Certified Lactation Counselor Exam Questions and Answers.

Certified Lactation Counselor Exam Questions and Answers. __________________ increases and _____________________ decreases in babies while suckling. - ANSWER-Gastrin, somatostatin .3 strategies for increasing BF initiation and duration - ANSWER-Promotion, Protection, Support .10 steps to successful BF - ANSWER-1. Written BF policy. Skin to Skin immediately after birth. 2. Train healthcare staff 3. Inform pregnant women about benefits and management of BF 4. Help all mothers initiate BF within 1 hour after birth 5. Show mother’s how to BF and maintain lactation 6. Exclusive breast milk only 7. Practice rooming in 24 hours a day 8. Encourage BF on demand 9. No artificial teats or pacifiers 10. Establishment of BF support groups .AAP recommendations for BF observation in hospital - ANSWER-Formal eval/documentation by trained staff at least once per shift Assess latch, position, transfer, exams .Abscess - ANSWER-Full of pus, not milk May be MRSA + Nursing other breast can still be possible May not be visible; deep in breast Ultrasound-guided technique to drain is safe and efficient; should be first choice (though may need to be repeated) .Alcohol and lactation - ANSWER--Oxytocin decreases while prolactin increases -Oxytocin release can easily be blocked -Is water soluble, so it passes in and out of milk as it does blood. Pump and dump won’t speed up process. .All mammals have ____________________________ in their milk - ANSWER-lactose .Allergy vs. intolerance - ANSWER--Allergy is a full-body response: eczema, asthma, skin eruptions, etc -Intolerance is discomfort is a specific location: gas, colic .Alveolar Cells - ANSWER-found in the walls of the alveoli, simple squamous epithelial cells, main sites of gas exchange .Alveoli - ANSWER-Small glands in the breast that produce milk .Are mother’s GI hormones impacted by sucking and skin contact? - ANSWER-Yes, it activates the parasympathetic nervous system. Increases in gastrin, CCK, and insulin have been observed. .At-Breast Supplementer - ANSWER-a device that allows a supplement to be given while a baby is actively nursing at the breast, ex: Supplement Nursing System .Atopy - ANSWER-hypersensitive or allergic state involving an inherited predisposition .Average number of feeds in a day? - ANSWER-8-12 .Baby poop on days 1-2, 2-3, and 4+ - ANSWER-Meconium, greenish transitional, yellow/seedy .Baby suckle causes a signal to go through the - ANSWER-Thoracic/intercostal nerves (T3-T5) .Benefits of BF-SIDS - ANSWER-EBF at 1 month, decreased SIDS rate 50% & after 2months +, BF has protective effect against .Benefits of BM for premies - ANSWER-faster brain maturation rapid maturation in intestinal barrier function significantly lower odds of incidence of NEC & death .Benefits of donor milk - ANSWER--Preventative -Cost Effective -Safe .Benefits of rooming-in - ANSWER--Feeding cues more easily observed -Babies are held STS more -Fed at their “best” times -Learning happens together .BF and Environmental Contaminants - ANSWER-Toxic exposure occurs in utero, minimally through milk. Some populations are at risk use to agriculture or occupational exposure. .BF and Food flavors - ANSWER--Food flavors pass through milk -Longer duration of BF, higher food variety at 3 years .BF initiation rates in the early 1970s - ANSWER-25% (all time low) .BF initiation trends by decade - ANSWER-Lowest rates- early 1970s Increased from early 70s to early 80s Dropped between early 80s to early 90s Increased again in 1990s .Biggest intervention time during the first 1000 days - ANSWER-Labor and birth- about a 30-hour window .Bilirubin - ANSWER-an orange-yellow pigment formed in the liver by the breakdown of hemoglobin and excreted in bile. .Blebs - ANSWER--Small white spots on the face of the nipple (looks like a milk filled blister) -One duct opening is covered -Stabbing pin point pen -May exit when treated as clogs -May require lancing .Breast Anatomy - ANSWER- .Breast augmentation incision most related to milk insufficiency - ANSWER-Peri-areolar (signs: perfectly round