CLC - Certified Lactation Counselor Supporting the Breastfeeding Dyad Questions and Answers — Questions and Answers
Question 1: A new mother reports that her 5-day-old, exclusively breastfed infant has had only one wet diaper and two small, dark stools in the last 24 hours. The infant is sleepy and has not initiated feeding cues. Which of the following is the MOST appropriate initial action for the Certified Lactation Counselor (CLC)?
- Advise the mother to begin supplementing with 1-2 ounces of infant formula after each breastfeeding attempt.
- Recommend the mother express milk and feed it to the infant with a spoon or cup.
- Perform a full feeding assessment, observing the latch and checking for signs of milk transfer. (Correct answer)
- Reassure the mother that this is normal newborn behavior and to continue offering the breast frequently.
Correct answer: Perform a full feeding assessment, observing the latch and checking for signs of milk transfer.
The infant's low output and lethargy are significant warning signs of inadequate milk intake. The CLC's primary role is to first assess the situation thoroughly. A full feeding assessment, including observing the latch, positioning, and looking for audible swallows, is crucial to identify the root cause of the problem, such as ineffective milk transfer. Recommending supplementation before assessment is premature, and while expressing milk might be part of the care plan, assessment must come first. Reassurance is inappropriate given the potential for dehydration and poor weight gain.
Question 2: Which of the following is a reliable indicator of adequate milk transfer and sufficient intake in a one-week-old breastfed infant?
- The mother's breasts feel soft after feedings.
- The infant sleeps for a four-hour stretch at night.
- The infant has at least six to eight wet diapers in 24 hours. (Correct answer)
- The mother can express a large volume of milk after a feeding.
Correct answer: The infant has at least six to eight wet diapers in 24 hours.
By day five and onwards, a well-hydrated infant should have at least six heavy, wet diapers every 24 hours. This is a key, reliable indicator of adequate milk intake. Breasts feeling soft is a subjective sign and can happen as the milk supply regulates. A long sleep stretch may be a sign of lethargy due to poor intake, not a sign of being well-fed. Pumping volume is not an accurate measure of what the baby transfers from the breast.
Question 3: A mother is concerned because her three-week-old infant, who was previously content, is now nursing very frequently and seems fussy. The mother worries her milk supply is decreasing. What is the MOST likely explanation for this behavior?
- The mother's diet has changed, affecting the taste of her milk.
- The infant is experiencing a growth spurt and is increasing the milk supply. (Correct answer)
- The mother has an overactive let-down reflex, causing the infant to fuss.
- The infant has developed a preference for bottle-feeding.
Correct answer: The infant is experiencing a growth spurt and is increasing the milk supply.
Increased feeding frequency and fussiness around 3 weeks, 6 weeks, and 3 months are classic signs of a growth spurt. During these times, the infant nurses more often to signal the mother's body to produce more milk to meet their growing needs. While other issues can cause fussiness, a growth spurt is the most common explanation for this specific scenario.
Question 4: During a consultation, a CLC observes a mother holding her baby in a cross-cradle position. The baby's mouth is open wide, lips are flanged out, and more of the areola is visible above the baby's top lip than below. The mother reports a pinching pain throughout the feeding. What should the CLC address first?
- Suggesting a different feeding position, like the football hold.
- The asymmetrical latch, as the baby's chin should be pressed into the breast for a deeper latch. (Correct answer)
- The mother's pain tolerance and offering reassurance.
- The possibility of an underlying medical issue like thrush.
Correct answer: The asymmetrical latch, as the baby's chin should be pressed into the breast for a deeper latch.
While many signs of a good latch are present, persistent pain is a key indicator that the latch is not optimal. The description suggests an asymmetrical latch where the baby may not be taking in enough of the lower part of the areola. Ensuring the baby's chin is deeply pressed into the breast and the nipple is aimed toward the roof of the mouth facilitates a deeper, more comfortable, and effective latch. Changing positions or investigating other causes is secondary to first correcting the mechanics of the current latch.
Question 5: A mother calls a CLC stating her two-day-old infant is crying frequently and she is worried she doesn't have enough milk. Which statement by the CLC is the most appropriate counseling response?
- "You should give the baby some formula, it sounds like he is starving."
- "Let's talk about what's happening. Crying is a late hunger cue. What other signs have you noticed?" (Correct answer)
- "Don't worry, all babies cry. Your milk will come in soon enough."
- "You probably need to pump after every feeding to increase your supply."
Correct answer: "Let's talk about what's happening. Crying is a late hunger cue. What other signs have you noticed?"
This response is client-centered, gathers more information, and provides education without causing alarm. It opens a dialogue by asking about other feeding cues (like rooting or hand-to-mouth) and correctly identifies crying as a late sign of hunger. It validates the mother's concern while guiding the conversation toward a productive assessment. The other options are either alarmist, dismissive, or offer advice without proper assessment.
Question 6: Within the CLC scope of practice, which of the following actions is appropriate when supporting a breastfeeding dyad?
- Diagnosing the infant with ankyloglossia (tongue-tie).
- Prescribing a galactagogue to increase milk supply.
- Developing an individualized, evidence-based feeding plan with the mother. (Correct answer)
- Performing a frenotomy to correct a tongue-tie.
Correct answer: Developing an individualized, evidence-based feeding plan with the mother.
According to the CLC Scope of Practice, a key role is to conduct assessments and develop an evidence-based care plan in collaboration with the client to help them meet their goals. Diagnosing medical conditions like tongue-tie, prescribing medications, and performing surgical procedures are outside the CLC scope of practice and require a referral to a licensed medical provider.
CLC - Certified Lactation Counselor Supporting the Breastfeeding Dyad Questions and Answers
A new mother reports that her 5-day-old, exclusively breastfed infant has had only one wet diaper and two small, dark stools in the last 24 hours.
The infant is sleepy and has not initiated feeding cues.
Which of the following is the MOST appropriate initial action for the Certified Lactation Counselor (CLC)?