ALPP CLC EXAM QUESTIONS AND
ANSWERS
breast feeding: a public health priority - answer- has been recognized as a public
health priority in tropical climates since the 1930's, but not until the 1990's in the US
costs to prevent needless deaths - answer- less than $6 billion/year worldwide
suboptimal breastfeeding - answer- accounts for more than 3,340 maternal and child
deaths a year, 80% are maternal
nursing a baby for a year or more - answer- decreases by 10-15% the risk of
developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease
women who do not breastfeed - answer- are at greater risk for myocardial infarction
and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and
ovarian cancer
WHO and UNICEF three strategies - answer- for increased breastfeeding initiation
and duration in every country: promotion, protection, and support
breastfeeding promotion - answer- focuses on advantages of breastfeeding on a
personal, community, country, or global level
breastfeeding protection - answer- focuses on government, manufacturer, and social
responsibility to assure breastfeeding's ability to compete with commercial interests;
includes addressing improper marketing practices; the AAP advices not to provide
formula, company gift bags, and industry-authored handouts; in the US, state and
local breastfeeding legislation addresses breastfeeding in public, employment
issues, jury duty, family law, mothers in prison, etc.
breastfeeding support - answer- focuses on the interaction of "helpers" with family as
well as program development and implementation
community expertise - answer- variety of community expertise is needed to promote,
protect, and support breastfeeding
International models - answer- for integrating breastfeeding promotion, protection,
and support as well as balancing technical information, programs, and protocols
CLC - answer- nationally recognized designation awarded by the ALPP to those who
are exam eligible and pass the exam; have competenct verified
CLCs and IBCLCs - answer- health professionals who provide lactation support
why is breastfeeding so difficult? - answer- 1. unrealistic expectations
2. lack of timely interventions
,unrealistic expectations - answer- lack of preparation for what the newborn period
would look like
lack of timely interventions - answer- mother's problems at 3 to 7 days posed as the
greatest risk to stopping
breastfeeding trends - answer- last 150 years or som rates have declined
international code of matketing of breastmilk substitutes (the code) - answer- an
international health policy framework to regulate the marketing of breastmilk
substitutes in order to protect breastfeeding
- published by the WHO in 1981
- internationally agreed voluntary code of practice
- written in response to the marketing activities of the infant feeding indurstry which
were promoting formula feeding over breastfeeding, which in turn was leading to
dramatic increases in maternal and infant morbidity and mortality
- subsequent clarifying and extending resolutions have been passed by the world
health assembly
the code - answer- regulates the marketing of breastmilk substitutes which includes
infant formulas, follow-on formulas, and any other food or drink, together with feeding
bottles and teats, intended for babies and young children; sets standards for the
labeling and quality of products and for how the law should be implemented and
monitored within countries
restricting marketing - answer- does not mean that the products cannot be made
available, neither does it restrict parents choice; it simply aims to make sure that
their choices are made based on full, impartial information, rather than misleading,
inaccurate, or biased marketing claims
the strategy - answer- is intended as a guide for action
- it identifies interventions with a proven positive impact
- it emphasizes providing mothers and families the support they need to carry out
their crucial roles
- it explicitly defines the obligations and responsibilities in this regard of
governments, international organizations, and other concerned parties
the world breastfeeding trends initiative - answer- intended to track, assess, and
monitor the implementation of the "global strategy" at the country and sub-country
level
what contributes to low rates of ebf globally? - answer- - caregiver and societal
beliefs favoring mixed feeding
-hospital and healthcare practices and policies that are not supportive of BF
- lack of adequate skills and support
- aggressive promotion of infant formula and other breastmilk substitutes
- inadequate maternity/paternity leave legislation
- workplace policies
- lack of knowledge about dangers of not exclusively BF and proper BF techniques
,how to support ebf - answer- increase hospital and health system capacity regarding
baby friendly hospital initiative
-provide community based strategies including campaigns tailored to local context
-strengthen monitoring and enforcement of the code
-enact at least 6 months paid maternity leave
-invest in training and capacity building in protection, promotion, support
