IBCLC Exam Questions With Correct Answers

What are green/shiny stools a sign of? - Answer -sign of overproduction leading to less fat in milk, faster digestion causing not enough time for lactase to digest the lactose in milk. An improved latch could allow for more fat flow Signs of oversupply - Answer Rapid weight gain in infant, unsettled baby after feeding, recurrent plugged ducts and mastitis, painful feedings, voluminous (huge volumes of) stools- often green & shiny What causes nipple pain? - Answer Improper latch--> need lactation support to help with proper latch on, good seal True/false: baby should be pulled into breast. - Answer False! Do not pull baby into breast, let baby tilt head back for optimal latch. Hand on back of baby's head can interfere baby's interoral function by restricting the movement of the cranio-cervical spine--> causes nipple trauma. Make sure crook of arm in cradle position does not block baby from being able to fully tilt back. Should a latch be symmetric or asymmetric? - Answer Asymmetric! A baby should form a teat with breast tissue underneath the nipple as part of a latch What is a symmetric latch - Answer Not a good latch, causes nipple damage Asymmetric latch - Answer Optimal attachment to the breast, where the baby's lips are not centered in relationship to the areolar, but rather vertically off-centered with the baby's chin and lower lip closer to the edge of the areola than the baby's upper lip. A baby should form a teat with breast tissue underneath the nipple as part of a latch Do nipple creams work? - Answer Continued questions of effectiveness, fear of ingestion by baby Should a frenotomy be suggested for tongue tie? - Answer No study was able to report that frenotomy led to better long term breastfeeding Tongue tied breastfeeder - Answer -complete feeding assessment and suggest ways to optimize latch. -refer onward for diagnosis (have PCP diagnose TT) -provide support What is a fissure straight down the nipple evidence of? - Answer A symmetric latch. Top lip needs to have good seal, moist part of lip should be touching nipple, can roll out top lip, to reduce injury during BF Is there a deep latch with nipple stretching? - Answer If nipple not stretched deeply into mouth, less oxytocin flows, less fat is in mix. With less fat, milk digested quicker = not enough time for baby to make enough lactase to digest lactose in milk. What to do for oversupply? - Answer Decrease additional stimulation/milk removal if possible Consider block feeding (only nursing on one side only per feeding) Watch for mastitis Try australian posture (mother down under, baby on top) Consider donating to milk bank Consult with HCP for medical dx How many mL considered oversupply? - Answer normal milk production = 750-1000 mL/day Thrush during BF - Answer painful for mother & baby. may be visible or may not (whiteness that can't be wiped off) -mother will have itchy, flaky, shiny skin -candida not found inside the ducts or milk Treatment of candida on breast - Answer -nystatin first line -flucanizole second line -throw out all yeast vectors (pacifiers sterilize breast pumps) -flucanazole oral capsules may be used to clean yeast vectors due to the biofilm created on pacifiers by candida What to do if antifungal treatment for yeast doesn't work? - Answer Not candida infection! Reynaud's Phenomenon - Answer -vasospasm of nipple, recognized by triple color sign: from white--> blue--> raspberry or bicolor sign white --> raspberry. pain is extreme and spasmodic (not continuous) -this happens after feeding once baby's mouth comes off nipple has vasospasm, feels like frostbite treatment of reynauds - Answer -prevent/decrease cold exposure -avoid vasoconstrictive drugs such as caffeine and hypertensive drugs, nicotine -can use nifedipine or calcium channel blocker Nipple pain and poor milk transfer that is persistent despite optimal latch - Answer -can use nipple shield as a test to see if baby exerting too much pressure? -OT involvement -in rare cases baby have a strong sucking vacuum as measured by a pressure transducer or nipple shield Clogs/plugs - Answer Palpable lumps of milk within the lumen or duct system, usually not visible. Solids dont get absorbed...could be too tight of a bra slowing flow of milk what to do for clogs/plugs - Answer Encourage massage using side of hand and warm compresses. Do double nursing by doubling up on side of clog to push it out. point baby's chin toward clog See PCP if clog hasnt moved in 24-48 hours or systemic symptoms of inflammation (flu like s/s) When to call PCP for clog/plug - Answer If plug hasn't moved in 24-48 hrs or systemic signs of inflammation (flu like s/s) Causes of clogs/plug - Answer too tight nursing bra what is a bleb - Answer small white spots on the face of the nipple that look like milk-filled blisters. one duct opening is usually covered what does a bleb feel like - Answer