1 R-CERP

Assess and Refer With Confidence

Rachel O'Brien, MA, IBCLC, PMH-C
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Opens 11/14/2026

Abstract

Not every lactation professional wants to manage complex bottle refusal cases, and not every professional should. But bottle refusal questions arrive whether or not a practitioner has sought them out, and the generic advice that gets offered in that moment is not neutral. Advice that does not fit the baby can prolong the problem, and in some cases can push a baby from refusal into aversion.

This course provides a triage framework for practitioners who want to offer safe initial guidance and to recognize, quickly and reliably, when a case belongs with someone else. Learners work through a structured brief assessment: the history questions that separate a straightforward case from a complicated one, the yellow flags that call for closer attention, and the red flags that call for prompt referral.

The course then addresses referral itself, which is the part most often done badly. Learners map the referral landscape, including lactation professionals who specialize in bottle refusal, speech-language pathologists and occupational therapists, providers who assess oral restriction, pediatricians, and perinatal mental health providers, and develop language for explaining scope of practice and referral recommendations in a way that maintainsrather than erodes a family's trust.

Meet your instructor

Rachel O'Brien, MA, IBCLC PMH-C

Rachel O'Brien is an IBCLC with a MA in human lactation who runs a busy private practice in Boston and specializes in bottle refusal. Rachel works 1:1 with families to help their babies learn to eat from the bottle, without tears.
"I love it when the confusion clears and the families I work with realize that they know more than they think they do, and that their instincts are almost always right!"
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Rachel began her specialization in bottle refusal in 2019 and when the pandemic hit Rachel realized that bottle refusal had become a much more widespread feeding problem. Rachel developed a method for teaching parents how to re-frame their baby's "bottle refusal" and to work with their baby instead of against them. Rachel does 1:1 bottle refusal visits both in her office and virtually, and has worked with families across the USA and internationally. Rachel has presented on bottle refusal at national conferences and is known among parents and other professionals as a bottle wizard.  

Rave Reviews for Rachel

Rachel shares her knowledge in a clear and understandable way and then provides helpful examples that solidify the information in a “real world” way. 100% recommend!

Piper Prach, IBCLC

Rachel is a fantastic educator!  

Renee Neuens, RN IBCLC

I can not tell you how much I enjoyed this course. Rachel teaches in a way that makes everything so understandable. 

Kelly Menne, IBCLC

Knowledge Gap

There is no established triage framework for bottle refusal. A practitioner presented with a bottle refusal question has to decide, in real time and usually without training for it, whether this is a case they can help with, a case they should refer, or a case in which the safest answer is to say very little.

In the absence of a framework, the default is generic advice. Try a different bottle. Have someone else offer it. Leave the house. That advice is widely repeated and is treated as harmless because it is non-invasive. It is not harmless. When the underlying cause is an oral function issue, a flow rate mismatch, or an emerging aversion, generic advice delays appropriate assessment and can worsen the baby's response to the bottle.

The second half of the gap is communication. Practitioners who correctly identify that a case is beyond their scope often deliver that message in a way that reads to the family as a refusal of care. Referral is a clinical skill, and it can be taught. This course treats it as one.

Objectives

01

Conduct a brief, structured assessment to determine the risk level of a bottle refusal presentation.

02

Differentiate between presentations that can be safely supported with limited general guidance and those that require referral.

03

Identify the yellow and red flags in infant feeding that indicate a need for prompt referral or escalation.

04

Communicate scope of practice and referral recommendations to families clearly, and in a manner that maintains trust and continuity of care.

VII Clinical Skills [TK CERPs]

VII A1. Feeding devices
VII B5. Educating professionals, peers, and students

Annie Frisbie IBCLC Inc has been accepted by the International Board of Lactation Consultant Examiners® (IBLCE®) as a Preferred Provider for the listed Continuing Education Recognition Points (CERPs) programme. Determination of CERPs eligibility or CERPs Provider status does not imply IBLCE’s endorsement or assessment of education quality. As a Preferred Provider, Annie Frisbie IBCLC Inc attests that it complies with the WHO Code and subsequent WHA resolutions.

Course contents

Annie Frisbie IBCLC Inc has been accepted by the International Board of Lactation Consultant Examiners® (IBLCE®) as a Preferred Provider for the listed Continuing Education Recognition Points (CERPs) programme. Determination of CERPs eligibility or CERPs Provider status does not imply IBLCE’s endorsement or assessment of education quality. As a Preferred Provider, Annie Frisbie IBCLC Inc attests that it complies with the WHO Code and subsequent WHA resolutions.
Open to learners carrying a valid lactation credential. Other registrants are subject to refund minus a $50 processing fee. Contact us if you have questions about your eligibility.
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Annie Frisbie IBCLC, Inc actively supports the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly (WHA) resolutions. Therefore, Annie Frisbie IBCLC, Inc is not a company, inclusive of manufacturers, distributors, or marketers, whose products fall within the scope of the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes (1981) and subsequent World Health Assembly (WHA) resolutions (e.g., infant formula, bottles, and teats).

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