ALPP Certified Lactation Counselor (CLC)
Comprehensive Examination
2026/2027 Edition
300 Questions | 3 Versions (A, B, C) | 100 Questions Each
Aligned with ALPP Standards, WHO/UNICEF BFHI Guidelines,
and Evidence-Based Lactation Practice
Version Questions Content Focus
A (Q1-100) 1-100 Communication, Physiology, Infant Assessment, Ethics
B (Q101-200) 101-200 Clinical Challenges, Medications, Special Populations, Expression
C (Q201-300) 201-300 BFHI/WHO Code, High-Risk, EBP/Research, Case Studies
Question Format: Multiple Choice (A-D) with Correct Answer and Detailed Rationale
Cognitive Levels: 25% Recall | 50% Application | 25% Analysis
Question Style: 75% Scenario-Based | 15% Direct Recall | 10% Case Analysis
,ALPP Certified Lactation Counselor (CLC) Exam | 2026/2027 Edition 300 Questions (3 Versions)
VERSION A
Questions 1-100
Communication, Counseling, & Cultural Competence (Q1-25)
Lactation Anatomy & Physiology (Q26-50)
Infant Assessment & Feeding Evaluation (Q51-75)
Documentation, Ethics, & Professional Standards (Q76-100)
Page 2
,ALPP Certified Lactation Counselor (CLC) Exam | 2026/2027 Edition 300 Questions (3 Versions)
Communication, Counseling, & Cultural Competence
Questions 1-25
Q1: A new parent tells a CLC, "I tried breastfeeding yesterday and it was painful. I just don't think I can keep going."
Which response best demonstrates the OARS technique of asking an open-ended question?
A. Are you ready to stop breastfeeding altogether?
B. Can you tell me more about what the pain felt like and when it started?
C. Did you try using lanolin cream on your nipples?
D. Would you like me to show you a different latch technique?
Correct Answer: B
Rationale: Open-ended questions invite the client to elaborate in their own words, which builds rapport and reveals important
clinical details. Asking "Can you tell me more…" is a classic OARS open question, whereas the other options are closed questions
that limit the conversation.
Q2: A father reports that he has been waking at 2 AM every night to bring the baby to his partner for feeds. He looks
exhausted but says, "I just want to help." Which response is the best example of an affirmation?
A. That's great that you're helping, but you really need your sleep too.
B. It takes a lot of dedication to get up every night like that — your baby is lucky to have you.
C. You should consider bottle-feeding expressed milk so you can sleep more.
D. Most fathers don't do that much, so you're doing better than average.
Correct Answer: B
Rationale: An affirmation recognizes the client's strengths and efforts sincerely and without comparison. The correct option
acknowledges the father's specific behavior and its positive impact. The first option undermines the affirmation with "but," and
the fourth option uses unhelpful comparison.
Q3: A mother says, "My mother-in-law keeps telling me my baby is too skinny and that I should give formula. I feel like
everyone is judging me." Which response best uses reflective listening?
A. You shouldn't listen to her — your baby's growth is fine.
B. Have you thought about having your mother-in-law speak with me directly?
C. It sounds like you're feeling judged and pressured by your family, which makes feeding feel even harder.
D. Let's look at the baby's weight chart so you can show her the numbers.
Correct Answer: C
Rationale: Reflective listening mirrors the client's emotions and meaning back to them, showing empathy and deep
understanding. The correct option captures both the feeling of being judged and the impact on the mother's feeding experience.
The other options either dismiss the feeling or jump to problem-solving.
Q4: During a counseling session, a parent has discussed returning to work in two weeks, concerns about pumping at
the office, and worry that her supply will drop. Which response best demonstrates the OARS technique of
summarizing?
A. So to summarize, your main concern is just about pumping at work.
B. Let me see if I have this right — you're going back to work soon, you're unsure how pumping will work in your
office, and you're worried your milk supply might decrease as a result. Is that close?
C. The most important thing is to start pumping now so your supply is established before you return.
D. A lot of mothers worry about supply, but most do just fine when they go back to work.
Correct Answer: B
Page 3
, ALPP Certified Lactation Counselor (CLC) Exam | 2026/2027 Edition 300 Questions (3 Versions)
Rationale: A summary collects the key themes the client has shared and presents them back for confirmation. The correct option
weaves together all three concerns and invites the client to verify accuracy, which strengthens the therapeutic alliance. The first
option is an incomplete summary, and the others give advice.
Q5: A parent who is exclusively formula-feeding says, "Part of me wishes I had tried harder to breastfeed, but I also
feel relieved that others can help with feeds." What is the most appropriate MI-consistent response?
A. It's not too late to start breastfeeding if you want to try.
B. Formula feeding is a perfectly valid choice, so you shouldn't feel regret.
C. If you had received better support, you probably would have breastfed successfully.
D. It sounds like you have mixed feelings — there's a part of you that feels regret, and another part that values the
flexibility of formula feeding. What are those feelings like for you?