painful stabbing pinpoint pain how to get rid of blebs - Answer Same as clog treatment. Sometimes need t be lanced by HCP Common mastitis - Answer -can be non-infective or infective -blocked ducts from engorgment, hurried feedings, nipple shield (pressure will build until milk sneaks out of space, body reacts to this like invader) causes of common mastitis - Answer -tight bra (look for indentation of breast straps) -use of breast shell or nipple shell -attachment difficulties -anemia in the mother -tongue tie in baby (ineffective milk emptying) s/s common mastitis - Answer systemic- fever, ill, malaise, redness, pain, one inflamed breast What bacteria causes infective mastitis - Answer Staphylococcus tx common mastitis - Answer NSAIDS first line but make sure diagnosed by PCP -must keep pumping/breastfeeding to keep milk flowing. keeps breasts soft/comfortable to avoid abscess development Abscess on breast - Answer Localized areas of pus and necrotic tissue that can develop with a breast infection •Can develop in the subcutaneous, intramammary, retromammarylayers •Symptoms include pain, swelling, redness, fever, increased WBC count, palpable mass -pocket of pus forms in the breast -from untreated mastitis Antibiotics for mastitis? - Answer Usually for double mastitis, not generally proscribed for one breast common mastitis. If treatment uneffective consider anemia, ductal or inflammatory breast cancer Double mastitis - Answer EMERGENT AND UNCOMMON- tissue of both breasts inflamed. organism cause of double mastitis - Answer strep -potentially fatal, whole body inflammation, sepsis -not a problem with milk signs of inflammatory breast cancer - Answer - breast tissue is red, warm, has orange peel (peau d'orange), pitting appearance on skin surface - breast mass may or may not be present True/false: MRSA can look like mastitis when on breast - Answer TRUE can masquerade as mastitis. might see peeling skin, pitting. can also cause lesions and abscess. Abscess on breast is full of ... - Answer PUS not MILK. as many as 60% positive for MRSA. can you nurse on same side as abscess - Answer No should nurse on other breast. must be aware of possible contamination on flanges, pump parts, can not track infection from one side to other. abscess surgical intervention - Answer can cut through nerves and ducts. try to avoid surgical intervention treatment of abscess - Answer drainage through ultrasound-guided technique is first choice (needle aspiration often has to be repeated) Report any suspicious area of the breast to a qualified provider because it could be... - Answer MRSA or herpes- fatal for babies Goldsmith's sign - Answer The association of a baby's persistent refusal of one breast with possible breast cancer in the mother -can also happen suddenly with older babies -rule out common problems such as ear infection, teething, birth trauma -CA may be diagnosed as late as 5 yrs after this sign Neonatal hypoglycemia - Answer -symptomatic infants = glucose of 40 requires per APP -dextrose & BF = first line tx -SGA, LGA, diabetic moms, late preterm infants at gretest risk Signs of neonatal hypoglycemia - Answer • Jitteriness, tremors • Poor muscle tone • Diaphoresis (sweating) • Poor suck, failing to sustain latch • Tachypnea • Tachycardia • Dyspnea • Grunting • Cyanosis • Apnea • Low temperature • High-pitched cry • Irritability • Lethargy & poor feeding • Seizures, coma • No signs (some infants may be asymptomatic) Do healthy term newborns need glucose checks - Answer No Jaundice is caused by - Answer Unconjugated bilirubin that accumulates in blood stream of newborn because fetal-type blood cells are broken down and live and intestines too immature to excrete at fast pace. Pathologic jaundice - Answer Result of an underlying disease appearing before 24 hours (or persistent after day 7) -due to sepsis, blood incompatibility Bhutani curve - Answer Chart that can be used to determine when bilirubin levels require treatment Early onset jaundice - Answer "Physiological" or "starvation" jaundice Peaks 72-96h after delivery Frequently related to underfeeding "lack of breastfeeding" jaundice Late onset jaundice - Answer develops second week of life infant thriving, gaining wt, stooling pathologic causes ruled out factor in human milk increases the intestinal absorption of bilirubin -often called breastmilk jaundice actually related to metabolic issues with infant -do not discontinue breastfeeding, can persist for 12 weeks Kernicterus - Answer Bilirubin encephalopathy, a form of brain damage resulting from unconjugated bilirubin entering the brain. Characterized by lethargy, poor feeding, vomiting, irregular respiration, perhaps death -can damage brain, spinal cord and nerve cells. warning signs of kernicterus - Answer extreme jaundice (advancing from upper body to lower body), lethargy, fussiness, feeding difficulties, muscle rigidity, high pitched cry -fewer