CLC EXAM 2024 LATEST QUESTIONS AND VERIFIED
ANSWERS UPDATED
What are green/shiny stools a sign of?
-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
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?
Improper latch--> need lactation support to help with proper latch on, good seal
True/false: baby should be pulled into breast.
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?
Asymmetric! A baby should form a teat with breast tissue underneath the nipple as part
of a latch
What is a symmetric latch
Not a good latch, causes nipple damage
Asymmetric latch
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?
,Continued questions of effectiveness, fear of ingestion by baby
Should a frenotomy be suggested for tongue tie?
No study was able to report that frenotomy led to better long term breastfeeding
Tongue tied breastfeeder
-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?
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?
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?
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?
normal milk production = 750-1000 mL/day
Thrush during BF
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
-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?
Not candida infection!
Reynaud's Phenomenon
-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
-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
-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
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
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
If plug hasn't moved in 24-48 hrs or systemic signs of inflammation (flu like s/s)
Causes of clogs/plug
, too tight nursing bra
what is a bleb
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
painful stabbing pinpoint pain
how to get rid of blebs
Same as clog treatment. Sometimes need t be lanced by HCP
Common mastitis
-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
-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
systemic- fever, ill, malaise, redness, pain, one inflamed breast
What bacteria causes infective mastitis
Staphylococcus
tx common mastitis
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
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
ANSWERS UPDATED
What are green/shiny stools a sign of?
-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
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?
Improper latch--> need lactation support to help with proper latch on, good seal
True/false: baby should be pulled into breast.
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?
Asymmetric! A baby should form a teat with breast tissue underneath the nipple as part
of a latch
What is a symmetric latch
Not a good latch, causes nipple damage
Asymmetric latch
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?
,Continued questions of effectiveness, fear of ingestion by baby
Should a frenotomy be suggested for tongue tie?
No study was able to report that frenotomy led to better long term breastfeeding
Tongue tied breastfeeder
-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?
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?
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?
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?
normal milk production = 750-1000 mL/day
Thrush during BF
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
-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?
Not candida infection!
Reynaud's Phenomenon
-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
-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
-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
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
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
If plug hasn't moved in 24-48 hrs or systemic signs of inflammation (flu like s/s)
Causes of clogs/plug
, too tight nursing bra
what is a bleb
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
painful stabbing pinpoint pain
how to get rid of blebs
Same as clog treatment. Sometimes need t be lanced by HCP
Common mastitis
-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
-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
systemic- fever, ill, malaise, redness, pain, one inflamed breast
What bacteria causes infective mastitis
Staphylococcus
tx common mastitis
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
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
