2024|25 CLC EXAM | QUESTIONS AND VERIFIED SOLUTIONS 100% GUARANTEED
What are green/shiny stools a sign of? - -sign of overproduction leading to less fat in
milk, faster digestion causing not enough time for lactase to digest the lactose in milk.
An improved latch could allow for more fat flow
Signs of oversupply - Rapid weight gain in infant, unsettled baby after feeding,
recurrent plugged ducts and mastitis, painful feedings, voluminous (huge volumes of)
stools- often green & shiny
What causes nipple pain? - Improper latch--> need lactation support to help with proper
latch on, good seal
True/false: baby should be pulled into breast. - False! Do not pull baby into breast, let
baby tilt head back for optimal latch. Hand on back of baby's head can interfere baby's
interoral function by restricting the movement of the cranio-cervical spine--> causes
nipple trauma. Make sure crook of arm in cradle position does not block baby from
being able to fully tilt back.
Should a latch be symmetric or asymmetric? - Asymmetric! A baby should form a teat
with breast tissue underneath the nipple as part of a latch
What is a symmetric latch - Not a good latch, causes nipple damage
Asymmetric latch - Optimal attachment to the breast, where the baby's lips are not
centered in relationship to the areolar, but rather vertically off-centered with the baby's
chin and lower lip closer to the edge of the areola than the baby's upper lip. A baby
should form a teat with breast tissue underneath the nipple as part of a latch
Do nipple creams work? - Continued questions of effectiveness, fear of ingestion by
baby
Should a frenotomy be suggested for tongue tie? - No study was able to report that
frenotomy led to better long term breastfeeding
Tongue tied breastfeeder - -complete feeding assessment and suggest ways to
optimize latch.
-refer onward for diagnosis (have PCP diagnose TT)
-provide support
What is a fissure straight down the nipple evidence of? - A symmetric latch. Top lip
needs to have good seal, moist part of lip should be touching nipple, can roll out top lip,
to reduce injury during BF
,Is there a deep latch with nipple stretching? - If nipple not stretched deeply into mouth,
less oxytocin flows, less fat is in mix. With less fat, milk digested quicker = not enough
time for baby to make enough lactase to digest lactose in milk.
What to do for oversupply? - Decrease additional stimulation/milk removal if possible
Consider block feeding (only nursing on one side only per feeding)
Watch for mastitis
Try australian posture (mother down under, baby on top)
Consider donating to milk bank
Consult with HCP for medical dx
How many mL considered oversupply? - normal milk production = 750-1000 mL/day
Thrush during BF - painful for mother & baby.
may be visible or may not (whiteness that can't be wiped off)
-mother will have itchy, flaky, shiny skin
-candida not found inside the ducts or milk
Treatment of candida on breast - -nystatin first line
-flucanizole second line
-throw out all yeast vectors (pacifiers sterilize breast pumps)
-flucanazole oral capsules may be used to clean yeast vectors due to the biofilm
created on pacifiers by candida
What to do if antifungal treatment for yeast doesn't work? - Not candida infection!
Reynaud's Phenomenon - -vasospasm of nipple, recognized by triple color sign: from
white--> blue--> raspberry or bicolor sign white --> raspberry.
pain is extreme and spasmodic (not continuous)
-this happens after feeding once baby's mouth comes off nipple has vasospasm, feels
like frostbite
treatment of reynauds - -prevent/decrease cold exposure
-avoid vasoconstrictive drugs such as caffeine and hypertensive drugs, nicotine
-can use nifedipine or calcium channel blocker
Nipple pain and poor milk transfer that is persistent despite optimal latch - -can use
nipple shield as a test to see if baby exerting too much pressure?