than 4 wet or dirty diapers/24 hrs can skin to skin help a latch? - Answer yes- influences state organization and motor system modulation, can help with difficulty latching and sustaining a feed skin to skin with twins- each breast... - Answer warms up depending on the temperature of each baby closest to breast preemies/skin to skin - Answer decreased time of nicu stay, improved weight gain, more mature sleep patterns, improved cerebral blood flow, warmer/more stable, better breastfeeding Negative influences on milk production - Answer Long spaced between feedings Long, slow feedings-can effect prolactin production Excessive pressure in breast Breast surgery/injury Suboptimal breast anatomy Why does pressure occur in breast? - Answer Vascular, lymphatic, and third-spacing forces, especially early on Sensory activation- lactogenesis II Normal fullness vs engorgement - Answer Normal fullness= breast soft, body temp normal, mother feels well, breast may be hot, baby can grasp nipple Engorgment = hard breast, temp normal or higher, feels discomfort, breast hot & shiny, nipple difficult to grasp, baby can't latch When do engorgment symptoms most commonly occur? - Answer In days 3-5 Mothers who have had IV fluids in labor have higher levels of swelling up to day 9 C-section moms experience peak engorgement 24-48 hours later than those who deliver vaginally What can decrease risk of engorgement early on? - Answer More time spent BF in the first 48 hours How does engorgement work - Answer Pressure builds up inside of the breast- as pressure increases, milk production decreases, nature's early lactation dry up mechanism -failure to resolve symptomatic engorgement may have negative impact on continued adequate milk supply What causes pressure to build up in breast - Answer -lactogenesis II (Secretory activation) -too much milk left in breast -missed feedings -restrictive bras and clothing -breast implants (storage capacity reduction= greater incidence of lactation insuffiency) Why is breast surgery/injury a concern for BF? - Answer -damage to nerves/ducts may not be patent -peri-areolar incision extends all around areola, look for defined margin where color changes from areola to breast. Types of breast reduction - Answer -free nipple graft -pedicle (women who underwent breast reduction surgery had shorter time of exclusive/any BF) -chest masculinization "top" surgery Supporting chest feeding - Answer -restarting testosterone and binding were common concerns -care providers should communicate an understanding of gender dysphoria and transgender identities in order to build trust and provide transgender competent care Counseling implications after breast surgery - Answer -likelihood of full breastfeeding is unknown -hormonal exposure of pregnancy and lactation may mitigate some effects of surgery -assessment and close follow up are the keys -assure adequate nutrition for the infant -determine innervation/sensation Anatomical concerns for BF - Answer -absence of breast changes (in pregnancy or early days postpartum) -no postpartum breast fullness or signs of abundant milk production -hypoplastic breasts -discrepant breast size -one implant may indicate that were was a discrepant breast size When counseling moms with breast surgery- ask yourself - Answer Are ducts patent? Are nipple pores patent? Are there signs of hormonal connection? Are there concerns about weight gain of baby? Is there adequate pediatric supervision? With flat or inverted nipples- consider if the hormones are functioning optimally - Answer Prolactin is secreted by nipple stroking Oxytocin is secreted by nipple stretching = OPTIMAL LATCH NEEDS TO EXIST How does nipple change during a BF? - Answer Nipple stretches 1-2 times length, then stable in length. Expands in diameter into the open mouth to accommodate optimal milk flow. Nipple compresses during swallow Inverted nipple counseling implications - Answer -babeis don't need nipple to latch, must form "teat" -may evert during pregnancy or postpartum -flat nipples always evert during suckling -both may evert from stimulation (cold, sex, finger) -ask if and when nipple everts -look over shoulder just after feeding for nipple eversion and compare to pre-feed nipple -if not seen, intensive follow up -consider expressure, assure adequate nutrition Grade I Inverted NIpple - Answer Easily pulled out by pump or infant nursing Grade 2 Inverted Nipple - Answer can be pulled out but doesn't maintain projection Grade 3 Inverted Nipple - Answer Difficult or impossible to pull out How to classify inverted nipples - Answer It's about function during feeding, not how the nipple looks at rest -grade 1 & 2 go back in rapidly -grade 3 inverted nipple, before & after are the same Women with uncorrected Grade 3 inverted nipples had... - Answer lower prolactin levels and therefore less milk Does prenatal nipple prep help improve inverted nipples? - Answer No