Lactation professionals are detectives.

From the first client contact to the last, your eyes and ears are open for clues.

You catch the hints that might mean an incorrect latch, tethered oral tissues, a milk supply problem.

You read the body language of your client and their baby and gauge how they’re feeling.

But can you pick up these signs and signals on a computer screen?

It can definitely be harder!

Virtual consults have become a big part of many people’s practices, due to the COVID-19 pandemic.

And while there are advantages to seeing clients virtually (no commute for them or you, ease of scheduling, a broader coverage area) there are also challenges.

Doing a great assessment can be one of them.

Try these three things the next time you’re working virtually.

Having your client send you a few key videos before the consult can allow you to do a much better assessment than relying on the live session. Ask for the following:

A video of a nursing session, especially of problems. This way, you can assess challenges at the breast when they’re happening, in case they don’t happen during the consult.

An oral assessment video. Oral structures and function can be hard to assess in a virtual consult. Asking your client to attempt an oral assessment video beforehand can give you a better view. Check out a video showing parents how to do this here: How to do an oral motor assessment on your baby on Vimeo.

Miscellaneous other videos. Consider asking a client to record a pumping session or a flange fit ahead of time, or any other specific issues you think might apply.

2.) Switch between phone and computer for better views. Having your client use their phone’s camera to show their baby’s latch can allow for much better angles than having them use their computer. But the small screen size will make it harder for them to see what you are demonstrating and teaching. So be prepared to suggest toggling between devices for the best experience.

A great assessment relies on eliciting all the key information. In a virtual environment, try these tips:

• Remove distractions from your environment.
• Use noise-canceling headphones.
• Look directly at the client. If you need to look away to take notes, tell them first.
• Pay close attention to body language, since it is harder to catch.
• Use both nonverbal cues (nodding encouragingly) and verbal affirmations to let your client know you heard.
• Do not interrupt.
• Ask open-ended questions (instead of yes or no questions) to elicit the most information.

Ready for more? These tips were drawn from LER’s comprehensive course, Mastering the Art of Virtual Lactation Support

In this course, Robin Kaplan, M.Ed., IBCLC, also covers choosing a platform, HIPAA compliance, building your own library of videos to share with clients, handling technical and connectivity problems, and key questions to ask in a virtual consult to evaluate what’s happening with oral motor function, pain, milk transfer, and milk supply.

Kaplan has been an instructor and clinical site mentor for aspiring lactation consultants since 2013. She offers in-person consults to families in San Diego and has provided virtual lactation consultations to families around the world since 2018.

When you come into the world as a multiple, you’re used to sharing. But even if you’re a multiple, some things should be your very own! Among these is individualized care from your lactation support professional.

Each baby in the set of multiples is unique and has unique needs. When you’re supporting a family with multiples, it’s important to keep this in mind.

You catch the hints that might mean an incorrect latch, tethered oral tissues, a milk supply problem.

Everything from your initial assessment to your care plans (one for each baby) to your follow ups should carefully consider each baby as an individual.

With that in mind, here are six things every baby in a set of multiples needs to be their very own.

1) Their own pace and expectations. From how quickly they gain weight to how fast they learn to latch (and later, to how fast they walk, talk, and read), every baby in a set of multiples deserves to operate on their own timeline. Their twin (or triplet) might serve as a natural comparison point, but they shouldn’t! Each baby has had their own unique experience and has their own strengths and challenges. Reminding parents—and yourself—to compare each baby only to their own trajectory is key.

2) Their own feedings at the breast/chest. Feeding babies separately is time consuming, but especially in the early days, giving each baby time alone at the breast or chest can really help. Encourage the nursing parent to offer at least some feedings alone until each baby is nursing effectively.

3) Their own chance to bond. The bond between each multiple and their parent is unique and develops in its own way. Most parents bond first with the babies as a unit. Later, they bond with each one more individually. Reassure parents that this pattern is normal—and that many factors can influence how quickly they bond with each one—for example, one baby comes home while the other has a longer hospital stay, or one is able to feed at the breast before the others. Letting parents know that being in different places on their bonding journey with each baby doesn’t mean anything is wrong can relieve a lot of worry.

4) Their own lactation care plan. Creating a separate care plan for each infant, rather than one for all the multiples, is important. This will help parents focus on individual challenges, goals, and successes.

5) Their own hour of your time. And of course, creating separate care plans takes more time. When you’re seeing multiples, plan to add an extra hour for each additional baby you’re working with.

6) Their own follow up schedule. When you’re planning for follow-up consults, don’t forget that one baby may need a follow-up when the others do not, and one baby may require more follow ups than others. Make decisions about whether and when to see each baby again on an individual basis.

