Reframing the Clinical Approach

Breastfeeding Assessment and Intervention for the Medically Fragile Infant


 CEUs for OT, SLP, and PT specific to breastfeeding & improving outcomes in the NICU, PICU, and medically fragile infants


In this 4 hour, self-paced continuing education course, you’ll learn to establish, support, and maximize breastfeeding outcomes in the NICU, PICU, or high-risk follow-up clinics

Providing CEUs & L-CERPs for Healthcare Professional

IBLCE Long-Term Provider

4. 0 L-CERPs

Human milk for the medically fragile infant is critical


How can you support and prolong the breastfeeding relationship in medically complex infants?


This course covers the specific importance of breastfeeding for medically fragile infants, the establishment of the mother's milk supply (and how this is different when the infant is hospitalized), breastfeeding assessment within the intensive care units (including LATCH score and PIBBS), interventions to support medically fragile infants, and case studies to highlight strategies for successful implementation (including sequential videos marking the infant's progress and outcome).


You can advance your skills and inform the team regarding breastfeeding in the NICU and with fragile infants.


NICU Course Learning Objectives:

Participants will be able to:

  1. Identify the difference in mother’s breastmilk composition between full-term infants versus pre-term infants
  2. Identify components of the Baby-Friendly Hospital Initiative specific to pre-term infants
  3. Identify the different components of the pre-term infant breastfeeding behavior scale (PIBBS)
  4. Identify breastfeeding positions that take into consideration the limitations the standard neonatal intensive care unit (NICU)
  5. Identify the benefits of skin-to-skin in the medically fragile infant

Specific information and case studies to advance your skills to confidently work with NICU and medically fragile infants 


Latch and positioning using clinical observation during feeding

Suck, swallow, breathe coordination patterns in the premature infant and the mature infant

Nutritive sucking versus non-nutritive sucking during clinical observation

Step-by-step walk-through for how to score the LATCH Assessment and PIBBS Assessment. Watch the footage of infants breastfeeding and score this assessment alongside the instructor followed by an in-depth explanation of the scoring process.

Breastfeeding interventions and breastfeeding tools (nipple shield, supplemental nursing system, and more) explained

How to monitor babies for signs and symptoms of dysphagia during breastfeeding 

Case Study A follows a late-term infant born at 35 weeks with temperature instability and slow weight gain from evaluation to discharge

Case Study B follows an infant with Trisomy 21 (Down Syndrome) with a cardiac condition who receives all nutrition via NG tube from evaluation on day 3 of life to discharge

Timed Agenda

This is a complex area of practice and we know it takes time to absorb and apply new information in the NICU. We also know you’ll have a variety of medically fragile infants on your caseload. That’s why this CE course is self-paced and you can replay the videos as many times as you’d like for 6 months rather than trying to understand everything the first time through. 

Course Information

7 minutes

  • Introduction
  • Disclosures
  • Learning objectives
  • Course overview

Establishing Breastfeeding

1 hour 14 minutes

  • The Importance of Breastfeeding - 31 min
  • Establishing Mother's Milk Supply - 43 min

NICU Assessment & Evaluations

1 hour 5 minutes

  • Breastfeeding Assessment - 20 min
  • Standardized Assessment (LATCH + PIBBS) - 31 min
  • Instrumental Evaluations of Swallowing at the Breast - 14 min

Feeding Interventions for Fragile Infants

1 hour 30 minutes

  • Interventions and tools - 61 min
  • Case Studies - 29 min

CE Course Assessment & Feedback

5 minutes

  • Conclusion 
  • Feedback survey and multiple choice assessment - untimed

Reframing the Clinical Approach

Breastfeeding Assessment and Intervention for the Medically Fragile Infant



Establish, support, and maximize breastfeeding outcomes in the NICU & PICU



Kelly Andrasik McLeod, OTD, OTR/L, BCP, IBCLC, CNT

Kelly has been an occupational therapist since 2008, practicing in both adult and pediatric settings. She specializes in feeding and swallowing rehabilitation for medically fragile infants in the neonatal intensive care unit. She has received her advanced practice certification in “Swallowing Assessment, Evaluation, and Intervention” and was within the first group of therapists to become a Certified Neonatal Therapist (CNT). Additionally, she is trained and certified as an International Board-Certified Lactation Consultant (IBCLC). 

