ALPP Certified Lactation Counselor (CLC) Exam
Practice Test (Latest 2025/2026 Edition)
Comprehensive 200-Question Study and Review Guide
with Verified Answers & Rationales
Overview
The Certified Lactation Counselor (CLC) Exam Real Test is designed to help candidates
prepare for the Academy of Lactation Policy and Practice (ALPP) certification examination.
This comprehensive study resource mirrors the structure, format, and core competencies of
the actual CLC exam. It aims to reinforce your understanding of lactation science, counseling
strategies, and evidence-based maternal-infant care practices.
Exam Focus Areas
1. Anatomy & Physiology of Lactation – Breast structure, milk production, hormonal
regulation, and infant feeding reflexes.
2. Human Milk Composition & Benefits – Nutritional content, immunological
components, and comparison with formula.
3. Counseling & Communication Skills – Client-centered communication, cultural
sensitivity, ethics, and confidentiality.
4. Breastfeeding Management – Latch and positioning, assessment of milk transfer,
handling common problems (engorgement, mastitis, nipple pain).
5. Infant Nutrition & Growth – Normal feeding patterns, supplementation guidelines, and
growth assessment.
6. Pumping, Storage & Returning to Work – Pump types, safe milk handling, and
supporting breastfeeding mothers in workplace settings.
7. Public Health, Policy & Education – WHO/UNICEF Baby-Friendly Initiative, maternal
support programs, and breastfeeding promotion strategies.
Section 1 — Questions 1–50 (Foundations: anatomy, physiology, basics)
1. The hormone primarily responsible for milk ejection (letdown) is:
A. Estrogen
B. Progesterone
C. Oxytocin
, D. Prolactin
Rationale: Oxytocin causes myoepithelial cell contraction around alveoli,
producing milk ejection.
2. The hormone primarily responsible for milk production (synthesis) is:
A. Insulin
B. Prolactin
C. Cortisol
D. Oxytocin
Rationale: Prolactin stimulates alveolar epithelial cells to synthesize milk
components.
3. Colostrum differs from mature milk because it:
A. Has more lactose than mature milk
B. Is lower in protein than mature milk
C. Is higher in immunoglobulins (especially IgA)
D. Has higher % water than mature milk
Rationale: Colostrum is rich in IgA and other immune factors.
4. The functional milk-secreting units of the breast are:
A. Lactiferous sinuses
B. Ductules
C. Alveoli (lobules)
D. Areola glands
Rationale: Alveoli (clusters of secretory epithelial cells) produce milk.
5. Milk removal primarily regulates milk supply through:
A. Hormone-only mechanisms
B. Timing of infant sleeps
C. Autocrine (local) feedback based on milk removal
D. Frequency of maternal exercise
Rationale: Local removal of milk influences supply via autocrine feedback
(e.g., FIL).
6. The most reliable sign of effective breastfeeding in a newborn is:
A. Audible swallowing during every feed
B. Maternal nipple pain
C. Steady weight gain after initial loss
, D. Frequent stools only
Rationale: Weight gain pattern indicates adequate intake and nutrition.
7. Typical newborn weight loss in the first 3–5 days is:
A. 10–15% of birth weight
B. 5–10% of birth weight
C. 0–2% of birth weight
D. >15% of birth weight
Rationale: Up to 7–10% is expected; >10% usually requires evaluation.
8. Mature milk generally appears by:
A. 12 hours postpartum
B. 24 hours postpartum
C. 3–5 days postpartum
D. 10–14 days postpartum
Rationale: Transition from colostrum to mature milk commonly occurs 3–5
days.
9. The best initial latch position for most dyads to assess is:
A. Unsupported back-lying only
B. Infant’s nose to nipple with chin to breast (effective latch)
C. Infant’s chin away from the breast
D. Nipple to palate only
Rationale: Nose-to-nipple alignment encourages wide mouth and optimal
latch.
10.A sign of a shallow latch is:
A. Wide, open mouth
B. Areola far from infant’s mouth
C. Painful/nipples with pinching pain and clicking sounds
D. Audible swallowing
Rationale: Shallow latch often causes nipple pain and clicking.
11.Effective breastfeeding sessions in first week usually occur:
A. Every 6–8 hours
B. Only at night
C. 8–12+ times in 24 hours (on-demand)
D. Every 2 minutes continuously
, Rationale: Frequent removal of milk supports supply and newborn
hydration.
12.Jaundice from breastfeeding that improves with formula supplementation
and resolves is likely:
A. Pathologic jaundice
B. Breastfeeding-associated (insufficient intake) jaundice
C. Breast-milk jaundice
D. Hemolytic disease
Rationale: Early insufficient intake → increased bilirubin; resolves with
improved intake.
13.True breastmilk jaundice (peaks later, not due to low intake) commonly
peaks at:
A. Day 1–2
B. Day 3–5
C. 2–3 weeks of age
D. After 2 months
Rationale: Breast-milk jaundice is a benign, later-onset phenomenon
related to milk components.
14.The primary macronutrient for infant brain development in human milk is:
A. Carbohydrate only
B. Long-chain polyunsaturated fatty acids (LC-PUFAs)
C. Starch
D. Plant protein
Rationale: LC-PUFAs like DHA support neurodevelopment; milk fat provides
these.
15.An infant who feeds every 2–3 hours and exhibits 6–8 wet diapers/day
likely:
A. Is underfed
B. Has diarrhea
C. Is likely receiving adequate hydration
D. Needs formula supplementation automatically
Rationale: Frequent wet diapers (after day 4–5) indicate good hydration.
