Behind the Latch

In this conversation, Dr. Elizabeth Kar discusses her research on breastfeeding promotion and the challenges faced by breastfeeding families during the COVID-19 pandemic, particularly the impact of reduced lactation support and the infant formula shortage. She emphasizes the importance of lactation consultants and community support in successful breastfeeding, critiques the marketing strategies of formula companies, and calls for better policies to protect and promote breastfeeding. In this conversation, Margaret Saltysiak and Elizabeth Kar discuss the complexities surrounding infant feeding choices, particularly the challenges of breastfeeding and formula feeding. They highlight the fragility of the infant feeding infrastructure in the U.S., the lessons learned from the pandemic regarding breastfeeding support, and the critical need for paid family leave to support new parents. The discussion also emphasizes the importance of addressing the needs of vulnerable populations and ensuring equitable access to breastfeeding support and resources.

Chapters
00:00 Introduction to Elizabeth Kar and Her Work
03:03 Exploring the Triple Threat to Breastfeeding Families
06:00 The Impact of COVID-19 on Lactation Support
09:02 The Role of Lactation Consultants
11:59 The Formula Shortage and Its Effects
14:58 The Marketing Influence of Formula Companies
18:06 The Need for Better Infant Feeding Policies
21:43 The Challenges of Infant Feeding Choices
24:15 Fragility of Infant Feeding Infrastructure
27:20 Lessons from the Pandemic on Breastfeeding Support
30:25 The Need for Paid Family Leave
33:48 Addressing Vulnerable Populations in Breastfeeding Support

Guest
Elizabeth Kar, RDN, PhD, IBCLC
Triple Threat or Mere Inconvenience? Exploring the Effect of COVID-19
Precautions, Lack of Access to Lactation Care, and the Infant Formula
Shortage on Breastfeeding Behavior of Parents in the Midwest of the
United States

Connect with Margaret
📬 Email: [email protected]
📸 Instagram: @margaretsalty
📘 Facebook: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine

Margaret interviews, Molly Waymouth, a senior policy analyst at RAND, and they discuss her research on informal milk sharing, its prevalence, risks, and policy implications. They explores how systemic barriers and economic factors influence families' choices and what can be done to improve access to safe, affordable donor milk and lactation support.
Chapters
00:00 Introduction to the Conversation
05:37 Molly's Background and Research Focus
07:10 Exploring Milk Sharing Practices
09:35 The Economics of Donor Milk
11:23 Understanding the Support Gaps
13:48 Equity and Access in Milk Sharing
16:27 Risks of Informal Milk Sharing
16:50 The Need for Comprehensive Support
18:34 Innovative Approaches to Milk Sharing
18:50 Designing an Ideal Support System
20:27 Conclusion and Future Directions
21:22 outro.mp3

Resources
JAMA Open Network Publication - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841048
RAND Corporation - https://www.rand.org/
LinkedIn Profile of Molly Waymouth - https://www.linkedin.com/in/mollywaymouth/

Connect with Margaret
mail: [email protected]
Instagram: @margaretsalty
Facebook: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine

In this episode of Behind the Latch, Margaret Salty interviews Trillitye Paullin, CEO and co-founder of Free to Feed, who shares her groundbreaking work translating emerging research on food reactivity in breastfeeding into practical clinical guidance.
Together, they unpack one of the most misunderstood topics in lactation: how dietary proteins transfer into breast milk and what that actually means for managing elimination diets. Trillitye explains why the long-standing belief that proteins remain in breast milk for weeks is not supported by current evidence—and how confusing “transfer timing” with “healing timing” has led to unnecessary dietary restriction and early weaning.
They also explore the realities of non-IgE-mediated food allergies, why traditional allergy testing often fails these families, and how IBCLCs can more effectively assess, manage, and refer these cases.
This conversation offers a practical, evidence-based framework that has the potential to change how clinicians support breastfeeding dyads navigating food reactivity.
Key Takeaways for Clinicians
Food proteins transfer into breast milk quickly—often within minutes—and typically clear within hours, not weeks
The timeline we see clinically is often driven by infant healing, not ongoing exposure
Elimination diets should be reassessed early (around 5 days) to determine effectiveness
Not all symptoms warrant elimination—rule out more common causes first
Most infants with food reactivity will have symptoms emerge between 2–4 months
Cow’s milk and soy are the most common triggers, but other foods may be involved
Reintroduction is critical to avoid unnecessary long-term restriction
Severe symptoms or lack of improvement beyond dairy/soy elimination should prompt referral
Non-IgE-mediated allergies cannot be diagnosed with standard allergy testing
Supporting parental mental health is essential—elimination diets are a significant burden

