CLC Exam Study Guide Exam New Version/ ALPP CLC Exam
Study Guide Updated Version Actual Exam
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
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.
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
-pocket of pus forms in the breast
-from untreated mastitis
, Antibiotics for mastitis? - Usually for double mastitis, not generally proscribed for one
breast common mastitis. If treatment uneffective consider anemia, ductal or
inflammatory breast cancer
Double mastitis - EMERGENT AND UNCOMMON- tissue of both breasts inflamed.
organism cause of double mastitis - strep -potentially fatal, whole body inflammation,
sepsis
-not a problem with milk
signs of inflammatory breast cancer - - 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 - TRUE can masquerade as
mastitis. might see peeling skin, pitting. can also cause lesions and abscess.
Abscess on breast is full of ... - PUS not MILK. as many as 60% positive for MRSA.
can you nurse on same side as abscess - 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 - can cut through nerves and ducts. try to avoid surgical
intervention
treatment of abscess - 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... -
MRSA or herpes- fatal for babies
Goldsmith's sign - 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 - -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 - • Jitteriness, tremors
• Poor muscle tone
• Diaphoresis (sweating)
Study Guide Updated Version Actual Exam
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
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.
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
-pocket of pus forms in the breast
-from untreated mastitis
, Antibiotics for mastitis? - Usually for double mastitis, not generally proscribed for one
breast common mastitis. If treatment uneffective consider anemia, ductal or
inflammatory breast cancer
Double mastitis - EMERGENT AND UNCOMMON- tissue of both breasts inflamed.
organism cause of double mastitis - strep -potentially fatal, whole body inflammation,
sepsis
-not a problem with milk
signs of inflammatory breast cancer - - 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 - TRUE can masquerade as
mastitis. might see peeling skin, pitting. can also cause lesions and abscess.
Abscess on breast is full of ... - PUS not MILK. as many as 60% positive for MRSA.
can you nurse on same side as abscess - 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 - can cut through nerves and ducts. try to avoid surgical
intervention
treatment of abscess - 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... -
MRSA or herpes- fatal for babies
Goldsmith's sign - 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 - -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 - • Jitteriness, tremors
• Poor muscle tone
• Diaphoresis (sweating)
