Certified Lactation Counselor (CLC)Real Actual Exam | 2025/2026
Edition – REAL Proctored Exam, 2Versions Included (300 Verified
Questions & Correct Answers | Graded A+)
Predominant Breastfeeding
Babies who receive breastmilk and other liquids (e.g. water, minerals, vitamins,
oral meds).
Breastfeeding
Baby receives human milk, as well as other foods or fluids, including formula.
Complementary Feeding
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
3 strategies for increasing BF initiation and duration
Promotion, Protection, Support
What types of hormonal imbalance can impact milk supply?
-Maternal obesity
-Diabetes
-Prediabetes (insulin dysregulation)
-Hypo or Hyperthyroidism
-PCOS
-Drugs (pseudoephedrine- decreased milk supply 24%, corticosteroids- temp
suspension of lactation)
How does smoking impact milk supply?
-less milk
-lower prolactin levels
-increases risk of early weaning
-babies nap less
What is the babies exposure if a mother is smoking while BF?
,-Most exposure via passive smoking + mother's milk. Least mother's milk alone.
Middle is passive smoking alone.
-Not much research for E-Cigs. Transfer of nicotine appears minimal.
Cadmium
Soy formula has 6x more than cow's milk. Formula fed babies can be exposed to
up to 12x the amount.
When does milk revert to colostrum?
Mid pregnancy
What is tandem nursing?
Nursing two babies not from the same pregnancy.
What are some issues associated with tandem nursing?
-Milk volume increases faster, (though less engorgement 2 nursers)
-May need education on managing flow
-Nurse newborn first and frequently
-Find time for non-nursing interactions with older babies
What about pacifiers and milk production?
-Studies contradict each other.
-Some research suggests that pacifiers reduce BF as early as 2-4 months.
-Pacifer is an indicator that the parents need extra help (sore nipples, hunger,
crying?)
What are some public health implications of pacifier use?
1. Increased diarrhea in the first 3 years
2. Increased instances of ear infections
What does the AAP say regarding pacifier and SIDS?
Delay intro until BF is firmly established (3-4 weeks of age)
Who should have pacifiers?
Preemies- earlier hospital d/c, improved physiologic/behavioral responses,
reduced time for oral feeding.
,What are the concerns related to nipple shield.
1. Uncertain of effects on milk supply
2. 3x risk of not exclusively breastfeeding
3. Increased risk for infant weight loss and dehydration
4. Increased risk of early weaning
5. There is limited research
6. Can have fungal biofilm exposure (must use a scrub brush to remove bacteria)
7. Difficulty weaning from the shield
Why is water dangerous?
1. Can cause water intoxication
2. More likely to need formula supplementation
How does confidence impact BF?
Discontinuation at 2 weeks is linked to lack of confidence on day 1 or 2.
Counseling implications for women with fears about milk supply
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
What are the 5 main categories that women fall into regarding how women
learn?
Silence
Received
Subjective
Procedural
Constructed
How women learn: Silence
-Feel voiceless, powerless, and mindless
-Sometimes in abusive relationships
-May be afraid of words
, -Feel dependent on others
-Don't trust selves
-Have little awareness of their intellectual abilities
How do you develop a relationship with women in silence?
-Keep message simple, use few words
-Short, easy, comfortable messages
-Nothing to remember
-May need an advocate
How women learn: Knowledge
-Believe all authorities tell the truth
-Like to learn the right answer and repeat to the teacher
-Don't like ambiguity
-Want to talk to "leader/authority".
How do you develop a relationship with women receiving knowledge?
-Project authority
-Avoid ambiguity
-Make advantages concrete
-Provide demonstration and return demonstration of the "right" way
How women learn: Subjective Knower
-Believe knowing is personal, private, and based on intuition.
-Believe experience drives knowledge
-Sense of authority arises from the power of the group
-Trust own intuition
-Inner voice guides them
-Distrusts male experts
-Trust women with similar experiences
-Support groups are helpful
-Like natural things like BF.
-Want to be helped by someone who has BF.
