CBS Clinical Procedures & Protocols 3 — Questions and Answers
Question 1: A CBS is observing a breastfeeding session and notes the infant's jaw is barely moving and cheeks are dimpling. What does this suggest?
- Effective nutritive sucking
- Non-nutritive sucking or poor latch affecting suction (Correct answer)
- Normal sucking bursts during a letdown
- The infant is full and slowing the feed
Correct answer: Non-nutritive sucking or poor latch affecting suction
Minimal jaw excursion with cheek dimpling indicates the infant is not effectively extracting milk, often due to shallow latch or inadequate suction.
Question 2: Which protocol best supports milk supply maintenance for a mother returning to work?
- Pumping once per workday and breastfeeding on non-work days
- Pumping approximately every 2-3 hours during separation to match the infant's feeding frequency (Correct answer)
- Switching to formula during work hours and breastfeeding at home only
- Pumping only when feeling full to avoid oversupply
Correct answer: Pumping approximately every 2-3 hours during separation to match the infant's feeding frequency
Matching pumping frequency to the infant's typical feeding pattern during separation maintains breast stimulation and prolactin levels needed to sustain milk supply.
Question 3: A mother presents with a red, wedge-shaped area of breast tenderness, fever, and flu-like symptoms. The CBS should recommend she:
- Immediately wean to rest the breast
- Continue frequent breastfeeding or milk removal, apply warmth, rest, and contact her provider for antibiotic evaluation (Correct answer)
- Apply ice packs and reduce feeding frequency
- Switch to exclusive pumping for two weeks
Correct answer: Continue frequent breastfeeding or milk removal, apply warmth, rest, and contact her provider for antibiotic evaluation
Mastitis is treated with continued frequent milk removal, warmth, rest, hydration, and evaluation by a healthcare provider for antibiotic therapy if needed.
Question 4: When assessing breast anatomy, which finding would most concern a CBS regarding future milk production capacity?
- Large breast size
- Tubular breast shape with widely spaced breasts and hypoplastic tissue (Correct answer)
- Asymmetrical breast size
- Stretch marks on the breast
Correct answer: Tubular breast shape with widely spaced breasts and hypoplastic tissue
Tubular (hypoplastic) breasts with wide spacing are associated with insufficient glandular tissue, which may limit milk production regardless of breastfeeding management.
Question 5: For a mother with a history of breast augmentation via periareolar incision, the CBS should counsel that:
- Breastfeeding is always contraindicated after this surgery
- Milk supply may be affected due to potential nerve and duct disruption near the areola (Correct answer)
- Silicone implants will contaminate breast milk
- No impact on breastfeeding is expected from any breast surgery
Correct answer: Milk supply may be affected due to potential nerve and duct disruption near the areola
Periareolar incisions carry a higher risk of disrupting milk ducts and nipple innervation compared to other incision sites, potentially impacting milk supply and letdown.
Question 6: The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) evaluates which two domains?
- Latch quality and infant weight gain
- Appearance items and function items (Correct answer)
- Nipple pain scores and milk transfer volume
- Tongue shape and palate height
Correct answer: Appearance items and function items
The HATLFF assesses both the appearance of the frenulum (structural) and the function of the tongue (movement and sucking ability) to evaluate ankyloglossia.
Question 7: A mother of a 3-day-old reports her baby nursed every hour all night. The CBS should first assess:
- Whether the mother should begin formula supplementation
- Latch effectiveness and whether the infant is transferring adequate milk (Correct answer)
- The infant's sleep environment for safety
- Whether the mother has postpartum depression
Correct answer: Latch effectiveness and whether the infant is transferring adequate milk
Frequent feeding in a newborn may signal ineffective milk transfer rather than a supply problem; assessing latch and conducting a test weight clarifies the clinical picture.
CBS Clinical Procedures & Protocols 3
A CBS is observing a breastfeeding session and notes the infant's jaw is barely moving and cheeks are dimpling.
What does this suggest?