CLC - Certified Lactation Counselor Common Breastfeeding Challenges Questions and Answers — Questions and Answers
Question 1: A new mother calls a lactation counselor on day four postpartum, reporting that her breasts are hard, warm, and painful. She says her baby is having trouble latching because her nipples are flat. Which of the following is the most likely cause of these symptoms?
- Mastitis
- Plugged duct
- Engorgement (Correct answer)
- Normal lactogenesis II
Correct answer: Engorgement
The client's symptoms—hard, warm, painful breasts and flattened nipples occurring 3-5 days postpartum—are classic signs of breast engorgement. Engorgement is caused by an increase in milk volume, blood flow, and lymphatic fluid, which can make the breasts feel full and firm, sometimes leading to difficulty with latching. While mastitis involves inflammation and can cause warmth and pain, it is often accompanied by systemic symptoms like fever and flu-like aches and is typically localized to one area of the breast. A plugged duct presents as a specific, tender lump rather than diffuse hardness of the entire breast. While these symptoms occur during lactogenesis II, the severity described indicates a challenge beyond the normal fullness of milk 'coming in'.
Question 2: Which of the following is the MOST reliable indicator that a one-week-old, exclusively breastfed infant is getting enough milk?
- The mother's breasts feel soft after feedings.
- The infant nurses for 20 minutes on each side at every feeding.
- The infant has at least six wet diapers and several yellow, seedy stools per day. (Correct answer)
- The infant appears content and sleeps for three hours between feedings.
Correct answer: The infant has at least six wet diapers and several yellow, seedy stools per day.
Adequate output, specifically at least six wet diapers and multiple (typically 3-5) yellow, seedy stools in a 24-hour period for a newborn, is a primary and reliable sign of sufficient milk intake. While breasts feeling softer after a feed can suggest milk transfer, it's a subjective measure. The duration of a feeding is not a reliable indicator of milk transfer, as some infants are more efficient than others. Infant contentment and sleep patterns can be influenced by many factors besides hunger.
Question 3: A breastfeeding mother presents with a painful, cracked nipple on one side. She states the pain is sharp and occurs throughout the feeding. What is the MOST important initial intervention for the lactation counselor to take?
- Recommend applying a hydrogel pad for pain relief.
- Suggest the mother pump from the affected side until the nipple heals.
- Assess the infant's latch and the mother's positioning. (Correct answer)
- Advise the mother to apply expressed breast milk to the nipple after feedings.
Correct answer: Assess the infant's latch and the mother's positioning.
The most common cause of nipple pain and trauma is an incorrect or shallow latch. Therefore, the priority intervention is to observe a full feeding to assess the baby's latch and the mother's positioning to identify and correct the root cause of the problem. While hydrogel pads, pumping, and applying breast milk can be helpful adjunctive therapies for healing and comfort, they do not address the underlying issue that is causing the damage.
Question 4: A client diagnosed with mastitis asks if she should continue to breastfeed her baby. What is the appropriate advice for a lactation counselor to provide?
- She should stop breastfeeding on the affected side but can continue on the unaffected side.
- She must stop breastfeeding entirely and pump and discard the milk until the infection clears.
- She should continue to breastfeed frequently on both sides, ensuring the affected breast is drained well. (Correct answer)
- She should only breastfeed if she is not taking antibiotics for the infection.
Correct answer: She should continue to breastfeed frequently on both sides, ensuring the affected breast is drained well.
Continued and effective milk removal is a critical component of treating mastitis. Encouraging the mother to continue nursing, starting on the affected side if possible, helps to clear the inflammation and prevent the condition from worsening or leading to an abscess. The milk is safe for the baby, and stopping nursing abruptly on the affected side can exacerbate the problem. Most antibiotics prescribed for mastitis are safe for breastfeeding.
Question 5: A mother is concerned about her milk supply because her 6-week-old infant has started nursing more frequently and seems fussy in the evenings. Her breasts also no longer feel as full as they did in the early weeks. What is the most likely explanation for this?
- A significant drop in her milk supply requiring supplementation.
- The infant is experiencing a normal growth spurt and cluster feeding. (Correct answer)
- The mother's diet is negatively impacting her milk production.
- The infant is developing a preference for a bottle.
Correct answer: The infant is experiencing a normal growth spurt and cluster feeding.
It is common for infants to experience growth spurts around 6 weeks of age, leading to increased feeding frequency (cluster feeding) to signal the body to produce more milk. It's also normal for a mother's milk supply to regulate around this time, causing the breasts to feel softer. These signs, without evidence of poor weight gain or low diaper output, do not indicate a true low milk supply problem.
Question 6: An infant is having difficulty latching, makes a clicking sound while nursing, and the mother is experiencing nipple pain. The infant's mother notes a heart-shaped tip of the tongue when the baby cries. This presentation is most consistent with which of the following conditions?
- Thrush (Candida albicans)
- Ankyloglossia (tongue-tie) (Correct answer)
- Cleft palate
- Low milk supply
Correct answer: Ankyloglossia (tongue-tie)
The combination of poor latch, clicking sounds (indicating loss of suction), maternal nipple pain, and a heart-shaped tongue tip are classic signs of ankyloglossia, or tongue-tie. The restricted movement of the tongue due to a short or tight lingual frenulum prevents the baby from latching deeply and effectively removing milk. While the other options can present breastfeeding challenges, they do not typically include the specific physical sign of a heart-shaped tongue.
CLC - Certified Lactation Counselor Common Breastfeeding Challenges Questions and Answers
A new mother calls a lactation counselor on day four postpartum, reporting that her breasts are hard, warm, and painful.
She says her baby is having trouble latching because her nipples are flat.
Which of the following is the most likely cause of these symptoms?