How do you develop a relationship with women who are subjective knowers?
Edition – REAL Proctored Exam, 2Versions Included (300 Verified
Questions & Correct Answers | Graded A+)
Predominant Breastfeeding
Babies who receive breastmilk and other liquids (e.g. water, minerals, vitamins,
oral meds).
Breastfeeding
Baby receives human milk, as well as other foods or fluids, including formula.
Complementary Feeding
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
3 strategies for increasing BF initiation and duration
Promotion, Protection, Support
What types of hormonal imbalance can impact milk supply?
-Maternal obesity
-Diabetes
-Prediabetes (insulin dysregulation)
-Hypo or Hyperthyroidism
-PCOS
-Drugs (pseudoephedrine- decreased milk supply 24%, corticosteroids- temp
suspension of lactation)
How does smoking impact milk supply?
-less milk
-lower prolactin levels
-increases risk of early weaning
-babies nap less
What is the babies exposure if a mother is smoking while BF?
,-Most exposure via passive smoking + mother's milk. Least mother's milk alone.
Middle is passive smoking alone.
-Not much research for E-Cigs. Transfer of nicotine appears minimal.
Cadmium
Soy formula has 6x more than cow's milk. Formula fed babies can be exposed to
up to 12x the amount.
When does milk revert to colostrum?
Mid pregnancy
What is tandem nursing?
Nursing two babies not from the same pregnancy.
What are some issues associated with tandem nursing?
-Milk volume increases faster, (though less engorgement 2 nursers)
-May need education on managing flow
-Nurse newborn first and frequently
-Find time for non-nursing interactions with older babies
What about pacifiers and milk production?
-Studies contradict each other.
-Some research suggests that pacifiers reduce BF as early as 2-4 months.
-Pacifer is an indicator that the parents need extra help (sore nipples, hunger,
crying?)
What are some public health implications of pacifier use?
1. Increased diarrhea in the first 3 years
2. Increased instances of ear infections
What does the AAP say regarding pacifier and SIDS?
Delay intro until BF is firmly established (3-4 weeks of age)
Who should have pacifiers?
Preemies- earlier hospital d/c, improved physiologic/behavioral responses,
reduced time for oral feeding.
,What are the concerns related to nipple shield.
1. Uncertain of effects on milk supply
2. 3x risk of not exclusively breastfeeding
3. Increased risk for infant weight loss and dehydration
4. Increased risk of early weaning
5. There is limited research
6. Can have fungal biofilm exposure (must use a scrub brush to remove bacteria)
7. Difficulty weaning from the shield
Why is water dangerous?
1. Can cause water intoxication
2. More likely to need formula supplementation
How does confidence impact BF?
Discontinuation at 2 weeks is linked to lack of confidence on day 1 or 2.
Counseling implications for women with fears about milk supply
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
What are the 5 main categories that women fall into regarding how women
learn?
Silence
Received
Subjective
Procedural
Constructed
How women learn: Silence
-Feel voiceless, powerless, and mindless
-Sometimes in abusive relationships
-May be afraid of words
, -Feel dependent on others
-Don't trust selves
-Have little awareness of their intellectual abilities
How do you develop a relationship with women in silence?
-Keep message simple, use few words
-Short, easy, comfortable messages
-Nothing to remember
-May need an advocate
How women learn: Knowledge
-Believe all authorities tell the truth
-Like to learn the right answer and repeat to the teacher
-Don't like ambiguity
-Want to talk to "leader/authority".
How do you develop a relationship with women receiving knowledge?
-Project authority
-Avoid ambiguity
-Make advantages concrete
-Provide demonstration and return demonstration of the "right" way
How women learn: Subjective Knower
-Believe knowing is personal, private, and based on intuition.
-Believe experience drives knowledge
-Sense of authority arises from the power of the group
-Trust own intuition
-Inner voice guides them
-Distrusts male experts
-Trust women with similar experiences
-Support groups are helpful
-Like natural things like BF.
-Want to be helped by someone who has BF.
How do you develop a relationship with women who are subjective knowers?