Ready to learn more? These suggestions are drawn from LER’s course Breastfeeding Multiples. Instructor Nichelle Clark, IBCLC, RLC, CBS, founder of SonShine and Rainbows Lactation Services in Virginia, USA, covers health concerns during multiple pregnancy, positioning, managing supplements, ensuring adequate intake, and more.

A few years ago, scientists studying Lyme Disease in an area of Appalachia (United States) noticed something strange.

A lot more people with fair skin than people of color were being diagnosed with Lyme Disease.

The researchers got curious.

They asked, is the difference simply because white people are more likely to live in “endemic areas,” areas heavy with Lyme Disease?

The answer was no.

Even when you control for where people live, and the activities they engage in, the discrepancy holds true—fewer people of color are diagnosed with Lyme.

Then researchers noticed something else: Fewer people of color were being diagnosed with Lyme, but many more were being diagnosed with arthritis.

What was going on?

Ultimately, researchers made a critical connection.

When someone has symptoms of acute Lyme Disease, doctors look for one thing: the distinctive bull’s eye rash.

On fair skin, that rash jumps right out at you.

On darker skin, it can be easy to miss.

And doctors were missing it.

With serious consequences.

Patients whose Lyme Disease is missed in its early stage can face chronic and late Lyme Disease, with months of unexplained suffering and serious health complications.

What does all this have to do with lactation?

As it turns out … a lot.

Lactation professionals usually have great observation skills.

When you first see a client, you are probably looking for many clues as to what is causing their challenges.

But how often in an assessment do you consider the client’s skin tone?

What if we told you that many, many common breast/chest and nipple conditions can look very different depending on the skin tone of the person you’re seeing?

They can.

And like the doctors diagnosing Lyme Disease, if you’re not aware of the differences, you are likely to miss something.

Here are three common examples.

Mastitis. In both clients with fair skin and darker skin, mastitis involves flu-like symptoms and an unresolved clog. The difference? In a light-skinned client, there is likely a defined area of redness—erythema—or red streaking. And we’re trained to notice that redness as part of the diagnostic picture. It looks painful and emergent. A client with darker skin may actually have mastitis that is more severe, but because an area of erythema (redness) isn’t evident, we can miss the diagnosis.

Vasospasm. You see a client with nipple pain and a characteristic blanched/white spot on the nipple after their baby feeds. What happens next? You’re expecting to see the skin turn from white to blue and back to red/pink. But for this client, the skin simply fades back to brown. What is happening? The answer: In clients with dark skin, this is a normal presentation of vasospasm. But if you don’t realize that, your assessment may miss it.

Surgical scars: You probably check for breast/chest surgery scars. But they can be harder to see on those with darker skin tones, leading you to fail to ask key questions.

These are far from isolated examples.

Many other breast/chest and nipple conditions present differently on different skin tones.

Adding to the issue, the vast majority of lactation training textbooks and courses show almost exclusively fair-skinned breasts and pink nipples.

This is true even though 70 percent of the global population—the overwhelming majority of people in the world— do not have the fair skin pictured.

As a lactation care provider, what can you do?

Here are four tools:

Build awareness. Remember that your exposure to diverse and representative imagery has been limited, and so your default concept of how a breast/chest will look with various conditions is limited.

Seek out diverse images. Look for opportunities to study images of non-white breasts/chests, nipples, and common conditions. An excellent tool is The Melanated Mammary Atlas.

Truly engage. During assessments, truly observe. Ask questions and listen to the answers (both body language and words). Believe what your client tells you.

Thinking flexibly. Especially when symptoms are atypical or not obvious, it becomes critical to consider all the pieces of the clinical picture before drawing conclusions. When you’re staying aware of the full clinical picture, you’re less likely to be thrown by seeing or not seeing one element.

For example, the client with flu-like symptoms and a clogged duct, but with no visibly red area?

Listen to their experiences, truly hear what they’re telling you, pay attention to the totality of signs and symptoms, and you will probably draw the right conclusion.

There’s much more to learn on this important topic.

This information is drawn from our new class, “How Did I Miss That? Breast Assessment in Non-White Skin Tones: Enhanced.”

The course is taught by Nekisha Killings, MPH, IBCLC, practicing IBCLC and Director of Equity, Inclusion, and Belonging at LER.

Killings is also the creator of The Melanated Mammary Atlas, an online tool dedicated to displaying mammary-related conditions on Asian, Indegenous, Black, and Brown skin.

Learn more about the class here. Also available for CME credit here.

Visit the Melanated Mammary Atlas here.