areola, jagged line from bottom of areola) .Breast development during menstruation - ANSWER-- Estrogen: Induces Ductal System development - Progesterone: Induces Lobular-Alveolar development .Breast reduction techniques related to BF struggles - ANSWER-Free-nipple graft (nipple entirely removed), pedicle technique, anchor incision- straight line down from areola .Breastfed baby growth patterns - ANSWER-Consistent across the world EBF babies gain faster than FF babies until 3mo, then they gain more slowly than FF babies This is now standard and not FTT- until it became standard, healthy EBF babies seemed to drop percentiles .Breastfeeding - ANSWER-Baby receives human milk, as well as other foods or fluids, including formula. .Breastfeeding issues with late preterm and early-term babies - ANSWER--May need more opportunities to develop latch and transfer skills; weak suck and latch -Often less alert with less stamina -States change quickly, from deep sleep right to cry -Very subtle feed cues -May have a high suck to swallow ratio .Cadmium - ANSWER-Soy formula has 6x more than cow’s milk. Formula fed babies can be exposed to up to 12x the amount. .Caffeine - ANSWER--Habits doesn’t relate directly to caffeine in milk -Can accumulate in preemies and very newborns .Calcium needs in mother’s - ANSWER--May need dietetic counseling -Have a lot of calcium during pregnancy, not enough during lactation. -Women experience 3-9% decrease in bone density during lactation. .Can a woman BF if she has a flat or inverted nipple? - ANSWER-Yes! -Baby’s don’t need a nipple to latch, they form the teat. -Many nipples evert from sucking, some don’t. -If the nipple does not evert, the baby’s weight gain will need to be followed closely. .Can milk fat be different if the baby is male or female? - ANSWER-Yes.. Mother’s seem to produce milk that is 25% higher in fat content for males. .Candida/Thrush (Yeast overgrowth) - ANSWER--May cause pain for mother and baby -May be visible or not -Itchy, flaky, and dashing nipple/breast skin .Carb content of human milk - ANSWER-7% .Causes of low EBF rate globally - ANSWER-Beliefs about mixed feedings Lack of hospital/healthcare support Formula promotion Lack of family leave policies Lack of knowledge of dangers of not EBF Lack of knowledge of BF techniques .Causes of lowered milk production - ANSWER-Long time between feeds Long, slow feeds Excess pressure in breast (vascular pressure, lymphatic pressure, excess fluid in labor, implants, oversupply early on) .CCK (cholecystokinin) - ANSWER-Hormone that regulates the emptying of the gallbladder and secretion of enzymes by the pancreas. .CDC mPINC - ANSWER-Score of this test has positive relationship to in-hospital breastfeeding and EBF rates at 8 weeks .Colostrum - ANSWER-Thick, milky fluid secreted by the breast during pregnancy and during the first days after birth before lactation begins. Causes a laxative effect which helps the baby pass meconium. .Colostrum is high or low in lactose? - ANSWER-Low .Common mastitis - ANSWER-- Often occurs around holidays or with nipple shield use - NSAIDS (like ibuprofen) often a first step to treatment -if treatments are not effective, consider anemia or rarely IBC .Complementary Feeding - ANSWER-Process starts when BM alone or infant formula alone is no longer sufficient to meet nutritional requirements of infants, therefore other foods or liquids are introduced. Typically child is between 6-23 months .Concerns with breastfeeding babies with Down syndrome - ANSWER--low tone, fewer cues - depressed reflexes; hard to latch on and have a wide gape - hypotonic perioral muscles, weak suck -deficiency in smooth tongue movement -skeletal abnormalities decrease volume or oral cavity -macroglossia: abnormally large tongue -improvement over time is very possible .Concerns with nipple shields - ANSWER--Decrease nipple sensation (impacts supply) -3x higher risk of not EBF -Difficulty weaning from shield -Needs to be cleaned frequently -Close follow up required .Conditioned Response from Milk Ejection (Let down) - ANSWER--Example- Mother lets down when not near