CLC EXAM QUESTIONS WITH COMPLETE
SOLUTION
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
-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.
SOLUTION
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
-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.
