CLC Exams
Questions and
Complete Solution
Denning [Date] [Course title]
,What are green/shiny stools a sign of? - Correct 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 - Correct 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? - Correct Answer: Improper latch--> need lactation support to help with
proper latch on, good seal
True/false: baby should be pulled into breast. - Correct 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? - Correct Answer: Asymmetric! A baby should form a teat
with breast tissue underneath the nipple as part of a latch
What is a symmetric latch - Correct Answer: Not a good latch, causes nipple damage
Asymmetric latch - Correct 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? - Correct Answer: Continued questions of effectiveness, fear of ingestion by
baby
Should a frenotomy be suggested for tongue tie? - Correct Answer: No study was able to report that
frenotomy led to better long term breastfeeding
Tongue tied breastfeeder - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct Answer: normal milk production = 750-1000 mL/day
Thrush during BF - Correct 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 - Correct 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? - Correct Answer: Not candida infection!
Reynaud's Phenomenon - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct Answer: If plug hasn't moved in 24-48 hrs or systemic signs of
inflammation (flu like s/s)
Causes of clogs/plug - Correct Answer: too tight nursing bra
what is a bleb - Correct Answer: small white spots on the face of the nipple that look like milk-filled
blisters. one duct opening is usually covered
Questions and
Complete Solution
Denning [Date] [Course title]
,What are green/shiny stools a sign of? - Correct 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 - Correct 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? - Correct Answer: Improper latch--> need lactation support to help with
proper latch on, good seal
True/false: baby should be pulled into breast. - Correct 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? - Correct Answer: Asymmetric! A baby should form a teat
with breast tissue underneath the nipple as part of a latch
What is a symmetric latch - Correct Answer: Not a good latch, causes nipple damage
Asymmetric latch - Correct 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? - Correct Answer: Continued questions of effectiveness, fear of ingestion by
baby
Should a frenotomy be suggested for tongue tie? - Correct Answer: No study was able to report that
frenotomy led to better long term breastfeeding
Tongue tied breastfeeder - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct Answer: normal milk production = 750-1000 mL/day
Thrush during BF - Correct 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 - Correct 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? - Correct Answer: Not candida infection!
Reynaud's Phenomenon - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct Answer: If plug hasn't moved in 24-48 hrs or systemic signs of
inflammation (flu like s/s)
Causes of clogs/plug - Correct Answer: too tight nursing bra
what is a bleb - Correct Answer: small white spots on the face of the nipple that look like milk-filled
blisters. one duct opening is usually covered