-OT involvement
-in rare cases baby have a strong sucking vacuum as measured by a pressure
transducer or nipple shield
Clogs/plugs - Palpable lumps of milk within the lumen or duct system, usually not
visible. Solids dont get absorbed...could be too tight of a bra slowing flow of milk
,what to do for clogs/plugs - Encourage massage using side of hand and warm
compresses. Do double nursing by doubling up on side of clog to push it out. point
baby's chin toward clog
See PCP if clog hasnt moved in 24-48 hours or systemic symptoms of inflammation (flu
like s/s)
When to call PCP for clog/plug - If plug hasn't moved in 24-48 hrs or systemic signs of
inflammation (flu like s/s)
Causes of clogs/plug - too tight nursing bra
what is a bleb - small white spots on the face of the nipple that look like milk-filled
blisters. one duct opening is usually covered
what does a bleb feel like - painful stabbing pinpoint pain
how to get rid of blebs - Same as clog treatment. Sometimes need t be lanced by HCP
Common mastitis - -can be non-infective or infective
-blocked ducts from engorgment, hurried feedings, nipple shield (pressure will build until
milk sneaks out of space, body reacts to this like invader)
causes of common mastitis - -tight bra (look for indentation of breast straps)
-use of breast shell or nipple shell
-attachment difficulties
-anemia in the mother
-tongue tie in baby (ineffective milk emptying)
s/s common mastitis - systemic- fever, ill, malaise, redness, pain, one inflamed breast
What bacteria causes infective mastitis - Staphylococcus
tx common mastitis - NSAIDS first line but make sure diagnosed by PCP
-must keep pumping/breastfeeding to keep milk flowing. keeps breasts soft/comfortable
to avoid abscess development
Abscess on breast - Localized areas of pus and necrotic tissue that can develop with a
breast infection
•Can develop in the subcutaneous, intramammary, retromammarylayers
•Symptoms include pain, swelling, redness, fever, increased WBC count, palpable mass
-pocket of pus forms in the breast
-from untreated mastitis
, Antibiotics for mastitis? - Usually for double mastitis, not generally proscribed for one
breast common mastitis. If treatment uneffective consider anemia, ductal or
inflammatory breast cancer
Double mastitis - EMERGENT AND UNCOMMON- tissue of both breasts inflamed.
organism bcause bof bdouble bmastitis b- b bstrep b-potentially bfatal, bwhole bbody binflammation,
bsepsis
-not ba bproblem bwith bmilk
signs bof binflammatory bbreast bcancer b- b b- bbreast btissue bis bred, bwarm, bhas borange bpeel
b(peau bd'orange), bpitting bappearance bon bskin bsurface b
- bbreast bmass bmay bor bmay bnot bbe bpresent
True/false: bMRSA bcan blook blike bmastitis bwhen bon bbreast b- b bTRUE bcan bmasquerade bas
bmastitis. bmight bsee bpeeling bskin, bpitting. bcan balso bcause blesions band babscess.
Abscess bon bbreast bis bfull bof b... b- b bPUS bnot bMILK. bas bmany bas b60% bpositive bfor bMRSA.
can byou bnurse bon bsame bside bas babscess b- b bNo bshould bnurse bon bother bbreast. bmust bbe
baware bof bpossible bcontamination bon bflanges, bpump bparts, bcan bnot btrack binfection bfrom
bone bside bto bother.
abscess bsurgical bintervention b- b bcan bcut bthrough bnerves band bducts. btry bto bavoid bsurgical
bintervention
treatment bof babscess b- b bdrainage bthrough bultrasound-guided btechnique bis bfirst bchoice
b(needle baspiration boften bhas bto bbe brepeated)
Report bany bsuspicious barea bof bthe bbreast bto ba bqualified bprovider bbecause bit bcould bbe...
b- b bMRSA bor bherpes- bfatal bfor bbabies
Goldsmith's bsign b- b bThe bassociation bof ba bbaby's bpersistent brefusal bof bone bbreast bwith
bpossible bbreast bcancer bin bthe bmother
-can balso bhappen bsuddenly bwith bolder bbabies b
-rule bout bcommon bproblems bsuch bas bear binfection, bteething, bbirth btrauma b
-CA bmay bbe bdiagnosed bas blate bas b5 byrs bafter bthis bsign
Neonatal bhypoglycemia b- b b-symptomatic binfants b= bglucose bof b40 brequires bper bAPP
-dextrose b& bBF b= bfirst bline btx
-SGA, bLGA, bdiabetic bmoms, blate bpreterm binfants bat bgretest brisk
Signs bof bneonatal bhypoglycemia b- b b• bJitteriness, btremors
• bPoor bmuscle btone
• bDiaphoresis b(sweating)
• bPoor bsuck, bfailing bto bsustain blatch
