Breastfeeding support is recognised as a key public health priority within Ireland’s healthcare system. The HSE Breastfeeding Action Plan 2016–2021 identified the need to strengthen breastfeeding supports, improve breastfeeding rates, and ensure mothers and infants receive skilled, evidence-based care. As part of this initiative, Infant Feeding Lactation Specialist (IFLS) posts were developed to provide enhanced clinical support to Public Health Nurses (PHNs), Registered Midwives (RMs), and families experiencing complex breastfeeding challenges.

 

Establishing the service

In February 2023, the Infant Feeding Lactation Service was formally established within Dublin North City and County (DNCC) now realigned as IHA (integrated Health Area) Dublin North City and West and IHA Dublin North County. The service was developed with a whole-time equivalent post in Dublin North, and a 0.5 post in both Dublin North Central and Dublin North West. The development of the IFLS service was guided by national policy recommendations aimed at improving breastfeeding outcomes across Ireland. Initial priorities for the service focused on:

• Establishing the IFLS service structure within DNCC;
• Developing a referral pathway to the IFLS service for PHNs and RMs;
• Creating clinical documentation including a referral form, IFLS assessment document and referral criteria;
• Supporting staff education regarding the referral processes; and
• Developing local breastfeeding policies and procedures to guide clinical practice.

 

Professional qualifications and expertise

Infant feeding specialists are highly skilled clinicians with advanced expertise in breastfeeding and lactation management. Post specific criteria for the role includes:

• Registration in a relevant division of the Register of Nurses and Midwives, as maintained by the Nursing and Midwifery Board of Ireland (NMBI);
• A minimum of five years’ post registration experience;
• At least two years of experience in infant feeding and lactation care; and
• A recognized certified qualification in breastfeeding and lactation.

Many Infant Feeding and Lactation Specialists hold International Board-Certified Lactation Consultant (IBCLC) accreditation, recognised internationally as the gold standard qualification in lactation care. IBCLC certification requires completion of extensive lactation specific education, supervised clinical experience, and ongoing recertification through continuing professional development.

Some clinicians also hold the Professional Certificate in Breastfeeding and Lactation from UCD, which provides preparation for advanced lactation practice and IBCLC examination.

 

Role of the IFLS Service

The Infant Feeding Lactation Service provides specialist clinical support to PHNs and RMs delivering breastfeeding care within primary care services. The aim of the service is to support mothers and infants experiencing breastfeeding difficulties, while also enhancing the knowledge and confidence of healthcare professionals working in the community.

Services currently provided include:

• Specialist breastfeeding assessment and intervention and support for complex feeding challenges;
• Loan of breast pumps to families where clinically indicated;
• Low-level laser therapy (photobiomodulation) and ultrasound therapy for breastfeeding-related conditions;
• Clinical support and mentorship for PHNs and RMs;
• Delivery of the National Infant Feeding Education Programme (NIFEP);
• Support for staff undertaking IBCLC training and professional development;
• Development of breastfeeding-specific policies and procedures; and
• Support for HSE breastfeeding support groups across Dublin North.

The service also supports continuity of care between maternity hospitals and community services, particularly for medically complex babies and mothers experiencing significant breastfeeding difficulties. Strong multidisciplinary links have been developed with GPs, PHN teams, dieticians, ENT consultants, IFLS working within the maternity hospitals and also with Childrens Health Ireland (CHI) hospitals and community nursing services.

Referral pathway

Referrals to the IFLS service are accepted from PHNs and Registered Midwives working within primary care services. Prior to referral:

• The PHN completes a breastfeeding assessment using the breastfeeding observation and assessment tool (BOAT);
• An individualised care plan is developed; and
• Initial breastfeeding interventions are implemented.

Where breastfeeding challenges remain unresolved despite initial interventions, a referral is made to the IFLS service. Referral documentation includes the Breastfeeding Observation Assessment tool (BOAT), care plan, and referral form.

 

Who we see: Inclusion and exclusion criteria

The service primarily supports mothers and infants experiencing complex breastfeeding difficulties. Examples of inclusion criteria include:

• Infant weight loss greater than 10 per cent;
• Poor latch or ineffective suck despite PHN intervention;
• Persistent maternal pain during or after breastfeeding;
• Inadequate milk transfer and concerns regarding infant growth;
• Recurrent mastitis or blocked ducts;
• Breastfeeding following treatment for breast abscess;
• Maternal medical or birth history impacting breastfeeding;
• At-risk infants, including premature or medically unwell infants;
• Delayed breastfeeding initiation;
• Milk over- or under-supply; and
• Delayed attachment following exclusive expressing.

Exclusion criteria include maternal choice to exclusively express without medical indication, routine supplementation not related to feeding difficulties, or families already under the care of another lactation consultant.  

