CBS Clinical Procedures & Protocols 2 — Questions and Answers
Question 1: When performing a pre- and post-feed weight to assess milk transfer, the infant should be weighed in which condition?
- Naked without diaper
- With a dry diaper only
- With the same clothing and diaper without changing (Correct answer)
- Fully clothed with diaper
Correct answer: With the same clothing and diaper without changing
The infant must wear the same clothing and diaper (unchanged) for both pre- and post-feed weights so that any weight change reflects only milk intake.
Question 2: A mother reports her nipple turns white and becomes painful after feeds. Which clinical procedure is most appropriate to assess first?
- Ultrasound of the breast
- Visual inspection of latch and infant oral anatomy (Correct answer)
- Serum prolactin level
- Breast pump fitting assessment
Correct answer: Visual inspection of latch and infant oral anatomy
White, painful nipples after feeds often indicate vasospasm or Raynaud's phenomenon, but latch quality and oral anatomy must be assessed first as a correctable cause.
Question 3: What is the recommended protocol when a mother is separated from her preterm infant and needs to establish milk supply?
- Begin pumping at 24 hours postpartum
- Begin hand expression within 1 hour of birth, then pump 8-12 times per 24 hours (Correct answer)
- Pump every 4 hours during the day only
- Wait until the infant is stable before initiating pumping
Correct answer: Begin hand expression within 1 hour of birth, then pump 8-12 times per 24 hours
Early hand expression within one hour of birth followed by frequent pumping 8–12 times per 24 hours is the evidence-based protocol to establish milk supply for separated mothers.
Question 4: During a breastfeeding assessment, the CBS observes the infant making clicking sounds during sucking. This most likely indicates:
- Adequate milk transfer
- Loss of intraoral vacuum due to poor tongue seal or high palate (Correct answer)
- Normal swallowing pattern
- Hyperlactation in the mother
Correct answer: Loss of intraoral vacuum due to poor tongue seal or high palate
Clicking sounds during sucking indicate a break in the intraoral vacuum, often caused by poor tongue positioning, tongue-tie, or a high-arched palate.
Question 5: A nipple shield is indicated as a short-term clinical intervention for which scenario?
- Maternal overproduction of milk
- Flat or inverted nipples making latch difficult for the newborn (Correct answer)
- Infant preference for the left breast over the right
- Reducing nipple pain caused by thrush
Correct answer: Flat or inverted nipples making latch difficult for the newborn
Nipple shields can facilitate latch in newborns when flat or inverted nipples make it difficult, serving as a transitional tool while working toward direct latch.
Question 6: When teaching cup feeding as an alternative feeding method, the CBS should instruct the caregiver to:
- Pour milk slowly into the infant's mouth
- Tip the cup so milk touches the infant's lips and allow the infant to lap or sip (Correct answer)
- Fill the cup completely and tilt to a 90-degree angle
- Use a cup only when the infant is in a supine position
Correct answer: Tip the cup so milk touches the infant's lips and allow the infant to lap or sip
Cup feeding requires tipping the cup so milk just touches the lips, allowing the infant to lap or sip at their own pace rather than having milk poured in.
Question 7: After a frenotomy for ankyloglossia, the CBS should advise the family to begin post-procedure exercises to:
- Reduce infection risk at the wound site
- Prevent reattachment and improve tongue mobility (Correct answer)
- Stimulate milk letdown in the mother
- Evaluate if a second procedure is needed immediately
Correct answer: Prevent reattachment and improve tongue mobility
Post-frenotomy stretching exercises help prevent reattachment of the frenulum and promote optimal tongue mobility as healing occurs.
CBS Clinical Procedures & Protocols 2
When performing a pre- and post-feed weight to assess milk transfer, the infant should be weighed in which condition?