyond simple explanations. Persistent nipple pain, insufficient milk production, recurrent breast inflammation and infant feeding dysfunction rarely have a single cause. Assessment should consider the parent's health, breast anatomy, milk production, feeding or expressing practices, infant function, emotional wellbeing and wider circumstances.

Several presentations challenged the routine attribution of burning or shooting nipple pain to Candida. Possible causes include neuralgia, dermatitis, trauma, inflammation and mammary dysbiosis. The sessions on breast and nipple skin conditions also reinforced that conditions can appear differently across skin tones. For example, dermatitis may appear grey or violaceous rather than red on darker skin.

The complex breast-care programme explored the evolving understanding of plugged ducts, nipple blebs, mastitis, abscesses and hyperlactation. 'Plugged ducts' are no longer best understood as lumps of thickened milk physically blocking a duct. Current models place greater emphasis on inflammation, ductal narrowing, surrounding oedema and, in some cases, microbial dysbiosis or biofilm formation.

This has important implications for treatment. Aggressive massage, excessive heat and repeated attempts to 'empty' the breast may increase inflammation and tissue trauma. Appropriate strategies may include cold compresses, anti-inflammatory support where clinically suitable, responsive milk removal and attention to attachment, positioning, pumping practices and milk production. Nipple blebs should not automatically be unroofed.

The biomechanics package examined suck-swallow-breathe coordination, oral aversion and frequently missed aspects of oral assessment. Feeding is a complex neuromotor and sensory activity. Cranial nerve function, airway stability, respiratory timing, sensory processing and the autonomic nervous system all influence an infant's ability to feed effectively.

The oral-aversion presentation emphasised that defensive behaviours may represent a protective nervous-system response to discomfort, stress or previous negative experiences. Forced oral exercises or behavioural desensitisation alone may reinforce an infant's perception that feeding is unsafe. Supporting regulation, respecting infant cues and involving appropriate multidisciplinary professionals are central to trauma-informed feeding care.

Key take-home points

• Epilepsy or anti-seizure medication does not automatically preclude breastfeeding; support must be individualised.
• The immediate postpartum period requires careful planning for seizure risk, sleep and medication adherence.
• Breast and nipple symptoms require differential assessment rather than automatic treatment for thrush or 'blocked milk.'
• Deep massage, excessive pumping and routine unroofing of blebs may cause further trauma.
• Infant feeding assessment should include breathing, coordination, regulation and sensory responses - not oral anatomy alone.
• Oral aversion should be understood as a possible protective nervous-system response.
• Technology and AI may complement care but cannot replace skilled assessment.
• Research must be critically appraised before being translated into clinical recommendations.

Overall, the conference reinforced that high-quality lactation care requires curiosity, critical thinking, collaboration and respect for each family's circumstances and goals. I am grateful to ALCI for helping to make this valuable professional-development opportunity possible.