Choosing practitioners for support with your baby

So, you are worried about your baby’s feeding, sleep or reflux and you are looking for help?

How do you know from whom to seek help?

Unfortunately, with the current staffing and resourcing issues in the NHS and local authorities, exacerbated by the impact of Covid, more and more families are looking outside the NHS and other statutory services for support. Some families have always done this as there will always be limits to what any service can provide.

Infant feeding

With regards to breastfeeding support this used to often mean seeking out the free support run by volunteers via the national breastfeeding charities – Association of Breastfeeding Mothers, NCT, Le Leche League or Breastfeeding Network. Private, paid for support was exclusively provided by International Board Certified Lactation Consultants (IBCLCs). However, as interest has grown in infant feeding and more families are choosing to breastfeed (which are both hugely positive shifts in thinking and attitudes) lots of people are setting themselves up as ‘breastfeeding consultants’, feeding specialists’ and so on and charging for their services.

My concern is that families may end up paying a lot of money to see someone who has minimal or even no training and not get the support and help they need. My other concern is that the people offering these services are not regulated or supervised in any way and therefore may not be providing the best and most evidence-based help and support.

Personally, I would not have dreamt of charging anyone anything to see me for breastfeeding support until I had my IBCLC qualification even though I was a Registered Nurse and Health Visitor and qualified ABM Breastfeeding Counsellor and had already spent 8 years in total training and studying to gain recognised qualifications. It simply did not feel ethically right to charge until I had the gold standard IBCLC qualification and could offer that high level of expertise. But of course, this takes a lot of time, in terms of training and practical experience, and involves a lot of expense to achieve.

So as parents how to you choose an appropriate person to employ to help you? Where do you go to for information?

I recently saw a parent comment on social media that they had chosen their practitioner based on the fact they post alot on Instagram and ‘seemed’ passionate. Anyone can post on social media and create any impression they want. You just need the time to do this and good marketing skills. Call me a cynic but is that passion they are presenting a passion for supporting families or for making a name for themselves and generating income? There is a lot of alarming misinformation being shared on social media and this often goes unchallenged because it is being shared by people with large numbers of followers. LOOK AT THE QULIFICATIONS, EXPERIENCE AND ACCOUNTABILITY OF THE PERSON SHARING THE INFORMATION. Is there research to back up what they are saying? Ask them!

People who are passionate about infant feeding often come from a background of volunteer breastfeeding support. They may have held committee or training roles within organisations that support infant feeding. For example, the breastfeeding charities already mentioned, Lactation Consultants of Great Britain and The Association of Tongue-tie Practitioners. These roles are unpaid and involve alot of hard work and commitment.

Certainly, social media is a great place to start of search for practitioners, but you need to go so much further than this. You need to understand the qualifications and experience the person has and is offering. In the world of breastfeeding the IBCLC credential is the highest qualification out there. IBCLCs must complete a minimum of 90 hours taught training on lactation and a minimum of 1000 hours in practical breastfeeding support depending on experience and whether they are already a nurse, midwife, or doctor. (It was 2500 hours of practical support experience when I did it). They then sit a 4-hour (previously 6 hour) exam. They must follow a code of conduct and have a regulatory body. They are also required to prove they have kept up to date via a system whereby they have to re-certify every 5 years.

Breastfeeding Counsellors, who have trained via the charities previously mentioned, will have breastfed their own babies and done a training program with one of the national charities which can take to 2-3 years to complete. They are supervised by those charities and required to demonstrate that they are keeping up to date via continuing education.

Other qualifications in infant feeding usually do not have any entry requirements, or have such rigorous supervision, and assessment/examination and updating processes in place.

Where a practitioner is also a registered healthcare professional such as a Nurse, Midwife, Health Visitor, Doctor they will have obviously undergone years of training, taken exams, completed degrees, and so on and will be registered with a regulatory body (NMC in the case of nurses and midwives and GMC in the case of doctors). They will be required to demonstrate ongoing professional development and updating via the revalidation process which for nurses and midwives is every 3 years. If breastfeeding is part of their role, then they need to demonstrate they have kept up to date to perform that role. However, please remember most registered healthcare professionals only have basic breastfeeding education and, in many cases, do not have any, so if you are paying someone with these qualifications for infant feeding support you really do need to be asking specifically about the additional training they have had.

Does regulation matter? Yes, it does because it ensures that practitioners are keeping up to date and are accountable for their actions. So, if you have a problem or concern with the care, they have provided you can take that concern to their regulatory body to be dealt with via the regulatory body’s ‘fitness to practice’ processes.

Whilst Breastfeeding Counsellors are not regulated, unlike a registered healthcare professional or an IBCLC, you can raise concerns via their charity and that charity can take appropriate disciplinary action. If you employ someone without regulation or supervision, then you are on your own if there is a problem. Furthermore, the law only requires that healthcare professionals have professional indemnity insurance so the person who has just done a short online course in breastfeeding could be working without insurance. Make sure you check the person you are seeing has insurance.

But if they are charging a large fee surely that guarantees a good service? No, it does not? The level of fees people charge is often no reflection of expertise. I have seen people who have done just a 16-hour course in basic breastfeeding management charging far more than I do for a consultation. I would also caution against going for the cheapest option as offering an excellent quality service does involve expense and experience should be valued. Look at several practitioners offering similar services in your locality to gauge what a reasonable fee is and look carefully at what they are offering for that fee.

So, if you are looking for someone to support you with feeding your baby look for someone who has the IBCLC qualification, or a Breastfeeding Counselling qualification awarded by one of the charities mentioned. Ask about their experience and do they have insurance? Ask other local families who they have used and for their experiences. Almost all of my work comes via personal recommendation, and I fill all my clinics every week. I have a Facebook and Instagram page which I am not terribly active on and write limited content for as my energies are devoted to supporting my clients and educating my colleagues. So please look beyond the memes and flashy graphics on social media.