Correct Answer: D
Rationale: Motivational interviewing embraces ambivalence rather than resolving it for the client. The correct response reflects
both sides of the conflict and invites further exploration, which respects autonomy. The other options either push an agenda or
dismiss the client's expressed feelings.
Q6: A mother states she wants to breastfeed for at least one year because she knows it reduces health risks, but she
also mentions giving formula supplements at every night feed because she is "too tired." Which response best helps
develop discrepancy in an MI framework?
A. You know that supplementing will ruin your supply, right?
B. Most mothers feel too tired in the beginning, but you just have to push through it.
C. You've told me that reaching one year is really important to you because of the health benefits. How do the
nighttime supplements fit with that goal?
D. Maybe you should lower your goal to six months so it's more realistic.
Correct Answer: C
Rationale: Developing discrepancy highlights the gap between the client's stated goals and their current behavior without
confrontation. The correct option gently mirrors back the client's own values and prompts self-reflection. The other options are
confrontational, prescriptive, or dismissive.
Q7: Which of the following is a core principle of trauma-informed care in lactation support?
A. Creating a sense of safety, trustworthiness, and empowerment in every interaction
B. Avoiding any discussion of the client's birth experience to prevent re-traumatization
C. Insisting that the client disclose a history of trauma before providing care
D. Referring all clients with trauma histories exclusively to mental health professionals
Correct Answer: A
Rationale: Trauma-informed care is rooted in the principles of safety, trustworthiness, peer support, collaboration,
empowerment, and cultural sensitivity. It does not require disclosure or avoid topics, but rather ensures every interaction
minimizes risk of re-traumatization and maximizes the client's sense of control.
Q8: A CLC is working with a parent who had an unplanned cesarean birth. The parent flinches when the CLC reaches
toward her chest to demonstrate hand expression. What is the most trauma-informed first response?
A. Continue the demonstration quickly to get it over with before she changes her mind
B. Ask the parent if it is okay to touch her arm for guidance before moving closer, and respect her answer
C. Explain that hand expression is very important for her milk supply so she should try to tolerate it
D. Document the reaction and immediately refer her to a therapist before continuing
Correct Answer: B
Rationale: Trauma-informed practice prioritizes physical and emotional safety by seeking consent before touching and
respecting boundaries. Asking permission before any physical approach restores the client's sense of control, which is especially
Page 4
Comprehensive Examination
2026/2027 Edition
300 Questions | 3 Versions (A, B, C) | 100 Questions Each
Aligned with ALPP Standards, WHO/UNICEF BFHI Guidelines,
and Evidence-Based Lactation Practice
Version Questions Content Focus
A (Q1-100) 1-100 Communication, Physiology, Infant Assessment, Ethics
B (Q101-200) 101-200 Clinical Challenges, Medications, Special Populations, Expression
C (Q201-300) 201-300 BFHI/WHO Code, High-Risk, EBP/Research, Case Studies
Question Format: Multiple Choice (A-D) with Correct Answer and Detailed Rationale
Cognitive Levels: 25% Recall | 50% Application | 25% Analysis
Question Style: 75% Scenario-Based | 15% Direct Recall | 10% Case Analysis
,ALPP Certified Lactation Counselor (CLC) Exam | 2026/2027 Edition 300 Questions (3 Versions)
VERSION A
Questions 1-100
Communication, Counseling, & Cultural Competence (Q1-25)
Lactation Anatomy & Physiology (Q26-50)
Infant Assessment & Feeding Evaluation (Q51-75)
Documentation, Ethics, & Professional Standards (Q76-100)
Page 2
,ALPP Certified Lactation Counselor (CLC) Exam | 2026/2027 Edition 300 Questions (3 Versions)
Communication, Counseling, & Cultural Competence
Questions 1-25
Q1: A new parent tells a CLC, "I tried breastfeeding yesterday and it was painful. I just don't think I can keep going."
Which response best demonstrates the OARS technique of asking an open-ended question?
A. Are you ready to stop breastfeeding altogether?
B. Can you tell me more about what the pain felt like and when it started?
C. Did you try using lanolin cream on your nipples?
D. Would you like me to show you a different latch technique?
Correct Answer: B
Rationale: Open-ended questions invite the client to elaborate in their own words, which builds rapport and reveals important
clinical details. Asking "Can you tell me more…" is a classic OARS open question, whereas the other options are closed questions
that limit the conversation.
Q2: A father reports that he has been waking at 2 AM every night to bring the baby to his partner for feeds. He looks
exhausted but says, "I just want to help." Which response is the best example of an affirmation?
