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CERTIFIED LACTATION COURSE EXAM||2025-2026||-
QUESTIONS WITH CORRECT VERIFIED ANSWERS.
A+ GRADE
weaning
the addition of adding other foods to a diet, but not completely stopping or ceasing
breastfeeding
when did breastfeeding rates start to initially decline (i.e. in Britain), particularly
among the wealthy population?
16th-17th century and through the 18th century
which month did women historically think was the most important to breastfeed
during?
the summer (due to food spoilage)
what three ingredients made up the first commercial formula? (early 1800's/19th
XXWQcentury)
- wheat flour
- cows milk
- sugar
what was, and still is today, one of the biggest reasons why mothers quit
breastfeeding?
mothers report not producing enough milk
when did bottle feeding become the "new norm", thus, causing breastfeeding rates to
continue to decline?
20th century (particularly, mid 1900's) (1950's-1970's)
what is the WHO code?
an attempt to prevent excessive marketing of ABM (artificial baby milk) and to bring
awareness of benefits of breastfeeding (although this code is not law in many
countries as it interferes with marketing & freedom)
breastfeeding education to pubic is critical!
what are some other breastfeeding barriers mothers have?
- sexual vs functional aspects of breasts
- women in the workplace
- "im not producing enough milk"
- lack of support from medical profession
where are the breasts specifically located on the body?
- between 2nd & 6th rib
- from sternum to mid axillary line
- only gland in not fully functioning at birth
*may contain hair, sweat, and oil glands
hypoplastic breasts
- insufficient glandular tissues
- usually only extend from 3rd to 5th rib
- typically have more spacing between breasts (1.5 inches or more)
montgomery glands/tubercles
"small bumps" located around areola that become more prominent (hypertrophy)
during pregnancy & are thought to secrete substance during pregnancy/lactation &
contain scent glands to help guide infant to nipple, while also helping kill pathogens
that try to enter the body
areola
vary in shape & color; usually circular; become darker during pregnancy and do not
return to pre-pregnancy color
nipple
contain smooth muscle fibers for erectness and graspability; normally found at 4th
intercostal space that typically contain between 4-18 openings (9 on average) for
milk to be expressed through during lactation
nipple/areola complex
thought of as one entity; both elongate up to 2-3 times resting length during
breastfeeding;
areola = most sensitive part of breast
nipples = least sensitive
everted nipples
most common type of nipples; protrudes slightly at rest & everts well with stimulation
flat nipples
soft, but pliable & graspable
pseudo-inverted nipples
what is witch's milk?
breast buds/neonatal engorgement in full term infants that may be mistaken for baby
acne; self resolve by 4 weeks pp
why is it critical to ask mothers about breast changes during pregnancy when
completing an assessment
different hormones cause breast changes during pregnancy which are critical in
assisting with breastfeeding in the pp period;
examples:
- estrogen: cause ductile system to proliferate
- progesterone: promotes and increases the size of breast lobes and alveoli
- serum prolactin: nipple growth
- serum placental lactogen: areolar growth
Lactogenesis I
occurs between 16 - 20 weeks of pregnancy until milk surges, or comes in, after birth
breast size increases
differentiation between alveolar cells into secretory cells occur
hormone prolactin stimulates mammary secretory epithelial cells to produce milk
endocrine (hormonal) control
Lactogenesis II
occurs between PP day 3 - 8 where there is a rapid increase in milk volume for 2- 5
days, then abruptly levels off; this is the onset of copious milk supply
triggered by rapid drop in progesterone levels after placenta is delivered
will feel fullness and warmth in breasts
now switches from endocrine to autocrine control
galactopoiesis
maintenance of the established milk production under autocrine control
works on a supply & demand basis
breasts will decrease slightly by 6-9 months pp
involution
the process of weaning slowly over 3 months or longer when FIL (feedback inhibitors
of lactation) in breastmilk suppress lactation if milk is not removed from the breasts
describe colostrum
- "first milk"
- starts about 16-20 weeks gestation and mom may or may not leak this during
pregnancy (which is normal, nothing to worry about);
- clear to golden yellow in color, but may be greenish or brownish due to old blood
- very dense and thick, gel-like; present in small aounts
- acts as "gut primer" or "closure"; helps block out pathogens and clear meconium out
of gut
- physiologic capacity of stomach: only 20 mls at birth (note: anatomic capacity is
much larger, do not go by this)
transitional milk
milk produced between colostrum and mature milk; occurs by 3 days PP
occurs when "milk comes in" or when "milk comes to volume"; sensation of fullness
occurs during lactogenesis II
caused by rise in lactose in cells which draw water into secretion by osmosis and
enhances milk volume; can be sped up by increasing frequency of breast emptying
in first few days pp
mature milk
occurs between days 10 - 14 and onward
the longer the breastfeed, the higher the fat (caloric) content of milk (in both one feed
and longevity of feedings); fat content higher at end of feedings and the longer one
breastfeeds for in total
not all breastmilk is 20 cal/ounce
milk in second year of lactation has significantly increased fat & calories
Describe the differences between colostrum & mature milk in terms of composition
Colostrum: higher protein, higher cholesterol, high IgA antibodies
Mature milk: higher energy (calories), higher lactose, higher fat (the emptier the
breast, the higher the fat content in the milk because there is more fat toward the
end of breastfeeding)
what is the average caloric value of breastmilk (per ounce)?