Education and training

Education and professional development form a central component of the IFLS role. The HSE Breastfeeding Action Plan specifically identified breastfeeding education, training, and skills development for healthcare professionals as a key strategic priority. The IFLS service contributes to this objective through the delivery of education, mentorship and clinical support. Delivery of The National Infant Feeding Education Programme (NIFEP) commenced in late 2024. The National Infant Feeding Education Programme (NIFEP) is a structured, multi-phase training programme designed to equip healthcare staff with the knowledge, attitudes, and practical skills needed to support infant feeding. Its aim is to standardise the care and advice breastfeeding mothers receive across clinical and community settings. The programme is facilitated by community-based IFLS staff and midwives from the Rotunda, runs every six weeks, and includes a mix of Public Health Nurses, hospital midwives, and community midwives. The IFLS team work in collaboration with the Regional Centre for Nursing and Midwifery Education (RCNME).The programme comprises four phases: Phase 1 covers eLearning units on breastfeeding and formula feeding (~3.5 hours); Phase 2 is self-directed learning with reflective journaling (~1 hour); Phase 3 is hands-on Breastfeeding Skills Training covering skin-to-skin contact, positioning, attachment, and hand expressing; and Phase 4 provides supervised clinical practice. Evaluation and feedback have been excellent, with participants particularly highlighting the benefit of standardising care and working collaboratively across disciplines.   Other education initiatives delivered by the IFLS team include;

• BOAT education and training;
• Infant feeding learning and network forums;
• GP education programme; and
• National Breastfeeding Week education events.

 

Client feedback

Feedback from service users has been overwhelmingly positive. A formal commendation submitted to the ‘Your Service Your Say’ team praised the IFLS lactation consultant in Dublin North County for her exceptional, holistic, and non-judgmental care. The client — a public health professional with nearly 20 years’ experience — described the support as “one of the most positive experiences of my perinatal journey”, crediting the service with enabling her to continue breastfeeding after a difficult start following a Christmas Day birth with no hospital lactation support available. A Smart Survey conducted in January 2024 reinforced this experience more broadly. The vast majority of respondents described the service using phrases such as “absolutely brilliant” and “fantastic service,” with many stating they would not have continued breastfeeding without IFLS intervention. Rapid response time was highlighted as critical, as was the clinical expertise of staff — including identification of tongue tie — and the emotional and psychological support provided. The loan of hospital-grade breast pumps was also cited as a key practical benefit. The feedback strongly supports the case for continuation and expansion of the service, particularly given that Ireland’s breastfeeding rates remain among the lowest in Europe.  

Pumps funding/ultrasound and laser machines

Since IFLS posts were established, access to hospital-grade breast pumps has grown significantly. Initially around 20 pumps served all of DNCC. In 2025, additional funding through the National Childhood Programme enabled the purchase of further pumps, the establishment of a free rental process for families, donations to mothers and IPAS centres, and the supply of pumps within the PHN service. This expansion has been directly linked to improved outcomes, with the Smart Survey specifically noting the pumps as a positive factor in protecting and increasing milk supply. Confirmation has now been received of further funding for 2026, which will enable more integrated working with the maternity hospital in providing pumps to mothers. Funding was also approved for laser and ultrasound machines and for training and safety around using them. Laser (Photobiomodulation therapy) uses red light to accelerate tissue regeneration and reduce inflammation, with key benefits including healing of cracked nipples and pain relief. Therapeutic Ultrasound uses sound waves to generate heat and vibration, reducing pain and swelling in inflamed breast tissue. Both modalities have become an integral part of managing breastfeeding complications within the IFLS.  

Future of our service

To summarise the service to date, it continues to evolve in response to the needs of mothers, infants, and healthcare professional’s educational needs working within primary care services. Since its establishment, the IFLS service has contributed to strengthening breastfeeding supports across IHA Dublin North County and Dublin North City and West by improving access to timely assessment and intervention for families experiencing complex breastfeeding challenges. To date over 2,250 referrals have been received to the service, the most common reasons for referral to the service include: latch difficulties, low milk supply, breast inflammation and nipple damage. All referrals have been offered phone consultations, clinic and home assessments and often follow-up care. With increase demand for the service, the posts in Dublin North City and Dublin North West have been increased to full-time posts. The IFLS is at an exciting stage of development. Key priorities include establishing a dedicated peer support group for mothers experiencing Primary Low Milk Supply — a group that research shows can feel isolated in standard breastfeeding support settings. A staff advice clinic is also planned, where colleagues can bring complex cases for evidence-based support and troubleshooting. Looking further ahead, the service aims to bring breastfeeding education into schools, targeting young students and normalising breastfeeding from an early age. The team is optimistic about the direction of the service and the broader impact it can achieve.