disparity of US breastfeeding trends - answer- according to the CDC, "black mothers
are less likely than white to breast-feed their babies, and here's one possible reason
why: hospitals in neighborhoods with many black residents do less to promote
nursing than those in areas with more white residents"
anatomy of milk cells - answer- myoepithelial cells, connective tissue, capillaries,
anteriole, venule, alveolar cells
anatomy of human breast - answer- glandular tissue made up of clusters of alveoli
and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with
several duct openings
making milk - answer- messages from the breast travel through the nervous system
to the brain, then hormones travel to the breast through the blood system
hormone pathways - answer- two separate hormone pathways, pituitary gland is
important to both
prolactin levels - answer- go down in between nursing and rise during nursing
infrequent nursing - answer- leads to lower levels and less rise even with the same
amount of nipple contact
ongoing milk production - answer- positively associated with suckling within the first
2 hours after birth
initiation for mothers of preemies - answer- initiation of milk expression before one
hour resulted in significantly more milk when measured on days 7 and 42
triggering oxytocin mechanism #1 - answer- conditioned response - conditioned milk
ejection (let down) reflex
- was probably given too much importance in the years we didn't understand the
other mechanisms
- conditioned over time and lasts a lifetime
- is faster for women who already have one from previous breastfeeding
- to condition response.. smell, touch, hear the stimulus
triggering oxytocin mechanism #2 - answer- nipple stretching, happens with a proper
latch
triggering oxytocin mechanism #3 - answer- baby hand massage, each hand
movement releases oxytocin
, hormones of lactation - answer- have an emotional/behavioral function as well as
making and moving milk; aggression, protection, bonding & trust
milk composition - answer- is complex
- each species of mammal milk is different
- milk is "species specific"
nest or cache - answer- mammal species with high fat/protein and low water content
= infrequent feeds
nest = bunnies
cache = deer
carry, follow, or hibernate - answer- mammal species with hither water content milk
have more frequent feeds
carry = koala
follow = elephants
hibernate = bears
our culture - answer- wants us to be nesters when it comes to feeding, but our milk
composition indicates that we should be carriers
the brain - answer- most rapidly developing organ in human newborns; human milk
is the ideal fuel for brain growth
nursing pattern - answer- should be frequent to accommodate human milk
composition
stages of making human milk - answer- lactogenesis I, lactogenesis II, lactogenesis
III
lactogenesis I - answer- secretory differentiation, placental hormones, colostrum
lactogenesis II - answer- secretory activation, after complete delivery of placenta,
rapid drop in progesterone, transitional milk
lactogenesis III - answer- lactation, galactopoesis, prolactin from frequent nipple
stimulation, frequent removal of milk, mature milk
breastmilk composition - answer- human milk changes continually, makes it
impossible to obtain a single representative sample of milk
preterm milk - answer- appears to have a different composition for the first 5-7 weeks
after delivery independent of gestational age at delivery
- appears to be higher in protein, fat, and electrolytes than term milk
- if baby is SGA, LGA, or AGA, does not make a difference in milk composition
after 1 year of lactation - answer- has significantly increased fat and energy contents
ANSWERS
breast feeding: a public health priority - answer- has been recognized as a public
health priority in tropical climates since the 1930's, but not until the 1990's in the US
costs to prevent needless deaths - answer- less than $6 billion/year worldwide
suboptimal breastfeeding - answer- accounts for more than 3,340 maternal and child
deaths a year, 80% are maternal
nursing a baby for a year or more - answer- decreases by 10-15% the risk of
developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease
women who do not breastfeed - answer- are at greater risk for myocardial infarction
and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and
ovarian cancer
WHO and UNICEF three strategies - answer- for increased breastfeeding initiation
and duration in every country: promotion, protection, and support
breastfeeding promotion - answer- focuses on advantages of breastfeeding on a
personal, community, country, or global level
breastfeeding protection - answer- focuses on government, manufacturer, and social
responsibility to assure breastfeeding's ability to compete with commercial interests;
includes addressing improper marketing practices; the AAP advices not to provide
formula, company gift bags, and industry-authored handouts; in the US, state and
local breastfeeding legislation addresses breastfeeding in public, employment
issues, jury duty, family law, mothers in prison, etc.