Kelly received her doctorate degree in occupational therapy (OTD) in 2019 from Kansas University Medical Center, where her focus was occupational therapy’s role in maximizing breastfeeding support and improving breastfeeding outcomes for medically fragile infants. In addition to her clinical passions focused in the NICU, Kelly is a passionate instructor, serving as an adjunct faculty member at Kansas University Medical Center’s post-professional occupational therapy doctoral program. 

Frequently Asked Questions


What makes this course different from other lactation or pediatric courses?

This course is specific to breastfeeding assessment and intervention strategies for medically fragile infants in the NICU, PICU, and high-risk follow up clinics. 

It brings in the therapist’s perspective for breastfeeding and optimizing outcomes for infants.


Who is this intended course for?

  • Occupational Therapy Practitioners (OT, COTA)
  • Speech Language Pathologists (SLP)
  • Physical Therapists ( PT & PTA) 

 that desires to work or currently works in the NICU, PICU, or high-risk follow-up clinic. This course is excellent for NICU therapists that already have a CLC, CBS, etc.


Are there prerequisites for this course?

There are no required prerequisites. 


How long will I have access to the course?

6 months from the purchase date. 

This allows you to apply the information to a variety of infants on your caseload over time, and review the modules as needed. We want you to deeply understand this information and provide the very best outcomes for the infants you treat. 


Can I count this course towards my 90 hours of lactation-specific education?

Absolutely! This course is approved for 4.0 L-CERPs. To receive credit for completion, each participant will need to complete a post-assessment with a passing score of at least 80% to ensure all learning objectives are met.


Information about AOTA CEUs

This course is approved for 0.4 AOTA CEUs

Participants will be required to:

  • Complete the course in its entirety (100% of the course watched)
  • Complete a multiple-choice post-assessment with a passing score of at least 80% (untimed test, 3 retakes)


Information about ASHA CEUs

0.4 ASHA CEUs for Speech-language pathologists. To receive ASHA CEUs, participants will be required to:

  • Ensure you are eligible to receive ASHA CEUs! Click here for more information
  • Complete the course in its entirety (watch time is tracked by the learning management system) 
  • Complete the multiple-choice post-assessment with a passing score of at least 80% (untimed test, 3 retakes)
  • There is no option for partial credit


Continuing Education Information for Physical Therapists

APTA does not approve individual companies and you will need to check with your individual state for online course requirements.

To best prepare you can save the following:

  • The certificate of completion that will be provided
  • List of references
  • A copy of the assessment questions


What is your refund/cancellation policy?

Refunds must be requested within 14 days of purchase by emailing [email protected]. A full refund is available if no modules have been started. A partial refund is available once ANY portion of the course has been viewed. The amount refunded is at the sole discretion of The Lactation OT LLC. There is no refund available after 14 days of purchase OR if module one has been completed. Recipients will receive acknowledgment of refund requests within 3 business days. If the request is valid per the terms listed above, the refund will be processed within 7 business days. If for any reason the course is canceled by The Lactation OT before the course is started, a full refund will be provided. 


How do I request special accommodation?

Please send us an email at [email protected] at least 14 days before starting the course with further details of your request.


Working in the NICU or with medically fragile infants as a therapist can be intimidating


Human milk is a critical piece that supports infant development, and breastfeeding can be established even in complex cases. 


As you gain experience and deepen your knowledge of specific topics, your confidence will increase — and so will the outcomes of your most fragile clients.

Bundle, Save, and Earn a Badge

Medically Fragile Infant (14 hours)

  • Breastfeeding Assessment and Intervention for the Medically Fragile Infant: Reframing the Clinical Approach

  • Failure to Thrive, Suboptimal Weight Gain, and the Lactation Savvy Therapist

  • Tube to Breast: Navigating the Transition from Enteral Feeding to Breastfeeding

Bundle + Save 15% Now  ➝

The Lactation OT is proud to provide lactation-specific CEUs and LCERPs to OT, SLP, PTs, IBCLCs, and healthcare professionals. Your clients depend on you, and we’re here to support you as you provide the most effective, evidence-based care possible. 

Together we can continue to raise the level of care in lactation and infant feeding.

Looking for more information? Have a comment or complaint. Send an email to [email protected]. View the complaint policy here.