IBCLC Common Clinical Challenges 2

Question 1

A mother reports that her 3-week-old infant has been cluster feeding every evening for several hours. What is the most appropriate guidance?

Accepted Answer

Reassure the mother that cluster feeding is normal and does not indicate low supply

Answer

Supplement with formula to satisfy the baby

Answer

Recommend scheduled feedings every 3 hours instead

Answer

Suggest the mother pump after each feeding to increase supply

Question 2

A mother with flat nipples is having difficulty achieving a deep latch. Which intervention should the lactation consultant try first?

Accepted Answer

Teach reverse pressure softening before latching

Answer

Recommend immediate use of a nipple shield

Answer

Suggest exclusive pumping until nipples evert

Answer

Advise using a breast shell between feedings

Question 3

An infant born at 35 weeks gestation is having difficulty coordinating suck-swallow-breathe during breastfeeding. What is the most appropriate first step?

Accepted Answer

Use paced feeding at the breast with frequent breaks

Answer

Switch to exclusive bottle feeding with expressed milk

Answer

Begin cup feeding until the infant matures

Answer

Wait until 40 weeks corrected age to attempt breastfeeding

Question 4

A mother presents with a white spot on her nipple that causes sharp pain during feeding. The area is firm to palpation. What is this most likely?

Accepted Answer

A milk bleb (blister) blocking a nipple pore

Answer

Candida infection of the nipple

Answer

Contact dermatitis from breast pads

Answer

Raynaud's phenomenon of the nipple

Question 5

A mother with type 1 diabetes reports that her milk production seems delayed. Her infant is 4 days old. What is the most likely explanation?

Accepted Answer

Insulin-dependent diabetes can delay lactogenesis II onset

Answer

Diabetes has no effect on lactogenesis

Answer

The mother's blood glucose is too high for safe breastfeeding

Answer

Diabetic mothers cannot produce sufficient prolactin

Question 6

A 2-month-old exclusively breastfed infant has not had a bowel movement in 7 days. The infant is gaining weight well, has adequate wet diapers, and appears content. What should the IBCLC advise?

Accepted Answer

This may be normal for an exclusively breastfed infant of this age

Answer

The mother should supplement with formula to stimulate bowel movements

Answer

The infant likely has a bowel obstruction and needs immediate evaluation

Answer

Recommend introducing water between feedings