Guest
Trillitye Paullin, PhD, CEO & Co-Founder, Free to Feed
Free to Feed
Supporting Families as They Navigate Infant Food Allergies
Connect with Margaret
📬 Email: [email protected]
📸 Instagram: @margaretsalty
📘 Facebook: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine

In this episode of Behind the Latch, Margaret Salty interviews Victoria Fonville, MS, PhD candidate in Nutrition at UNC Greensboro, about her recent scoping review on lactation during perinatal bereavement.
Together, they explore what the research actually tells us about lactation after infant loss—from the lived experiences of bereaved families to the gaps in care from healthcare providers. Victoria shares the key findings from her paper, including the four major areas studied—producing milk, support, stopping lactation, and donating milk—and the six themes that emerged: hurting, lacking, valuing, succeeding, connecting, and redeeming.
They discuss how lactation can serve as a powerful source of connection and identity for grieving mothers, why suppression is often presented as the default (and why that’s problematic), and how milk donation can be experienced as a deeply meaningful and even healing process for families navigating loss.
This episode challenges the way we approach bereavement care and emphasizes the importance of presenting all options—so families can make informed decisions that align with their goals and their grief.
Key Takeaways for Clinicians
Lactation after perinatal loss is common due to normal physiology, but remains poorly addressed in clinical care.
Bereaved mothers often experience both physical pain and emotional distress related to lactation, requiring compassionate and informed support.
“Lacking” was a dominant theme across studies, highlighting significant gaps in provider knowledge, training, and communication.
Lactation suppression is frequently presented as the only option, but this does not reflect the full range of choices available.
Producing milk can help maintain maternal identity and connection to the infant after loss.
Milk donation is often experienced as “redeeming,” helping families create meaning and process grief.
Healthcare providers should present all options—suppression, expression, donation, and keepsakes—without bias.
There is an urgent need for quantitative research to better understand care practices, outcomes, and donation patterns.
Compassion, presence, and individualized care are critical when supporting bereaved families.

Guest
Victoria Fonville, MS, PhD Candidate in Nutrition, University of North Carolina at Greensboro
Lactation During Perinatal Bereavement From the Perspective of Families and Support Providers: A Scoping Review
Connect with Margaret
📬 Email: [email protected]
📸 Instagram: @margaretsalty
📘 Facebook: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine

Dr. Bode shares his journey into human milk research and the founding of the Human Milk Institute—the only institute in the world dedicated entirely to studying human milk in all its complexity. Together, they explore how human milk research is evolving from isolated disciplines into a collaborative, systems-based science that integrates molecular biology, clinical care, and public health.
The conversation dives deep into human milk oligosaccharides (HMOs), the limitations of reductionist thinking in lactation science, and the urgent need to translate research into real-world clinical impact. Dr. Bode also shares his vision for the future, including the development of “lactology” as a formal field of study and what it would take to truly normalize breastfeeding on a global scale.
Key Takeaways for Clinicians
Human milk is far more than nutrition—it is a dynamic system of signaling, protection, and communication.
HMOs play multiple roles beyond the microbiome, including direct immune and systemic effects.
Donor milk retains key bioactive components like HMOs even after pasteurization.
Variation in milk composition across individuals and time is expected and biologically meaningful.
Clinical care must align with real-world problems—research must start with the needs of families.
Multidisciplinary collaboration is essential to advancing both science and clinical outcomes.
Maternal health directly influences milk production and composition.
Breastfeeding provides significant long-term health benefits for both infants and mothers.
Formula can improve—but it cannot replicate the adaptive, responsive nature of human milk.
Early identification of barriers and inequities is critical to improving breastfeeding outcomes.
The future of lactation care depends on bridging research, clinical care, and public health systems.

Guest
Dr. Lars Bode, PhD
Director, Human Milk Institute
Human Milk Institute
Triton Giving Day 04.29.2026

Connect with Margaret
📬 Email: [email protected]
📸 Instagram: @margaretsalty
📘 Facebook: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine