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CLC Section 3A & 3B EXAM/113 QUESTIONS & ANSWERS 2023
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CLC Section 3A & 3B EXAM/113 QUESTIONS & ANSWERS 2023
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CLC Section 3A & 3B EXAM/113 QUESTIONS &ANSWERS 2023
Lactation Counseling - --observe, explore, and coach
-parents, baby, & other family members know more about their situation &
resources than we do
-our job to observe, collect info, & explore mature of presenting issues, & to
coach families regarding feeding & nurturing their babies
-as we seek to understand the nature of the presenting issues, other
problems & concerns may be uncovered
-in our conceptual framework, problems & symptoms are not the same thing
(for example, pain w/ BF is a symptom of a different problem perhaps a poor
latch)
-thru BF counseling we seek to ID the true nature of the underlying problems
rather than only removing the presenting symptoms
-once we have gathered enough info about the nature of the problems at
hand, we can formulate potential solutions & propose them to the family
-it is up to the family to choose the solutions they are willing to implement &
to carry them out
-it's our responsibility to provide info & suggestions in an open, transparent,
non-judgmental manner, IDing strategies that may be useful for the family,
sharing pros & cons of IDed strategies, all in full acknowledgement that the
family will make the final determination regarding what actions to take, if
any, to address IDed challenges
-it's our responsibility to refer families for additional clinical support or other
eval as needed, if it is not available at our workplace or within our scope of
practice
-it's our responsibility to ensure adequate follow up for IDed BF problems
-Normal BF - --should be enjoyable experience
-shouldnt have pain or discomfort, but they are common
-follow feeding cues signaled by REM, bringing fist to mouth, seeking food w/
lips tongue & head, smack lips, extend tongue
-crying is late feeding cue
-Getting Started w/ BF - --in first hours and days the dyad learn to BF
together and move gradually from self-attached BF to collaborative BF
-each dyad moves in a unique pattern: one feed may be self-attachment and
the next collaborative
-BF moves into more collaborative after baby is able to locate the breast
-both will become more & more comfortable w/ collaborative feeding as they
learn together
-baby's arms should not cross over his/her body, but should embrace the
breast
-baby's hands knead breast while suckling, do not swaddle hands away
,-shouldn't be pain while nursing; after feed. nipple shouldn't be misshapen,
abraded, fissured, bruised, or blanched
-if there is pain, baby should be gently removed and allowed to relatch
-Self-Attached BF - --healthy baby should be dried after birth & placed on
chest for prolonged S2S
-dyad covers w/ warm blanket
-mom & newborn assessment, eye care, & other procedures are done w/
baby in S2S
-babies warm better in S2S compared to electric warmers (breasts will
increase and decrease in temp according to baby's needs)
-allow newborn baby to find breast & self attach. This may take more than 2
hours when labor analgesia has been used; do not force baby to breast,
doing so may stress baby, decrease willingness, & cause baby to place
tongue on roof of mouth
-S2S 9 Distinct Behaviors in Prep for Feeding - --birth cry
-relaxation
-awakening
-activity
-rest
-crawling/sliding
-familiarization
-suckling
-sleeping
-Collaborative BF - --as the baby seeks the breast the parent gently assists
-Sequence of Successful Feeding - --newborn held S2S or close to breast so
feeding cues may be observed
-when baby has cues, baby is brought to breast
-breast should be at normal angle (not held or shaped w/ hand; if large
breast put rolled up towel under breast, do not fold breast upward to see the
nipple)
-collaborative BF may bb initiated when baby exhibits appropriate cues:
rooting, increasing alertness/REM, flexing of legs & arms, mouthing w/ little
sucking motions, attempting to bring hand to mouth, sucking on fist or
finger, mouthing motions of lips and tongue
-crying is late feeding cue because it does not usually begin in full term
babies until more subtle cues have failed to elicit the parents attention
-less mature & more disorganized babies may pass quickly from deep sleep
(no REM) to crying
-when using collaborative BF strategy, baby is supported by the frame of the
parent's body which provides support needed to keep the baby at the breast
-parent finds a comfortable posture & makes breast accessible to baby
,-baby is allowed the freedom to achieve pain-free suckling w/ maximal milk
transfer
-BF sessions are best ended by the baby, when feeding ends baby is relaxed,
hands are open, arms are floppy, brow is smooth, toes are curled
