Certified Lactation Counselor
Predominant Breastfeeding - correct answer-Babies who receive breastmilk and other liquids
(e.g. water, minerals, vitamins, oral meds).
Breastfeeding - correct answer-Baby receives human milk, as well as other foods or fluids,
including formula.
Complementary Feeding - correct answer-Process starts when BM alone or infant formula
alone is no longer sufficient to meet nutritional requirements of infants, therefore other foods
or liquids are introduced. Typically child is between 6-23 months
3 strategies for increasing BF initiation and duration - correct answer-Promotion, Protection,
Support
Promotion - correct answer-Focuses on advantages of BF on a personal, community,
country, or global level. BF to the community.
Protection - correct answer-Focuses on government, manufacturer, and social responsibility
to assure BF ability to compete with commercial interests.
Includes state, local, an national laws regarding BF.
International Code of Marketing of Breast-milk Subsitutes - correct answer-Addresses
improper marketing practices by formula companies. It is not currently a law in the US.
What does the International Code Prohibit? - correct answer-Distributing free formula
Giving coupons for formula
What did the AAP resolution state in regards to the International Code? - correct answer-No
distributing formula, discharge bags, industry written handouts.
Support - correct answer-Focuses on interaction of helpers with family, as well as program
development and implementation.
10 steps to successful BF - correct answer-1. Written BF policy. Skin to Skin immediately
after birth.
2. Train healthcare staff
3. Inform pregnant women about benefits and management of BF
4. Help all mothers initiate BF within 1 hour after birth
5. Show mother's how to BF and maintain lactation
6. Exclusive breast milk only
7. Practice rooming in 24 hours a day
8. Encourage BF on demand
9. No artificial teats or pacifiers
10. Establishment of BF support groups
,Healthcare staff responsibility for working with lactating mothers include what? - correct
answer-1. Training
2. Minimum of 20 hours of training
3. 3 hours of competency verification
What are the indications for providing supplementation other than breast milk? - correct
answer-1. Medical condition
2. Parents request after being informed of consequences
Protocol for calculating Baby's daily needs - correct answer-Baby's weight x 2.5 (2.7 or 3.0 if
Baby needs to catch up weight) = daily ounces. PCP decides what the multiplier is!!!
What should be assessed 3-5 days after birth by PCP? - correct answer-Hydration
(elimination patterns)
Body weight (no more than 7% loss)
Observe Feeding
Maternal or infant issues
What is a CLC? - correct answer-Nationally recognized designation awarded by the ALPP.
Practice parameters are designated by professional scope of practice.
How many stools per day should a breast fed newborn have? - correct answer-4, some
yellow by day 4.
When should a baby be back to birth weight? - correct answer-12-14 days post birth
How much weight should a baby gain daily? - correct answer-Approximately 1 ounce
Why do women supplement with formula when there is no medical need? - correct answer-1.
Lack of preparation for what the newborn period would be like.
2. Lack of timely interventions
Alveoli - correct answer-Small glands in the breast that produce milk
At-Breast Supplementer - correct answer-a device that allows a supplement to be given
while a baby is actively nursing at the breast,
ex: Supplement Nursing System
Atopy - correct answer-hypersensitive or allergic state involving an inherited predisposition
What is the BFHI Baby Friendly Hospital Initiative - correct answer-Initiative by UNICEF and
WHO (1991) to support breastfeeding in hospitals and maternity centers. "The 10 Steps".
Unicef. Baby-Friendly Hospital Initiative. Available online:
http://www.unicef.org/programme/breastfeeding/baby.htm.
Bilirubin - correct answer-an orange-yellow pigment formed in the liver by the breakdown of
hemoglobin and excreted in bile.
,CCK (cholecystokinin) - correct answer-Hormone that regulates the emptying of the
gallbladder and secretion of enzymes by the pancreas.
Colostrum - correct answer-Thick, milky fluid secreted by the breast during pregnancy and
during the first days after birth before lactation begins. Causes a laxative effect which helps
the baby pass meconium.
Coryllos type - correct answer-Classification system for anklyloglossia (tongue-tie)
Dancer Hand Position - correct answer-Technique used to support Baby's chin and mother's
breast. Use Thumb and index finger under chin, remaining 3 fingers to support breast.
Alveolar Cells - correct answer-found in the walls of the alveoli, simple squamous epithelial
cells, main sites of gas exchange
myoepithelial cells - correct answer-contract in response to stimulation by sympathetic
nervous system and squeeze milk up the duct
Montgomery glands - correct answer-Bumps on breasts (Look like goosebumps)
Produce a unique blend of milk and sebum (skin oil)
Modern study of the structure of the breast reveals what? - correct answer--Fat is mixed
throughout the breast
-Uneven spacing of the ducts
-3-5 functioning nipple pores (May have 5-9, but not all work)
-No lactiferous sinus
What are the 2 hormones pathways that control lactation? - correct answer-Prolactin and
Oxytocin
Prolactin (4 details related to milk production) - correct answer-1. is triggered by touch
(pregnant and non pregnant women). Higher levels when stimulating breast/nipples vs
breast alone.