A. That's great that you're helping, but you really need your sleep too.
B. It takes a lot of dedication to get up every night like that — your baby is lucky to have you.
C. You should consider bottle-feeding expressed milk so you can sleep more.
D. Most fathers don't do that much, so you're doing better than average.
Correct Answer: B
Rationale: An affirmation recognizes the client's strengths and efforts sincerely and without comparison. The correct option
acknowledges the father's specific behavior and its positive impact. The first option undermines the affirmation with "but," and
the fourth option uses unhelpful comparison.
Q3: A mother says, "My mother-in-law keeps telling me my baby is too skinny and that I should give formula. I feel like
everyone is judging me." Which response best uses reflective listening?
A. You shouldn't listen to her — your baby's growth is fine.
B. Have you thought about having your mother-in-law speak with me directly?
C. It sounds like you're feeling judged and pressured by your family, which makes feeding feel even harder.
D. Let's look at the baby's weight chart so you can show her the numbers.
Correct Answer: C
Rationale: Reflective listening mirrors the client's emotions and meaning back to them, showing empathy and deep
understanding. The correct option captures both the feeling of being judged and the impact on the mother's feeding experience.
The other options either dismiss the feeling or jump to problem-solving.
Q4: During a counseling session, a parent has discussed returning to work in two weeks, concerns about pumping at
the office, and worry that her supply will drop. Which response best demonstrates the OARS technique of
summarizing?
A. So to summarize, your main concern is just about pumping at work.
B. Let me see if I have this right — you're going back to work soon, you're unsure how pumping will work in your
office, and you're worried your milk supply might decrease as a result. Is that close?
C. The most important thing is to start pumping now so your supply is established before you return.
D. A lot of mothers worry about supply, but most do just fine when they go back to work.
Correct Answer: B
Page 3
, ALPP Certified Lactation Counselor (CLC) Exam | 2026/2027 Edition 300 Questions (3 Versions)
Rationale: A summary collects the key themes the client has shared and presents them back for confirmation. The correct option
weaves together all three concerns and invites the client to verify accuracy, which strengthens the therapeutic alliance. The first
option is an incomplete summary, and the others give advice.
Q5: A parent who is exclusively formula-feeding says, "Part of me wishes I had tried harder to breastfeed, but I also
feel relieved that others can help with feeds." What is the most appropriate MI-consistent response?
A. It's not too late to start breastfeeding if you want to try.
B. Formula feeding is a perfectly valid choice, so you shouldn't feel regret.
C. If you had received better support, you probably would have breastfed successfully.
D. It sounds like you have mixed feelings — there's a part of you that feels regret, and another part that values the
flexibility of formula feeding. What are those feelings like for you?
Correct Answer: D
Rationale: Motivational interviewing embraces ambivalence rather than resolving it for the client. The correct response reflects
both sides of the conflict and invites further exploration, which respects autonomy. The other options either push an agenda or
dismiss the client's expressed feelings.
Q6: A mother states she wants to breastfeed for at least one year because she knows it reduces health risks, but she
also mentions giving formula supplements at every night feed because she is "too tired." Which response best helps
develop discrepancy in an MI framework?
A. You know that supplementing will ruin your supply, right?
B. Most mothers feel too tired in the beginning, but you just have to push through it.
C. You've told me that reaching one year is really important to you because of the health benefits. How do the
nighttime supplements fit with that goal?
D. Maybe you should lower your goal to six months so it's more realistic.
Correct Answer: C
Rationale: Developing discrepancy highlights the gap between the client's stated goals and their current behavior without
confrontation. The correct option gently mirrors back the client's own values and prompts self-reflection. The other options are
confrontational, prescriptive, or dismissive.
Q7: Which of the following is a core principle of trauma-informed care in lactation support?
A. Creating a sense of safety, trustworthiness, and empowerment in every interaction
B. Avoiding any discussion of the client's birth experience to prevent re-traumatization
C. Insisting that the client disclose a history of trauma before providing care
D. Referring all clients with trauma histories exclusively to mental health professionals
Correct Answer: A
Rationale: Trauma-informed care is rooted in the principles of safety, trustworthiness, peer support, collaboration,
empowerment, and cultural sensitivity. It does not require disclosure or avoid topics, but rather ensures every interaction
minimizes risk of re-traumatization and maximizes the client's sense of control.
Q8: A CLC is working with a parent who had an unplanned cesarean birth. The parent flinches when the CLC reaches
toward her chest to demonstrate hand expression. What is the most trauma-informed first response?
A. Continue the demonstration quickly to get it over with before she changes her mind
B. Ask the parent if it is okay to touch her arm for guidance before moving closer, and respect her answer
C. Explain that hand expression is very important for her milk supply so she should try to tolerate it
D. Document the reaction and immediately refer her to a therapist before continuing
Correct Answer: B
Rationale: Trauma-informed practice prioritizes physical and emotional safety by seeking consent before touching and
respecting boundaries. Asking permission before any physical approach restores the client's sense of control, which is especially
Page 4
