CERTIFIED LACTATION COUNSELOR FINAL EXAM ACTUAL
QUESTIONS AND ANSWERS SURE A+
✔✔What bacteria do formula fed babies have an over abundance of? - ✔✔C Diff
✔✔Vagal nerves (parasympathetic) - ✔✔Stimulates peristalsis and secretion not the GI
tract
✔✔splanchnic nerves - ✔✔Inhibits peristalsis and secretion. Adrenal gland increases
secretion of adrenaline and noradrenaline.
✔✔Somatostatin - ✔✔hormone that inhibits release of growth hormone and insulin
✔✔What promotes glucose induced insulin release and exert trophies effects of the
gut? - ✔✔Gastrin & CCK (cholecystokinin)
✔✔What increases gastrin and decreases somatostatin in babies? - ✔✔1. Sucking
2. Own species milk
3. Decreased stress
4. Wellness
5. Touch
✔✔When do babies start to suck? - ✔✔27 weeks.
✔✔What happens when babies suck? - ✔✔Sucking activates cutaneous receptors in
the babies mouth, causing the baby's parasympathetic nervous system to trigger
release of gastrin and decreased somatostatin. This makes us feel sleepy and full.
✔✔Are mother's GI hormones impacted by sucking and skin contact? - ✔✔Yes, it
activates the parasympathetic nervous system. Increases in gastrin, CCK, and insulin
have been observed.
✔✔How much weight loss is acceptable in a neonate after birth? - ✔✔No greater than
7% from birth & no loss after day 5.
✔✔What would cause an increase lose of weight in the first postpartum days? - ✔✔1.
Labor meds used
2. Interpartum fluids used
3. No labor prior to cesarean
✔✔Hypernatremia - ✔✔High concentration of sodium in the blood
✔✔Why would a baby develop hyperetremia or malnutrition - ✔✔1. Not feeding
frequently enough (e.g. q3-6 hours/day 5-10min/side=60-120 min/day)
,2. Babies too sleepy (likely due to lack of nutrition)
3. Babies should be fed on demand, not qxxx hours.
✔✔What color is meconium stool? - ✔✔Dark brown
✔✔What color is transitional stool? - ✔✔Green
✔✔What color is mature breast milk stool? - ✔✔Brown
✔✔What causes hyperinsulinemia? - ✔✔Excess insulin in the blood, due to
overproduction. This might cause the higher weight gain in formula fed babies. Could
also be related to high fat and protein levels in bovine formula.
✔✔What is a significant protective factor against obesity in children? - ✔✔BF
✔✔What does the White House Task Force on Childhood Obesity recommend? -
✔✔Exclusive BF for 6 month, then BF with complementary foods for 1 year or more.
✔✔What are some BF myths? - ✔✔1. Breast size matters.
2. She isn't drinking enough fluids
3. She is exercising too much, working too hard, not resting enough.
4. She is too stressed.
5. It's what she eats or doesn't eat.
✔✔How do we assure an adequate milk supply? - ✔✔1. Understanding of how BF
works
2. Early initiation and adequate BF
3. Appropriate BF assessment
4. Improved and early BF support
5. Appropriate HCP/LCP f/u in the postpartum
✔✔How much milk does a mother produce? - ✔✔750-1000mLs/day
✔✔What are some negative influences on milk supply? - ✔✔1. Long spaces between
feedings
2. Long, slow feedings
3. Excessive pressure on the breast
4. Breast surgery/injury
5. Anatomical concerns
6. Altered physiology
7. Physical objects
✔✔What could cause pressure on the milk-making cells? - ✔✔1. Vascular, lymphatic,
and third-spacing forces
2. Secretory activation - Lactogenesis II
,✔✔What are some characteristics of the normal breast? - ✔✔-Soft
-Normal body temp
-Mother feels well
-Breasts may be hot
-Nipple graspable
✔✔What are some characteristics of the engorged breast? - ✔✔-Hard
-Temp normal +
-Mother feels discomfort
-Breast hot, shiny
-Nipple is hard to grasp/latch
✔✔When do symptoms of engorgement occur? - ✔✔-Between days 3-5
-Moms with a lot of IV fluids, may have swelling up to day 9
-Women who have had a c-section experience it 24-48 hours later.
✔✔What happens to the engorged breast? - ✔✔- As pressure increases, milk
production decreases.
✔✔What causes pressure in the breast (engorgement)? 4 things... - ✔✔1. Milk left post
feed
2. Missed feedings
3. Restrictive bras and clothing
4. Breast implants (storage capacity is less)
✔✔What concerns are there with surgery and BF? - ✔✔-Damage to nerves
-Damage to ducts
-The periareolar incision is associated with lactation insufficiency.