-Baby Position At Breast For Maximal Milk Transfer - --baby is near breast
-baby's shoulders are supported at base of the neck
-no pressure on back of baby's head, baby must be able to tilt head
-baby's body rotated toward parent's chest (tummy to mummy)
-baby moved towards breast, lining up nose at nipple
-breast is not moved to baby; breast should lie in natural position & baby be
brought to breast
-start feed w/ nose opposite nipple assists baby to orient to breast via well-
developed sense of smell & aligns mouth at breast when baby's head tilts
back
-as baby chin comes closer to breast, he will gape, opening mouth very wide
as head tilts back (if baby fails to gape, repeat this maneuver)
-consider additional S2S to improve baby's motor state organization for baby
who fails to gape or nurse
-do not push nipple into baby's mouth, doing this can result in optimal
positioning of nipple or appropriate compression & release of breast & nipple
tissue (can cause pain, damage, & slow flow of milk)
-head tilt allows lower lip to seal to breast first followed by upper lip
-baby's mouth will appear off-center when compared w/ areola, baby's lower
lip will be against breast much father from nipple than upper lip (asymmetric
latch)
-baby seals to breast & begins to suck rapidly (could be 8 or more sucks to 1
swallow), then shifts into pattern of 2 sucks to 1 swallow or 1 suck to 1
swallow
-2:1 or 1:1 suck to swallow is a time of greater milk transfer; these are
interspersed w/ more rapid sucking sequences & occasional rest periods
-after colostral stage, baby can transfer several oz of milk in very few
minutes when appropriately latched & hungry
-there is no right length of feed to ensure adequate milk transfer, however
babies with consistently short (<5 min) or long (>20 min) feeds should be
assessed to ensure adequate milk transfer
-Proof of Success of BF Baby - --baby who is responsive & interactive
-growing well (about an oz a day after 5th day)
-producing at least 6 wet and 4 dirty diapers starting on day 4 and
continuing into the early weeks
-Concern: Baby Won't Latch: Feeding Refusal That is Continuous - --baby
refuses to feed from breast; baby won't latch, or will & immediately pull off &
cry
*Ask yourself: -have baby's weight gain & output been appropriate?
, -does baby look dehydrated, jaundice, or malnourished? does baby seem
alert & active or lethargic?
-are breasts so full & hard that baby is unable to form teat?
-has baby been forced to breast w/ pressure on back of head?
-what is family's response to baby's refusal?
-if onset is sudden & refusal is continuous, what has changed recently, (i.e.
has milk volume increased, change in family routine, nursing parent taking
new meds, nutritional supplements, etc)
*Watch out for: -presence of feeding cues prior to feeding
-process used to bring baby to breast
-visible signs of pain for either members of dyad
*What to do about it: -if breasts are hard & full, sufficient softening should be
done before attempting to feed
-is aggressive latch techniques are used, or pressure on back of baby's head
do S2S & allow baby to self-attach
-baby has trouble w/ increased volume or milk flow, make sure baby is able
to move head away from breast & let milk spray
-observe feed using feeding observation checklist
-is baby refuses to latch, ask that baby be held S2S until feeding cues are
observed & baby moves toward breast
-encourage bringing baby close to breast immediately upon observation of
feeding cues, & allow baby to find breast and self attach (babies need to
familiarize before latching as they learn sounds & smells & tastes of feeding
at breast)
-suggest alternate positions, encourage hand expression to release few
drops to offer baby to smell and lap; if baby latches can use alternate
massage / breast compression to increase flow if baby becomes fidgety
-suggest other changes to feeding process indicated by feeding observation
-persist in trying to uncover underlying reason for difficulty in coming to
breast; babies should show desire; not doing so raises a concern; continuing
demonstration of lack of desire warrants comprehensive pediatric exam
-schedule follow up & ensure appropriate referrals
*Expected resolution: -comfortable & effective feeding postures & positions
will be found
-is baby can't be helped to BF & PCP has prescribed supplementation,
frequent S2S is encourages in order to assist baby in developing comfort
when being held to breast
-consider at breast supplementation if supplementation is prescribed
-work to ensure adequate milk expression in order to build &/or maintain
abundant milk supply
*What else to consider: -if observation & positioning guidance do not resolve
refusal, referral for immediate broader eval is required; stuffy nose,
respiratory problems, ear or other infections, trauma (fractured collar bone,
torticollis) need to be ruled out
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