Latest 2023 CLC- Certified Lactation Counselor Exam- Latest Q&A

What duration of breastfeeding is associated with significantly reduced incidence of acute otits media (AOM)? A) Any breastfeeding B) Up to 3 mos C) More than 4-6 months - ANSWER C) More than 4-6 months Breastfeeding lowers the risk for the incidence of dental caries compared to children fed nonhuman milk from a bottle. True of False? - ANSWER True Does breastfeeding lower the risk of NEC in preterm infants? - ANSWER Yes Is there a difference in the protective effect against SIDS between babies that are exclusively breastfed vs. non-exclusively? - ANSWER Yes, babies that are exclusively breastfed have a stronger protective effect against SIDS Does breastfeeding lower the risk for the incidence of malocclusion (misalignment of teeth)? - ANSWER Yes True of False. Lactational amenorrhea, or the delay in return of menses after birth, is not associated with exclusive breastfeeding. - ANSWER False What are the physical benefits of breastfeeding to the lactating parent? - ANSWER Lower risk of breast cancer, lower risk of ovarian cancer, reduced risk of Type 2 diabetes, reduced risk of cardiovascular disease What are the 3 main steps of Evidence-Based Practice (EBP)? - ANSWER Best available clinical evidence, Clinical expertise, Patient concerns and needs What are the benefits of breastfeeding for infants? - ANSWER Protective against respiratory infections, asthma, gastrointestinal infections and diarrhea, ear infections, dental caries, teeth misalignment, NEC and SIDS, obesity, diabetes, higher performance on intelligence tests What are hypotonic lips in an infant? - ANSWER Abnormally LOW muscle tone or weakness in lips- may impact amount of suction, increase work of feeding, can contribute to milk loss and fatigue during feedings What are hypertonic lips in an infant? - ANSWER Abnormally HIGH muscle tone or overuse of lips- increased lip activity to hold breast in mouth What can hypertonic lips be an indication of? - ANSWER 1. Neurological abnormality or injury of the tongue, jaws, or facial nerves. 2. Can also be compensating for muscular weakness in the cheeks, jaw, or tongue or reduced lingual or labial mobility secondary to a tight labial frenulum or ankyloglossia (tongue-tie) 3. May be sensory in nature (hypo- or hypersensitive) What is a tethered maxillary frenulum? - ANSWER Referred to as upper or superior labial frenulum- a tightness or thickness in the band of tissue that attaches the upper lip to the upper gum What is a cleft lip? - ANSWER A fissure or opening in the upper lip, may extend into the nose, may be unilateral or bilateral What is the second most common birth defect? - ANSWER Cleft lip What is a sign of a possible tight maxillary frenulum? - ANSWER Blanching of the frenulum when gently lifting the upper lip, reduced lip movement What may cause sucking blisters? - ANSWER Friction from retracted lips, a tight maxillary frenulum restricting upper lip mobility, can be secondary cause of tight lingual frenulum (tongue-tie) or hypertonia When observing a feeding, what signs can indicate an issue with the infant's lips? - ANSWER Breaks in the seal with the breast, lip retraction and lip tremors, leaking milk What are 2 ways to help improve tone and strengthen the lip seal for infants with abnormal lip tone? - ANSWER 1. Provide firm pressure stimulus (i.e. tapping) on the lips prior to feeding. 2. Insert clean finger or round, somewhat firm pacifier, then partially pull it out of infant's mouth to induce the infant to pull it back. How can parents help infant with cleft lip breastfeed? - ANSWER By using finger or shape of the breast tissue to seal the cleft. What are buccal pads? - ANSWER Subcutaneous fat deposits in cheeks What can cause low facial tone or poorly developed buccal pads in an infant? - ANSWER Prematurity or low birth weight What are possible issues due to facial hypotonia? - ANSWER Decreased cheek stability hindering seal on the breast, infant needs to create a greater vacuum to generate and sustain suction, this increases the work of feeding and can cause fatigue before feeding is complete. How do you assess cheeks on an infant? - ANSWER Place a gloved finger inside infant's mouth and place a thumb on the outside of the cheek to sense the thickness of the fat pads. With thin cheeks, finger and thumb almost touch. How can you identify weak, thin, or unstable cheeks during a feed? - ANSWER Cheeks will collapse while baby sucks. Also look for dimples. What method can be used to assist an infant with low facial muscle tone during feeds? - ANSWER Dancer hold- provide external support during feeding by using fingers and hand to support infant's jaw and cheeks What is micrognathia? - ANSWER Abnormally small lower jaw What is retrognathia? - ANSWER Abnormally receding lower jaw What can severe micrognathia (abnormal small lower jaw) and retrognathia (abnormally receding lower jaw) be signs of? - ANSWER Pierre Robin sequence What can infant jaw clenching during feeding be a sign of? - ANSWER Hypertonia or a weakness in a different area (e.g. poor tongue or lip function) What do you look for when assessing an infant's jaws? - ANSWER Observe for asymmetry, Identify micrognathia or retrognathia, Identify jaw grading, clenching, or tremors during feeding How do you do an oral assessment of an infant's jaw? - ANSWER Insert gloved pinkie finger in corner of infant's mouth between posterior gum pads: 1. Count number of reflexive bites (chews) 2. Infant should respond with 10 chews per side 3. Observe difficulty producing reflexive bites or stress cues during assessment What are 2 things that can be done to assist an infant while feeding to assist with jaw issues? - ANSWER 1. Provide external jaw support with a finger placed under bony part of lower jaw to control/stabilize distance of jaw excursions 2. Identify feeding positions that emphasize postural stability (hip flexion, stabilize trunk) and maintain head extension to bring lower jaw closer to breast What methods can be done to improve results of infant feeding issues due to jaw abnormalities, weakness, or injury? - ANSWER 1. Exercise jaws several times a day 2. Refer infant for physical therapy or body work 3. Refer infant for speech or occupational therapy for assessment for feeding difficulties