2. Lengthening time between feeding leads to lower baseline levels. (Weaning)
3. levels go down between nursings and rise during nursing.
4. Infrequent nursing leads to lowering of this hormone
Average number of feeds in a day? - correct answer-8-12
What produces colostrum? - correct answer-Progesterone in the receptor sites
What produces more mature milk? - correct answer-Prolactin in the receptor sites
What happened when infants suckled in the first 2 hours of birth? - correct answer-Ingested
significantly more milk on day 4
, What happened to mother of preemies who initiated milk expression within 1 hour of birth? -
correct answer-Had significantly more milk when measured on days 7 and 42. Better to
stimulate breasts throughout the day right after birth to continue to stimulate production.
Oxytocin - correct answer-A hormone released by the posterior pituitary that stimulates
uterine contractions during childbirth and milk ejection during breastfeeding.
What 3 things can trigger Oxytocin? - correct answer-1. Conditioned response
2. Nipple stretching
3. Hand massage
Conditioned Response from Milk Ejection (Let down) - correct answer--Example- Mother lets
down when not near baby, but hears a baby cry.
-Conditioned over time
-Faster for women who have BF in the past
-To condition the response can use any sense-smell, touch, sound
Nipple stretching - correct answer-Only happens with a proper latch
Hand massage: Baby - correct answer-When we allow babies to be more hands on they can
help control flow rate by how they massage the breast.
How many triggers does Oxytocin have? Can it be triggered by stress. - correct answer-3
triggers. Yes.
What is hormone is triggered by stimulation? - correct answer-Prolactin
What 3 emotional/behavioral function do the hormones of lactation have besides making
milk? - correct answer-1. Aggression
2. Protection
3. Bonding/trust
What is special about the composition of milk? - correct answer-1. Mammal species with
higher water content milk feed more frequently.
2. Prolactin triggers production of lactose in the mammary cells.
What are the different care patterns of mammalian mother's and their babies? - correct
answer-1. Nest (eg. puppies, cats) OR cache (deer, rabbit)
2. Carry (monkey), follow (giraffe, bison), or hibernate (bear)
What kind of milk has the highest lactose of all mammalian milk? - correct answer-Human
milk: high in water, low in protein and fat.
When does paracellular transport occur? - correct answer-1. In the first few days after birth
2. Mother with low prolactin levels
When are cells not plump? - correct answer-During paracellular transport
Predominant Breastfeeding - correct answer-Babies who receive breastmilk and other liquids
(e.g. water, minerals, vitamins, oral meds).
Breastfeeding - correct answer-Baby receives human milk, as well as other foods or fluids,
including formula.
Complementary Feeding - correct answer-Process starts when BM alone or infant formula
alone is no longer sufficient to meet nutritional requirements of infants, therefore other foods
or liquids are introduced. Typically child is between 6-23 months
3 strategies for increasing BF initiation and duration - correct answer-Promotion, Protection,
Support
Promotion - correct answer-Focuses on advantages of BF on a personal, community,
country, or global level. BF to the community.
Protection - correct answer-Focuses on government, manufacturer, and social responsibility
to assure BF ability to compete with commercial interests.
Includes state, local, an national laws regarding BF.
International Code of Marketing of Breast-milk Subsitutes - correct answer-Addresses
improper marketing practices by formula companies. It is not currently a law in the US.
What does the International Code Prohibit? - correct answer-Distributing free formula
Giving coupons for formula
What did the AAP resolution state in regards to the International Code? - correct answer-No
distributing formula, discharge bags, industry written handouts.
Support - correct answer-Focuses on interaction of helpers with family, as well as program
development and implementation.
10 steps to successful BF - correct answer-1. Written BF policy. Skin to Skin immediately
after birth.
2. Train healthcare staff
3. Inform pregnant women about benefits and management of BF
4. Help all mothers initiate BF within 1 hour after birth
5. Show mother's how to BF and maintain lactation
6. Exclusive breast milk only
7. Practice rooming in 24 hours a day
8. Encourage BF on demand
9. No artificial teats or pacifiers
10. Establishment of BF support groups
,Healthcare staff responsibility for working with lactating mothers include what? - correct
answer-1. Training
2. Minimum of 20 hours of training
3. 3 hours of competency verification
What are the indications for providing supplementation other than breast milk? - correct
answer-1. Medical condition
2. Parents request after being informed of consequences
Protocol for calculating Baby's daily needs - correct answer-Baby's weight x 2.5 (2.7 or 3.0 if
Baby needs to catch up weight) = daily ounces. PCP decides what the multiplier is!!!
What should be assessed 3-5 days after birth by PCP? - correct answer-Hydration
(elimination patterns)
Body weight (no more than 7% loss)
Observe Feeding
Maternal or infant issues
What is a CLC? - correct answer-Nationally recognized designation awarded by the ALPP.