✔✔What are some anatomical concerns (red flags?) - ✔✔1. Absence of breast changes
in pregnancy or just after birth
2. No postpartum fullness or change from colostrum to mature milk
3. Unilateral underdeveloped breasts
4. One implant placed.
✔✔Things to consider when counseling mother's regarding changes to breast. - ✔✔1.
Assure privacy
2. Ask questions about surgery/improvements (when alone)
3. Determine innervation/sensation
✔✔What 4 questions should you ask yourself when counseling a mother about changes
to her breasts. - ✔✔- are the ducts and nipple pores patent?
-are there signs of hormonal connection?
-are there concerns for weight gain?
, -Is there adequate pediatric supervision?
✔✔Can a woman BF if she has a flat or inverted nipple? - ✔✔Yes!
-Baby's don't need a nipple to latch, they form the teat.
-Many nipples evert from sucking, some don't.
-If the nipple does not evert, the baby's weight gain will need to be followed closely.
✔✔What is a grade 1 inverted nipple? - ✔✔Easily pulled out
✔✔What is a grade 2 inverted nipple? - ✔✔Can be pulled out, but don't maintain their
projection
✔✔What is a grade 3 inverted nipple? - ✔✔Nipples are difficult or impossible to pull out.
✔✔What do we need to consider when counseling a woman with inverted nipples? -
✔✔1. Ask her if and when her nipple everts
2. Watch for nipple eversion after a feed.
3. If no eversion, then intensive f/u is likely needed.
4. Consider expression
5. Assure adequate infant nutrition
6. Check for FDA approval for devices used to evert the nipple.
✔✔Do women with inverted nipples produce less milk? - ✔✔Yes, research shows.
✔✔What aspects of physiology impact milk supply? - ✔✔-Iron deficiency anemia
-inadequate O2 to milk cells
-exhaustion or depression
✔✔What are some symptoms of Sheehan's syndrome? - ✔✔-low BP
-anemia
-fatigue
-hair loss
-dry hair
✔✔What is Sheehan's syndrome? - ✔✔Pituitary is deprived of blood and it's functions
become impaired.
✔✔What types of hormonal imbalance can impact milk supply? - ✔✔-Maternal obesity
-Diabetes
-Prediabetes (insulin dysregulation)
-Hypo or Hyperthyroidism
-PCOS
-Drugs (pseudoephedrine- decreased milk supply 24%, corticosteroids- temp
suspension of lactation)
QUESTIONS AND ANSWERS SURE A+
✔✔What bacteria do formula fed babies have an over abundance of? - ✔✔C Diff
✔✔Vagal nerves (parasympathetic) - ✔✔Stimulates peristalsis and secretion not the GI
tract
✔✔splanchnic nerves - ✔✔Inhibits peristalsis and secretion. Adrenal gland increases
secretion of adrenaline and noradrenaline.
✔✔Somatostatin - ✔✔hormone that inhibits release of growth hormone and insulin
✔✔What promotes glucose induced insulin release and exert trophies effects of the
gut? - ✔✔Gastrin & CCK (cholecystokinin)
✔✔What increases gastrin and decreases somatostatin in babies? - ✔✔1. Sucking
2. Own species milk
3. Decreased stress
4. Wellness
5. Touch
✔✔When do babies start to suck? - ✔✔27 weeks.
✔✔What happens when babies suck? - ✔✔Sucking activates cutaneous receptors in
the babies mouth, causing the baby's parasympathetic nervous system to trigger
release of gastrin and decreased somatostatin. This makes us feel sleepy and full.
✔✔Are mother's GI hormones impacted by sucking and skin contact? - ✔✔Yes, it
activates the parasympathetic nervous system. Increases in gastrin, CCK, and insulin
have been observed.
✔✔How much weight loss is acceptable in a neonate after birth? - ✔✔No greater than
7% from birth & no loss after day 5.
✔✔What would cause an increase lose of weight in the first postpartum days? - ✔✔1.
Labor meds used
2. Interpartum fluids used
3. No labor prior to cesarean
✔✔Hypernatremia - ✔✔High concentration of sodium in the blood
✔✔Why would a baby develop hyperetremia or malnutrition - ✔✔1. Not feeding
frequently enough (e.g. q3-6 hours/day 5-10min/side=60-120 min/day)
,2. Babies too sleepy (likely due to lack of nutrition)
3. Babies should be fed on demand, not qxxx hours.
✔✔What color is meconium stool? - ✔✔Dark brown
✔✔What color is transitional stool? - ✔✔Green
✔✔What color is mature breast milk stool? - ✔✔Brown
✔✔What causes hyperinsulinemia? - ✔✔Excess insulin in the blood, due to
overproduction. This might cause the higher weight gain in formula fed babies. Could
also be related to high fat and protein levels in bovine formula.
