ALPP CLC Exam Questions with
Accurate Answers
Clinical management procedures - ANSWERSFirst half of 2018 revised WHO/UNICEF
10 steps/baby friendly hospital initiative
Key Clinical Practices - ANSWERSSecond half of 2018 reviewed WHO/UNICEF 10
steps/baby friendly hospital initiative
Step 1.a. of BFHI - ANSWERSComply fully with international code of marketing of
breastmilk substitutes and relevant world health assembly resolutions
global standards of step 1.a. of BFHI - ANSWERS1. Standard procurement of feeding
bottles and nipples, not through gifts or subsidies
2. No display of products under code or items with logos of companies that produce
breastmilk substitutes, bottles, etc
3. Facility policy about abiding by code
4. At least 80% of health professionals can explain at least 2 elements of the code
Step 1.b. of BFHI - ANSWERSHave a written infant feeding policy that is routinely
communicated to staff and parents
Step 1.c. of BFHI - ANSWERSestablish ongoing monitoring and data-management
systems
Step 2 of BFHI - ANSWERSEnsure all staff have sufficient knowledge, competence,
and skills to support breastfeeding
Step 3 of BFHI - ANSWERSDiscuss the importance and management of breastfeeding
with pregnant women and their families
Minimum components of step 3 of BFHI - ANSWERSDiscussion of: importance of
breastfeeding, recommendation of at least 6 months EBF, importance of immediate and
sustained skin-to-skin, early initiation of breastfeeding, rooming in, good positioning and
attachment, and feeding cues
Step 4 of BFHI - ANSWERSFacilitate immediate and uninterrupted skin-to-skin contact
Step 5 of BFHI - ANSWERSSupport mothers to initiate and maintain breastfeeding and
manage common difficulties
Step 6 of BFHI - ANSWERSDo not provide breastfed newborns food or fluids other than
breast milk unless medically indicated
, Step 7 of BFHI - ANSWERSEnable mothers and their infants to remain together and
practice rooming in 24 hours a day
Step 8 of BFHI - ANSWERSSupport mothers to recognize and respond to their infants'
cues for feeding
Step 9 of BFHI - ANSWERSCounsel mothers on use and risks of feeding bottles, teats,
and pacifiers
Step 10 of BFHI - ANSWERSCoordinate discharge so that parents and their infants
have timely access to ongoing support and care
periareolar incision - ANSWERSIn history of breast surgery/injury, this factor is most
significantly associated with lactation insufficiency
Further history after breast augmentation - ANSWERSIs there nipple senstation? Are
ducts patent? Are nipple pores patent? Is there a history of change in breast
size/appearance during pregnancy?
Complications after breast augmentation in breastfeeding - ANSWERSEngorgement,
breast binding, and tight bras can reduce supply
Insufficient milk
Further history after breast reduction - ANSWERSNipple sensation? Ducts patent?
Nipple pores patent? Change in breast size/appearance during pregnancy?
Complications after breast reduction in breastfeeding - ANSWERSAdequacy of ongoing
milk supply impacted by nerve alteration; insufficient milk-making tissue; inability of milk
to exit the breast due to severed ducts; engorgement that does not resolve easily
Further history after identifying breasts differ significantly in size/appearance -
ANSWERSHave breasts responded to hormones of pregnancy? Are Montgomery
glands visible? Have breasts increased in size or changed appearance during
pregnancy?
Complications of marked difference in breasts (unilateral underdeveloped breast) -
ANSWERSInadequate ongoing milk supply
Further history for flat nipple - ANSWERSDoes nipple evert? Is nipple flat appearing
due to breast engorgement or edema? Does flat nipple respond to cold or tactile
stimulation? Can baby compress areola and breast around nipple to form teat?
Nipple shields - good solution for flat nipples? - ANSWERSNo! Long term use can
decrease milk supply
Accurate Answers
Clinical management procedures - ANSWERSFirst half of 2018 revised WHO/UNICEF
10 steps/baby friendly hospital initiative
Key Clinical Practices - ANSWERSSecond half of 2018 reviewed WHO/UNICEF 10
steps/baby friendly hospital initiative
Step 1.a. of BFHI - ANSWERSComply fully with international code of marketing of
breastmilk substitutes and relevant world health assembly resolutions
global standards of step 1.a. of BFHI - ANSWERS1. Standard procurement of feeding
bottles and nipples, not through gifts or subsidies
2. No display of products under code or items with logos of companies that produce
breastmilk substitutes, bottles, etc
3. Facility policy about abiding by code
4. At least 80% of health professionals can explain at least 2 elements of the code
Step 1.b. of BFHI - ANSWERSHave a written infant feeding policy that is routinely
communicated to staff and parents
Step 1.c. of BFHI - ANSWERSestablish ongoing monitoring and data-management
systems
Step 2 of BFHI - ANSWERSEnsure all staff have sufficient knowledge, competence,
and skills to support breastfeeding
Step 3 of BFHI - ANSWERSDiscuss the importance and management of breastfeeding
with pregnant women and their families
Minimum components of step 3 of BFHI - ANSWERSDiscussion of: importance of
breastfeeding, recommendation of at least 6 months EBF, importance of immediate and
sustained skin-to-skin, early initiation of breastfeeding, rooming in, good positioning and
attachment, and feeding cues
Step 4 of BFHI - ANSWERSFacilitate immediate and uninterrupted skin-to-skin contact
Step 5 of BFHI - ANSWERSSupport mothers to initiate and maintain breastfeeding and
manage common difficulties
Step 6 of BFHI - ANSWERSDo not provide breastfed newborns food or fluids other than
breast milk unless medically indicated
, Step 7 of BFHI - ANSWERSEnable mothers and their infants to remain together and
practice rooming in 24 hours a day
Step 8 of BFHI - ANSWERSSupport mothers to recognize and respond to their infants'
cues for feeding
Step 9 of BFHI - ANSWERSCounsel mothers on use and risks of feeding bottles, teats,
and pacifiers
Step 10 of BFHI - ANSWERSCoordinate discharge so that parents and their infants
have timely access to ongoing support and care
periareolar incision - ANSWERSIn history of breast surgery/injury, this factor is most
significantly associated with lactation insufficiency
Further history after breast augmentation - ANSWERSIs there nipple senstation? Are
ducts patent? Are nipple pores patent? Is there a history of change in breast
size/appearance during pregnancy?
Complications after breast augmentation in breastfeeding - ANSWERSEngorgement,
breast binding, and tight bras can reduce supply
Insufficient milk
Further history after breast reduction - ANSWERSNipple sensation? Ducts patent?
Nipple pores patent? Change in breast size/appearance during pregnancy?
Complications after breast reduction in breastfeeding - ANSWERSAdequacy of ongoing
milk supply impacted by nerve alteration; insufficient milk-making tissue; inability of milk
to exit the breast due to severed ducts; engorgement that does not resolve easily
Further history after identifying breasts differ significantly in size/appearance -
ANSWERSHave breasts responded to hormones of pregnancy? Are Montgomery
glands visible? Have breasts increased in size or changed appearance during
pregnancy?
Complications of marked difference in breasts (unilateral underdeveloped breast) -
ANSWERSInadequate ongoing milk supply
Further history for flat nipple - ANSWERSDoes nipple evert? Is nipple flat appearing
due to breast engorgement or edema? Does flat nipple respond to cold or tactile
stimulation? Can baby compress areola and breast around nipple to form teat?
Nipple shields - good solution for flat nipples? - ANSWERSNo! Long term use can
decrease milk supply