breastfeeding support - answer- focuses on the interaction of "helpers" with family as
well as program development and implementation
community expertise - answer- variety of community expertise is needed to promote,
protect, and support breastfeeding
International models - answer- for integrating breastfeeding promotion, protection,
and support as well as balancing technical information, programs, and protocols
CLC - answer- nationally recognized designation awarded by the ALPP to those who
are exam eligible and pass the exam; have competenct verified
CLCs and IBCLCs - answer- health professionals who provide lactation support
why is breastfeeding so difficult? - answer- 1. unrealistic expectations
2. lack of timely interventions
,unrealistic expectations - answer- lack of preparation for what the newborn period
would look like
lack of timely interventions - answer- mother's problems at 3 to 7 days posed as the
greatest risk to stopping
breastfeeding trends - answer- last 150 years or som rates have declined
international code of matketing of breastmilk substitutes (the code) - answer- an
international health policy framework to regulate the marketing of breastmilk
substitutes in order to protect breastfeeding
- published by the WHO in 1981
- internationally agreed voluntary code of practice
- written in response to the marketing activities of the infant feeding indurstry which
were promoting formula feeding over breastfeeding, which in turn was leading to
dramatic increases in maternal and infant morbidity and mortality
- subsequent clarifying and extending resolutions have been passed by the world
health assembly
the code - answer- regulates the marketing of breastmilk substitutes which includes
infant formulas, follow-on formulas, and any other food or drink, together with feeding
bottles and teats, intended for babies and young children; sets standards for the
labeling and quality of products and for how the law should be implemented and
monitored within countries
restricting marketing - answer- does not mean that the products cannot be made
available, neither does it restrict parents choice; it simply aims to make sure that
their choices are made based on full, impartial information, rather than misleading,
inaccurate, or biased marketing claims
the strategy - answer- is intended as a guide for action
- it identifies interventions with a proven positive impact
- it emphasizes providing mothers and families the support they need to carry out
their crucial roles
- it explicitly defines the obligations and responsibilities in this regard of
governments, international organizations, and other concerned parties
the world breastfeeding trends initiative - answer- intended to track, assess, and
monitor the implementation of the "global strategy" at the country and sub-country
level
what contributes to low rates of ebf globally? - answer- - caregiver and societal
beliefs favoring mixed feeding
-hospital and healthcare practices and policies that are not supportive of BF
- lack of adequate skills and support
- aggressive promotion of infant formula and other breastmilk substitutes
- inadequate maternity/paternity leave legislation
- workplace policies
- lack of knowledge about dangers of not exclusively BF and proper BF techniques
,how to support ebf - answer- increase hospital and health system capacity regarding
baby friendly hospital initiative
-provide community based strategies including campaigns tailored to local context
-strengthen monitoring and enforcement of the code
-enact at least 6 months paid maternity leave
-invest in training and capacity building in protection, promotion, support
disparity of US breastfeeding trends - answer- according to the CDC, "black mothers
are less likely than white to breast-feed their babies, and here's one possible reason
why: hospitals in neighborhoods with many black residents do less to promote
nursing than those in areas with more white residents"
anatomy of milk cells - answer- myoepithelial cells, connective tissue, capillaries,
anteriole, venule, alveolar cells
anatomy of human breast - answer- glandular tissue made up of clusters of alveoli
and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with
several duct openings
making milk - answer- messages from the breast travel through the nervous system
to the brain, then hormones travel to the breast through the blood system
hormone pathways - answer- two separate hormone pathways, pituitary gland is
important to both
prolactin levels - answer- go down in between nursing and rise during nursing
infrequent nursing - answer- leads to lower levels and less rise even with the same
amount of nipple contact
ongoing milk production - answer- positively associated with suckling within the first
2 hours after birth
initiation for mothers of preemies - answer- initiation of milk expression before one
hour resulted in significantly more milk when measured on days 7 and 42
triggering oxytocin mechanism #1 - answer- conditioned response - conditioned milk
ejection (let down) reflex
- was probably given too much importance in the years we didn't understand the
other mechanisms
- conditioned over time and lasts a lifetime
- is faster for women who already have one from previous breastfeeding
- to condition response.. smell, touch, hear the stimulus
triggering oxytocin mechanism #2 - answer- nipple stretching, happens with a proper
latch
triggering oxytocin mechanism #3 - answer- baby hand massage, each hand
movement releases oxytocin
, hormones of lactation - answer- have an emotional/behavioral function as well as
making and moving milk; aggression, protection, bonding & trust
milk composition - answer- is complex
- each species of mammal milk is different
- milk is "species specific"
nest or cache - answer- mammal species with high fat/protein and low water content
= infrequent feeds
nest = bunnies
cache = deer
carry, follow, or hibernate - answer- mammal species with hither water content milk
have more frequent feeds
carry = koala
follow = elephants
hibernate = bears
our culture - answer- wants us to be nesters when it comes to feeding, but our milk
composition indicates that we should be carriers
the brain - answer- most rapidly developing organ in human newborns; human milk
is the ideal fuel for brain growth
nursing pattern - answer- should be frequent to accommodate human milk
composition
stages of making human milk - answer- lactogenesis I, lactogenesis II, lactogenesis
III
lactogenesis I - answer- secretory differentiation, placental hormones, colostrum
lactogenesis II - answer- secretory activation, after complete delivery of placenta,
rapid drop in progesterone, transitional milk
lactogenesis III - answer- lactation, galactopoesis, prolactin from frequent nipple
stimulation, frequent removal of milk, mature milk
breastmilk composition - answer- human milk changes continually, makes it
impossible to obtain a single representative sample of milk
preterm milk - answer- appears to have a different composition for the first 5-7 weeks
after delivery independent of gestational age at delivery
- appears to be higher in protein, fat, and electrolytes than term milk
- if baby is SGA, LGA, or AGA, does not make a difference in milk composition
after 1 year of lactation - answer- has significantly increased fat and energy contents