Iron deficiency anemia/milk production - Answer -can be physiologic (poor oxygen to milk making cells) -due to exhaustion or depression altering parents coping behavior -more than 20% PP women have IDA -can decrease milk supply Sheehans syndrome/milk supply - Answer Hemorrhage can result in anemia & sheehans syndrome -pituitary deprived of blood and its funcitons are impaired--> can happen when PP hemorrhage is well managed -symptoms; Low BP, anemia, fatigue, profound hair loss, dry dull hair -can have low grade or transient sheehan-like symptoms that resolve fully or partially Thyroid imbalance/milk supply - Answer Maternal obesity/overweight/milk supply - Answer First 7 days = delay n lactogenesis II, increased odds of early weaning but increased supply = increased BF duration and intensity GDM & BF - Answer Breastfeeding helps lower DM odds after GDM PCOS/milk supply - Answer excess insulin = increased production of androgens = problems with ovulation and lactation -some studies show metformin can help -greater risk for insufficient milk -1/3 have oversupply Drugs/milk supply - Answer -psueoephedrine decreases milk supply by decreasing prolactin -corticosteroids cause temporary suspension of lactation -corticosteroids include betamethasone smoking/BF - Answer -smoking mothers make less milk -smoking mothers may have lower prolactin levels -women who smoke more wean earlier -smoking and nursing may result in babies who nap less -quitting smoking during pregnancy is significantly associated with reduced risk of premature birth -support to quit smoking should help to prolong breastfeeding duration, especially those most at risk for not exclusively breastfeeding -breastfeeding may mitigate adverse effects of smoking during pregnancy on the child's cognitive development -encourage breastfeeding, protect from 2nd hand smoke Nicotine patches & BF - Answer should only be used upon approval from PCP cadmium exposure - Answer -affects kidneys, liver, lungs, nerves as well as other body systems. cigarettes have cadmium SIDS/smoking - Answer 22% of cases related to maternal smoking during pregnancy Electronic cigarettes - Answer -understudied but transfer of nicotine is minimal Cannabis/BF - Answer exposure of infant to any passive smoke is concern. -no safe threshold limit for cannabis use in pregnancy -increased risk of preterm birth/LBW -high fat solubility of cannabinoids more difficult to analyze in breastmilk, THC more measurable in milk ~6 days after maternal marijuana use Retained placental fragments - Answer Lactogenesis stage II happens only after the dramatic fall of progesteromne that happens with the complete delivery of placenta. Stage I lactogenesis occurs during pregnancy. Nursing during pregnancy - Answer -safe for those not at risk for premature delivery Tandem nursing - Answer -nursing two babies not from same pregnacny -feed newborn first and frequently -find time for non-nursing interactions with older babies -milk volume increases faster but less engorgment is experienced with 2 nurslings -may require specific teaching to manage faster flow -help parents respond to different needs of each child Pacifiers/BF - Answer -pacifier use may be an indicator that parent needs extra BF teaching is it used because of...sore nipples? hunger? cryign? sleep problems? AAP says consider pacifier use at naptime and bedtime, for BF infants, delay pacifier introduction until BF has been firmly established Preemies/pacifiers - Answer -have earlier hospital d/c -reduced time to establish oral feeds/reach full feeds -tube fed babies gain wt faster and improved physiologic/behavioral responses Why did 1 oz/day formula lead to giving up BF? - Answer did not call for help, they gave bottle first -lacked confidence in milk supply, baby getting enough, BF in general depression/BF - Answer women are more likely to wean early with PPD or depression during pregnancy -early cessation of BF or not BF associated with increased risk of maternal PPD -negative experience w/ BF support = higher risk of PP depression -Mothers with high EPDS score more likely to d/c BF in 4-12 wks, unsatisfied w/ feeding method, more BF problems, lower levels of confience -negatively early BF experiences = more likely to have depressive symptoms at 2 months BF discontinuation at 2 wks associated with... - Answer lack of confidence to BF on day 1 or 2. Counseling implications: fear about milk supply - Answer -avoid giving inappropriate reassurance, gather facts and refer as needed per scope -undertake complete eval & history & feeding assessment before coming to conclusions- low milk supply rarely has 1 cause -provide adequate postpartum support: real/perceived cases of insufficient milk -establish community wide system eliminating the zone of professional unavailability especially days 3-7 Mammal species with high fat/protein and low water content... - Answer have infrequent feedings