baby, but hears a baby cry. -Conditioned over time -Faster for women who have BF in the past -To condition the response can use any sense-smell, touch, sound .Contraindication to BF or feeding EBM - ANSWER--Infant diagnosed with galactosemia. -Mother has HIV -Mother has HTLV1 or 2 (Human T-Cell Lympphotrophic Virus) [Japan] -Mother using drugs. -Mother has Ebola .Corrective interventions for breastfeeding a baby with Down syndrome - ANSWER-“Dancer hand” technique can help little, floppy, and/or hypotonic babies breastfeed better Use BM odor during gavage to enable earlier transition Individualize positions .Corticosteroids (Betamethasone) prior to delivery- impact on lactation - ANSWER-Delay in Lactogenesis II, lower milk volume 10 days after delivery .Coryllos type - ANSWER-Classification system for anklyloglossia (tongue-tie) .Counseling a mom with inverted nipples - ANSWER-Ask if/when nipples ever evert Observe carefully when baby unlatches to check nipple shape Intensive follow up of baby’s weight/output Check for safety for any devices mom may be using to evert nipples (nothing is recommended) Consider expression by hand or pump Assure adequate nutrition for baby! .Counseling implications for women with fears about milk supply - ANSWER-1. Give facts, not inappropriate reassurance 2. Complete an evaluation including history and feeding assessment 3. Provide adequate postpartum support 4. Establish a community wide system eliminating the “zone of professional unavailability”- especially days 3-7 .Cup feeding for preemies - ANSWER--Less increased in HR -Better oxygenation -Ability for infant to pace own feeding -More supplements, the less breastfeeding -Preferred method of WHO/UNICEF .Dancer Hand Position - ANSWER-Technique used to support Baby’s chin and mother’s breast. Use Thumb and index finger under chin, remaining 3 fingers to support breast. .Describe the optimal position for baby while breast feeding? - ANSWER--Baby tummy to tummy or chest to breast -Hips flexed -Shoulders and hips should align -Arms and hands around the breast .Do CLC’s assess tongue tie? - ANSWER-No. Assess and give suggestions to optimize latch. Then refer onward for diagnosis. .Do milk banks heat treat milk? - ANSWER-Yes, Destroys bacteria/viruses (e.g. HIV, Herpes, CMV). Retains 90% of nutrients .Do women with inverted nipples produce less milk? - ANSWER-Yes, research shows. .Does a mother need to nurse both breasts in one feed? - ANSWER-No. Some babies do better on one breast per feeding. .Does feeding a baby formula occasionally make a difference? - ANSWER-Yes, even just one bottle can impact the pH of the babies gut. Gut of exclusive BF baby is lower (more acidic), while gut of formula fed baby is more neutral .Does Fenugreek work to increase supply? - ANSWER-No evidence .Does Motilium (Domperidone) increase supply? - ANSWER--No studies support. -Not legal in US -Rare, but serious risks. Including death. .Does Reglan (Metoclopramide) increase supply? - ANSWER-No, no research. .Does stress play a role in hormone release? - ANSWER-stress can inhibit hormonal release - high levels of cortisol/catacholamines reduce oxytocin levels .Does when babies are born impact chances of supplementation? - ANSWER-Yes. Babies born between 10pm and 9am are more at risk. Lack of support? .Early onset jaundice - ANSWER--“Physiological” or “starvation” jaundice -Peaks 72-96h after delivery -Frequently related to underfeeding -“lack of breastfeeding” jaundice .EBF rate for under 6mo, globally - ANSWER-42% .Effects of psychosocial support (Doula) during labor and childbirth on BF - ANSWER--BF rates higher in women who received support. .Emergent mastitis - ANSWER--Tissue of both breasts inflamed simultaneously -Strep is probable- full body inflammation could be sepsis -Mother can still breastfeed -Call HCP immediately, may need ER (systemic) .Engorgement vs. normal fullness - ANSWER-Latch difficulties, shiny hot breast, instead of normal heavier/firmer feeling. .Ensuring adequate milk supply - ANSWER-Understanding of how BFing works Early initiation, adequate number of BFings (10-12