Practice parameters are designated by professional scope of practice.
How many stools per day should a breast fed newborn have? - correct answer-4, some
yellow by day 4.
When should a baby be back to birth weight? - correct answer-12-14 days post birth
How much weight should a baby gain daily? - correct answer-Approximately 1 ounce
Why do women supplement with formula when there is no medical need? - correct answer-1.
Lack of preparation for what the newborn period would be like.
2. Lack of timely interventions
Alveoli - correct answer-Small glands in the breast that produce milk
At-Breast Supplementer - correct answer-a device that allows a supplement to be given
while a baby is actively nursing at the breast,
ex: Supplement Nursing System
Atopy - correct answer-hypersensitive or allergic state involving an inherited predisposition
What is the BFHI Baby Friendly Hospital Initiative - correct answer-Initiative by UNICEF and
WHO (1991) to support breastfeeding in hospitals and maternity centers. "The 10 Steps".
Unicef. Baby-Friendly Hospital Initiative. Available online:
http://www.unicef.org/programme/breastfeeding/baby.htm.
Bilirubin - correct answer-an orange-yellow pigment formed in the liver by the breakdown of
hemoglobin and excreted in bile.
,CCK (cholecystokinin) - correct answer-Hormone that regulates the emptying of the
gallbladder and secretion of enzymes by the pancreas.
Colostrum - correct answer-Thick, milky fluid secreted by the breast during pregnancy and
during the first days after birth before lactation begins. Causes a laxative effect which helps
the baby pass meconium.
Coryllos type - correct answer-Classification system for anklyloglossia (tongue-tie)
Dancer Hand Position - correct answer-Technique used to support Baby's chin and mother's
breast. Use Thumb and index finger under chin, remaining 3 fingers to support breast.
Alveolar Cells - correct answer-found in the walls of the alveoli, simple squamous epithelial
cells, main sites of gas exchange
myoepithelial cells - correct answer-contract in response to stimulation by sympathetic
nervous system and squeeze milk up the duct
Montgomery glands - correct answer-Bumps on breasts (Look like goosebumps)
Produce a unique blend of milk and sebum (skin oil)
Modern study of the structure of the breast reveals what? - correct answer--Fat is mixed
throughout the breast
-Uneven spacing of the ducts
-3-5 functioning nipple pores (May have 5-9, but not all work)
-No lactiferous sinus
What are the 2 hormones pathways that control lactation? - correct answer-Prolactin and
Oxytocin
Prolactin (4 details related to milk production) - correct answer-1. is triggered by touch
(pregnant and non pregnant women). Higher levels when stimulating breast/nipples vs
breast alone.
2. Lengthening time between feeding leads to lower baseline levels. (Weaning)
3. levels go down between nursings and rise during nursing.
4. Infrequent nursing leads to lowering of this hormone
Average number of feeds in a day? - correct answer-8-12
What produces colostrum? - correct answer-Progesterone in the receptor sites
What produces more mature milk? - correct answer-Prolactin in the receptor sites
What happened when infants suckled in the first 2 hours of birth? - correct answer-Ingested
significantly more milk on day 4
, What happened to mother of preemies who initiated milk expression within 1 hour of birth? -
correct answer-Had significantly more milk when measured on days 7 and 42. Better to
stimulate breasts throughout the day right after birth to continue to stimulate production.
Oxytocin - correct answer-A hormone released by the posterior pituitary that stimulates
uterine contractions during childbirth and milk ejection during breastfeeding.
What 3 things can trigger Oxytocin? - correct answer-1. Conditioned response
2. Nipple stretching
3. Hand massage
Conditioned Response from Milk Ejection (Let down) - correct answer--Example- Mother lets
down when not near baby, but hears a baby cry.
-Conditioned over time
-Faster for women who have BF in the past
-To condition the response can use any sense-smell, touch, sound
Nipple stretching - correct answer-Only happens with a proper latch
Hand massage: Baby - correct answer-When we allow babies to be more hands on they can
help control flow rate by how they massage the breast.
How many triggers does Oxytocin have? Can it be triggered by stress. - correct answer-3
triggers. Yes.
What is hormone is triggered by stimulation? - correct answer-Prolactin
What 3 emotional/behavioral function do the hormones of lactation have besides making
milk? - correct answer-1. Aggression
2. Protection
3. Bonding/trust
What is special about the composition of milk? - correct answer-1. Mammal species with
higher water content milk feed more frequently.
2. Prolactin triggers production of lactose in the mammary cells.
What are the different care patterns of mammalian mother's and their babies? - correct
answer-1. Nest (eg. puppies, cats) OR cache (deer, rabbit)
2. Carry (monkey), follow (giraffe, bison), or hibernate (bear)
What kind of milk has the highest lactose of all mammalian milk? - correct answer-Human
milk: high in water, low in protein and fat.
When does paracellular transport occur? - correct answer-1. In the first few days after birth
2. Mother with low prolactin levels
When are cells not plump? - correct answer-During paracellular transport