Tongue-tie services

In relation to private tongue-tie services all practitioners providing divisions should be registered healthcare professionals so will be regulated by the NMC, GMC, GDC, etc. They are also required to either be registered with the CQC themselves, be employed by an organisation who has CQC registration or in the case of private doctors and surgeons they may have practicing privileges under a CQC registered hospital. Many practitioners like me have their own CQC registration which means we are inspected and our inspection reports and CQC rating are available on our websites. This gives families an extra level of reassurance around the quality of care they will receive and provides far more reliable and objective information than how many followers we have on social media.


So, what about sleep coaching/training and reflux experts?

I am a Holistic Sleep Coach and trained with BabyEm (Lyndsey Hookway). Their course is extensive, includes lectures from leaders in their field, is evidence based, updated, and taught over a 14-week period. The approaches taught take into account a wide range of issues such as family dynamics, environmental factors, health factors, social stressors, diversity, child development, and parental mental health. A lengthy assignment incorporating two case studies to complete. My assignment at 12,000 words was longer than my HV degree dissertation which was 10,000 words. The course in accredited by the Open College Network at level 6 (degree level). BabyEm provide continuing support and opportunities for continuing education and professional development. Not all training in sleep is as comprehensive. Some practitioners may have only done a stand-alone weekend course, and some may have been taught strategies such as ‘cry it out’ which many families do not find acceptable.

There is no regulatory body for sleep coaching and no requirement to be supervised or updated, unless that person is a registered healthcare professional such as a nurse or midwife, so again raising concerns can be difficult for parents as there is no one to go to and a lack of insurance may be an issue.

Now what about reflux specialists? What do we mean by reflux? Spitting up milk is normal in babies due to a weak lower oesophageal sphincter and provided baby is not in pain or distress and weight gain is not affected simple conservative measures like keeping baby upright, and offering smaller, frequent feeds may be all that is needed. Do we need to be paying hundreds of pounds for advice on managing this? But what about the babies who are thoroughly miserable with their reflux and cry all day and all night, throw up large volumes and are struggling with weight gain?

Of course, families need support with this but from whom? The Nice Guidance on Reflux in babies recommends that initial management should be a feeding assessment whether that baby is breast or bottle fed. A common cause of more severe reflux symptoms is aerophagia (swallowing of air during feeds) and simply improving the latch to the breast or reviewing bottle teats and bottle-feeding technique can reduce this and improve symptoms. A tongue-tie or other sucking or swallowing difficulty may also contribute to aerophagia. Food allergies (often to cow’s milk protein but sometimes to other allergens) can also trigger reflux symptoms. So, who can help? If families are struggling to get help via their GP or HV and are looking for private support than an IBCLC will have knowledge, training, and experience in managing reflux and will also be able to identify potential tongue tie and other sucking issues. They will also be familiar with allergy symptoms and can support families with accessing referrals to dieticians and paediatricians as needed.

So, I am not sure why we are seeing a growth in parents paying large sums of money to reflux specialists who are often from a lay background, with no professional healthcare qualifications, regulation or accountability, and a limited range of training, knowledge, and experience. My guess is parents are desperate for help but have no guidance on who to seek they help from. A considerable number of families I see have paid these specialists far more than any client has ever paid me for any level of support, only to be referred to me for tongue-tie assessment. The information they have paid those substantial amounts of money for is included in my feeding/tongue-tie assessment appointments.

People offering tongue-tie assessment

And finally, a word about the new emerging practitioner (who again may not be a registered healthcare professional so may not be regulated and accountable) calling themselves a ‘certified’ or ‘accredited’ tongue-tie assessor. Certified and accredited by whom? Certainly not any professional or regulatory body. Tongue-tie is a diagnosis that should only be made by a registered healthcare professional with additional specialist training. Assessment on whether division is safe for your baby and likely to be beneficial rests with the person holding the scissors and should be discussed with parents to enable informed decision making. The tongue-tie practitioner and parents carry the burden of responsibility for that baby.

Even though your GP is medically trained, you would not expect your GP to look at lump in your breast and tell you your breast needs removing. You would expect to be referred to a breast surgeon with specialist knowledge for further assessment and investigation and for that surgeon to advise you on whether surgery is necessary and what type of breast surgery or treatment is appropriate. So why would you pay someone who is not trained in tongue-tie division to advise you on whether a tongue-tie division is needed or not?

I have no problem with anyone working with families with babies in whatever capacity learning how to reliably spot the signs and symptoms of tongue-tie and learning how to identify potential restrictions in tongue function so they can refer on to a tongue-tie service appropriately. I have been training a wide variety of professionals including GPs, Surgeons, Dentists, Speech Therapists, Osteopaths, Chiropractors, Midwives, Nurses, HVs. IBCLCs, Breastfeeding Counsellors, Peer Supporters, Doulas, Maternity Nurses and so on since 2015 to identify potential tongue restrictions and refer on to tongue-tie services.

But if parents, or those supporting them, suspect a baby may have a tongue-tie and they are looking for private help with further assessment they should be looking at the directory of the Association of Tongue-tie Practitioners. Practitioners listed there can provide division as well if needed. I am afraid if you pay a practitioner who does not divide, for assessment of tongue-tie, you will end up paying twice as no tongue-tie practitioner will divide based on another practitioner’s assessment because they at are professionally, legally, and ethically accountable for the decision to treat or not treat that baby. My blog post Can I just pay for the snip? provides more information on this.

Your baby is precious. They deserve the best care. Many families are struggling financially. They should not be taken advantage of.



S Oakley 29/9/2022


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