Practice Test (Latest 2025/2026 Edition)
Comprehensive 200-Question Study and Review Guide
with Verified Answers & Rationales
Overview
The Certified Lactation Counselor (CLC) Exam Real Test is designed to help candidates
prepare for the Academy of Lactation Policy and Practice (ALPP) certification examination.
This comprehensive study resource mirrors the structure, format, and core competencies of
the actual CLC exam. It aims to reinforce your understanding of lactation science, counseling
strategies, and evidence-based maternal-infant care practices.
Exam Focus Areas
1. Anatomy & Physiology of Lactation – Breast structure, milk production, hormonal
regulation, and infant feeding reflexes.
2. Human Milk Composition & Benefits – Nutritional content, immunological
components, and comparison with formula.
3. Counseling & Communication Skills – Client-centered communication, cultural
sensitivity, ethics, and confidentiality.
4. Breastfeeding Management – Latch and positioning, assessment of milk transfer,
handling common problems (engorgement, mastitis, nipple pain).
5. Infant Nutrition & Growth – Normal feeding patterns, supplementation guidelines, and
growth assessment.
6. Pumping, Storage & Returning to Work – Pump types, safe milk handling, and
supporting breastfeeding mothers in workplace settings.
7. Public Health, Policy & Education – WHO/UNICEF Baby-Friendly Initiative, maternal
support programs, and breastfeeding promotion strategies.
Section 1 — Questions 1–50 (Foundations: anatomy, physiology, basics)
1. The hormone primarily responsible for milk ejection (letdown) is:
A. Estrogen
B. Progesterone
C. Oxytocin
, D. Prolactin
Rationale: Oxytocin causes myoepithelial cell contraction around alveoli,
producing milk ejection.
2. The hormone primarily responsible for milk production (synthesis) is:
A. Insulin
B. Prolactin
C. Cortisol
D. Oxytocin
Rationale: Prolactin stimulates alveolar epithelial cells to synthesize milk
components.
3. Colostrum differs from mature milk because it:
A. Has more lactose than mature milk
B. Is lower in protein than mature milk
C. Is higher in immunoglobulins (especially IgA)
D. Has higher % water than mature milk
Rationale: Colostrum is rich in IgA and other immune factors.
4. The functional milk-secreting units of the breast are:
A. Lactiferous sinuses
B. Ductules
C. Alveoli (lobules)
D. Areola glands
Rationale: Alveoli (clusters of secretory epithelial cells) produce milk.
5. Milk removal primarily regulates milk supply through:
A. Hormone-only mechanisms
B. Timing of infant sleeps
C. Autocrine (local) feedback based on milk removal
D. Frequency of maternal exercise
Rationale: Local removal of milk influences supply via autocrine feedback
(e.g., FIL).
6. The most reliable sign of effective breastfeeding in a newborn is:
A. Audible swallowing during every feed
B. Maternal nipple pain
C. Steady weight gain after initial loss
, D. Frequent stools only
Rationale: Weight gain pattern indicates adequate intake and nutrition.
7. Typical newborn weight loss in the first 3–5 days is:
A. 10–15% of birth weight
B. 5–10% of birth weight
C. 0–2% of birth weight
D. >15% of birth weight
Rationale: Up to 7–10% is expected; >10% usually requires evaluation.
8. Mature milk generally appears by:
A. 12 hours postpartum
B. 24 hours postpartum
C. 3–5 days postpartum
D. 10–14 days postpartum
Rationale: Transition from colostrum to mature milk commonly occurs 3–5
days.
9. The best initial latch position for most dyads to assess is:
A. Unsupported back-lying only
B. Infant’s nose to nipple with chin to breast (effective latch)
C. Infant’s chin away from the breast
D. Nipple to palate only
Rationale: Nose-to-nipple alignment encourages wide mouth and optimal
latch.
10.A sign of a shallow latch is:
A. Wide, open mouth
B. Areola far from infant’s mouth
C. Painful/nipples with pinching pain and clicking sounds
D. Audible swallowing
Rationale: Shallow latch often causes nipple pain and clicking.
11.Effective breastfeeding sessions in first week usually occur:
A. Every 6–8 hours
B. Only at night
C. 8–12+ times in 24 hours (on-demand)
D. Every 2 minutes continuously
, Rationale: Frequent removal of milk supports supply and newborn
hydration.
12.Jaundice from breastfeeding that improves with formula supplementation
and resolves is likely:
A. Pathologic jaundice
B. Breastfeeding-associated (insufficient intake) jaundice
C. Breast-milk jaundice
D. Hemolytic disease
Rationale: Early insufficient intake → increased bilirubin; resolves with
improved intake.
13.True breastmilk jaundice (peaks later, not due to low intake) commonly
peaks at:
A. Day 1–2
B. Day 3–5
C. 2–3 weeks of age
D. After 2 months
Rationale: Breast-milk jaundice is a benign, later-onset phenomenon
related to milk components.
14.The primary macronutrient for infant brain development in human milk is:
A. Carbohydrate only
B. Long-chain polyunsaturated fatty acids (LC-PUFAs)
C. Starch
D. Plant protein
Rationale: LC-PUFAs like DHA support neurodevelopment; milk fat provides
these.
15.An infant who feeds every 2–3 hours and exhibits 6–8 wet diapers/day
likely:
A. Is underfed
B. Has diarrhea
C. Is likely receiving adequate hydration
D. Needs formula supplementation automatically
Rationale: Frequent wet diapers (after day 4–5) indicate good hydration.