✔✔What is a significant protective factor against obesity in children? - ✔✔BF
✔✔What does the White House Task Force on Childhood Obesity recommend? -
✔✔Exclusive BF for 6 month, then BF with complementary foods for 1 year or more.
✔✔What are some BF myths? - ✔✔1. Breast size matters.
2. She isn't drinking enough fluids
3. She is exercising too much, working too hard, not resting enough.
4. She is too stressed.
5. It's what she eats or doesn't eat.
✔✔How do we assure an adequate milk supply? - ✔✔1. Understanding of how BF
works
2. Early initiation and adequate BF
3. Appropriate BF assessment
4. Improved and early BF support
5. Appropriate HCP/LCP f/u in the postpartum
✔✔How much milk does a mother produce? - ✔✔750-1000mLs/day
✔✔What are some negative influences on milk supply? - ✔✔1. Long spaces between
feedings
2. Long, slow feedings
3. Excessive pressure on the breast
4. Breast surgery/injury
5. Anatomical concerns
6. Altered physiology
7. Physical objects
✔✔What could cause pressure on the milk-making cells? - ✔✔1. Vascular, lymphatic,
and third-spacing forces
2. Secretory activation - Lactogenesis II
,✔✔What are some characteristics of the normal breast? - ✔✔-Soft
-Normal body temp
-Mother feels well
-Breasts may be hot
-Nipple graspable
✔✔What are some characteristics of the engorged breast? - ✔✔-Hard
-Temp normal +
-Mother feels discomfort
-Breast hot, shiny
-Nipple is hard to grasp/latch
✔✔When do symptoms of engorgement occur? - ✔✔-Between days 3-5
-Moms with a lot of IV fluids, may have swelling up to day 9
-Women who have had a c-section experience it 24-48 hours later.
✔✔What happens to the engorged breast? - ✔✔- As pressure increases, milk
production decreases.
✔✔What causes pressure in the breast (engorgement)? 4 things... - ✔✔1. Milk left post
feed
2. Missed feedings
3. Restrictive bras and clothing
4. Breast implants (storage capacity is less)
✔✔What concerns are there with surgery and BF? - ✔✔-Damage to nerves
-Damage to ducts
-The periareolar incision is associated with lactation insufficiency.
✔✔What are some anatomical concerns (red flags?) - ✔✔1. Absence of breast changes
in pregnancy or just after birth
2. No postpartum fullness or change from colostrum to mature milk
3. Unilateral underdeveloped breasts
4. One implant placed.
✔✔Things to consider when counseling mother's regarding changes to breast. - ✔✔1.
Assure privacy
2. Ask questions about surgery/improvements (when alone)
3. Determine innervation/sensation
✔✔What 4 questions should you ask yourself when counseling a mother about changes
to her breasts. - ✔✔- are the ducts and nipple pores patent?
-are there signs of hormonal connection?
-are there concerns for weight gain?
, -Is there adequate pediatric supervision?
✔✔Can a woman BF if she has a flat or inverted nipple? - ✔✔Yes!
-Baby's don't need a nipple to latch, they form the teat.
-Many nipples evert from sucking, some don't.
-If the nipple does not evert, the baby's weight gain will need to be followed closely.
✔✔What is a grade 1 inverted nipple? - ✔✔Easily pulled out
✔✔What is a grade 2 inverted nipple? - ✔✔Can be pulled out, but don't maintain their
projection
✔✔What is a grade 3 inverted nipple? - ✔✔Nipples are difficult or impossible to pull out.
✔✔What do we need to consider when counseling a woman with inverted nipples? -
✔✔1. Ask her if and when her nipple everts
2. Watch for nipple eversion after a feed.
3. If no eversion, then intensive f/u is likely needed.
4. Consider expression
5. Assure adequate infant nutrition
6. Check for FDA approval for devices used to evert the nipple.
✔✔Do women with inverted nipples produce less milk? - ✔✔Yes, research shows.
✔✔What aspects of physiology impact milk supply? - ✔✔-Iron deficiency anemia
-inadequate O2 to milk cells
-exhaustion or depression
✔✔What are some symptoms of Sheehan's syndrome? - ✔✔-low BP
-anemia
-fatigue
-hair loss
-dry hair
✔✔What is Sheehan's syndrome? - ✔✔Pituitary is deprived of blood and it's functions
become impaired.
✔✔What types of hormonal imbalance can impact milk supply? - ✔✔-Maternal obesity
-Diabetes
-Prediabetes (insulin dysregulation)
-Hypo or Hyperthyroidism
-PCOS
-Drugs (pseudoephedrine- decreased milk supply 24%, corticosteroids- temp
suspension of lactation)
