CLE Site Management & Monitoring 2 — Questions and Answers
Question 1: A breastfeeding mother reports that her baby is gaining less than 20 grams per day at 2 weeks of age. What is the most appropriate immediate action?
- Reassure her that slow weight gain is normal in the first month
- Refer to a physician or IBCLC for evaluation of feeding adequacy (Correct answer)
- Recommend supplementing with formula immediately without further assessment
- Advise the mother to increase her fluid intake only
Correct answer: Refer to a physician or IBCLC for evaluation of feeding adequacy
Weight gain below 20–30 g/day after the first week warrants prompt referral for thorough feeding evaluation.
Question 2: Which of the following urine output patterns in a 5-day-old breastfed infant is MOST consistent with adequate intake?
- 2 wet diapers per day
- 4 wet diapers per day with pale yellow urine
- 6–8 wet diapers per day with pale yellow urine (Correct answer)
- Concentrated dark urine in 6 diapers per day
Correct answer: 6–8 wet diapers per day with pale yellow urine
By day 5, six to eight pale, wet diapers per day indicate the infant is receiving sufficient breast milk.
Question 3: A lactation educator reviewing a newborn feeding log notices the baby is feeding only 4 times in 24 hours at day 3. What should the educator advise?
- This is acceptable since the baby seems content
- Encourage feeding at least 8–12 times per 24 hours and assess latch (Correct answer)
- Begin formula supplementation to ensure adequate calories
- Schedule a follow-up in one week and monitor weight then
Correct answer: Encourage feeding at least 8–12 times per 24 hours and assess latch
Newborns need 8–12 feedings per 24 hours to stimulate milk production and ensure adequate intake.
Question 4: When monitoring for mastitis in a breastfeeding client, the CLE should look for which combination of signs?
- Bilateral breast engorgement with mild tenderness
- Localized redness, warmth, swelling, and flu-like symptoms (Correct answer)
- Cracked nipples without breast pain or fever
- Sudden milk oversupply without breast discomfort
Correct answer: Localized redness, warmth, swelling, and flu-like symptoms
Mastitis classically presents with a localized red, hot, swollen area of the breast accompanied by systemic flu-like symptoms.
Question 5: A client at a hospital lactation education visit asks how to know if her colostrum is 'enough' for her newborn. The best evidence-based response is:
- Colostrum is never sufficient; all newborns need supplemental formula
- Small volumes of colostrum are designed to meet the newborn's stomach capacity and nutritional needs (Correct answer)
- She should pump after every feeding to measure exactly how much colostrum she produces
- Colostrum is only nutritional for the first 12 hours after birth
Correct answer: Small volumes of colostrum are designed to meet the newborn's stomach capacity and nutritional needs
Colostrum volume is small by design, matching the newborn's stomach size (5–7 mL) while providing concentrated nutrition and immune factors.
Question 6: Which monitoring tool is most commonly used by CLEs to track infant weight trends over multiple visits?
- APGAR scoring chart
- WHO Child Growth Standards weight-for-age chart (Correct answer)
- Body mass index (BMI) percentile chart
- Neonatal Abstinence Scoring tool
Correct answer: WHO Child Growth Standards weight-for-age chart
WHO Child Growth Standards are the recommended reference for plotting breastfed infant weight trajectories.
Question 7: A CLE is conducting a follow-up home visit at 10 days postpartum. The baby has not regained birth weight. The MOST appropriate step is:
- Continue monitoring for another week without intervention
- Reassure the mother that 10 days is too early to expect birth weight recovery
- Refer the mother-infant dyad to a physician and IBCLC for further evaluation (Correct answer)
- Advise the mother to stop breastfeeding temporarily to rest
Correct answer: Refer the mother-infant dyad to a physician and IBCLC for further evaluation
Most infants regain birth weight by 10–14 days; failure to do so by day 10 requires physician and IBCLC evaluation.
CLE Site Management & Monitoring 2
A breastfeeding mother reports that her baby is gaining less than 20 grams per day at 2 weeks of age.
What is the most appropriate immediate action?