First 3 weeks of life: 20.2 - 28.2 kcal
6 months: 22.5 - 36.25 kcal
9 months: 22.9 - 32.4 kcal
12 months: 19.4 - 34.6 kcal
*Essentially, it ranges from 18 - 23 kcal/oz
What volume of milk approximately should mom be pumping and should be used to
supplement if needed during first 5 days of life?
Day 1: 5 ml/feed
Day 2: 15 ml/feed
Day 3: 30 ml/feed
Day 4: 45 ml/feed
Day 5: 60 ml/feed
fat variation also is more specific to each baby's needs, thus, decreasing amount
baby needs to take from breast
remember: breast milk is , while formula is
alive; dead
what things should be assessed in the breastfeeding infant, which may affect how
well infant feeds or show effectiveness of breasfeeding?
- gestational age (term infants feed best)
- birth hx (long 2nd stage, forcep/vacuum use, position in utero, meconium aspiration,
AGAR scores, resuscitation efforts
- baby's ability to breastfeed (is anything out of the NORM)
- oral assessment/exam (tongue tie? thrush? cleft lip/palate? moist or dry mucous
membranes?)
- alertness levels (feeding cues, stress signals)
- muscle tone (normal extremity flexion? resistance when undressing or wet noodle?
head lag when in sitting position?)
- I&O:
1 void/day of life until day 5-6, then several a day = normal (excessive voiding in first
12 - 24 hours of life can be due to excessive maternal fluids during labor; if baby loses
more than 10% of weight but is feeding well with many many pees & poops--DONT
WORRY)
3 "scoopable" stools or more a day by day 4= normal
All infants will lose weight; Infant should be back to birth weight by day 10 pp & one
ounce weight gain per day until 3 mos old; normal weight loss = no more than 6.6%
**What is considered the norm when assessing an infant?
healthy, vigorous, full term infants
what infant stage of behavior do infants feed best in?
quiet alert stage
what are some hunger cues and infant might display, which tells the mother she
should put infant to breast immediately?
- mouthing (rooting)
- hand to mouth
- hand swipes to mouth
- sucking on hand
- tonguing
- head bobbing
what is the best intervention of under or over-aroused infants to help get them to
feed?
skin to skin
what is the Dancer Hand Position?
position mothers can use during breastfeeding to help support the breast and the
infant's jaw simultaneously during a feed
*very useful for hypotonic babies (i.e. LPT, Downs, preterm, mandibular asymmetry)`
what is the best way to know that breastfeeding is going well?
PAIN FREE WEIGHT GAIN
What is the best way to identify sick infants, which need further assessment and
intervention
Infants that dont want to eat:
- baby refuses to nurse 2x in a row
- 3 poor feedings in a row, after good feedings have been established
*Baby's physician needs to be contacted
what is another name for mongolian spots?
gray slate nevus
can a mother breastfeed an infant with galactosemia?
NO
Common traits in Down Syndrome:
- low muscle tone*
- flat facial features
- upward slant to eyes
- low set ears
- enlarged tongue
- super flexible
- single crease in palm of hand
- excessive spacing between toes
- congenital heart conditions
Is it okay to breastfeeding during a pregnancy?
Yes, unless mother has hx of preterm labor
What are the best practices to exhibit when counseling breastfeeding women?
- provide small, tidbits of information at various times so as not to overwhelm mother
- counsel women AT LEAST 4x for best outcomes
- face to face counsel sessions
- get on same eye level as mother (ex. sit knee-to-knee)
- eye contact
- be conscious of: tone of voice, body language, and facial expressions
- interact with mothers to allows them to participate in learning/counseling (ask
questions, etc.)
- address/focus on mother's needs & concerns
TOP THREE:
- Ask OPEN-ENDED questions
- Affirm feelings
- Educate
What is the most important goal in helping breastfeeding mothers achieve for
success?
CONFIDENCE
which hormone helps keep milk production under control until after delivery?
Progesterone--levels drop after delivery of placenta & milk production begins in
earnest
prolactin
hormone that builds up during pregnancy to get ready to make milk by acting on
lactoycytes; manufactures in hypothalamus and stored in anterior pituitary gland
what is the role of prolactin?
prolactin receptors develop early in lactation and remain constant after that, so
increasing prolactin levels are not needed it is permissive rather than regulatory
when is it important to establish good feeding techniques?
In the first two weeks; early and often
- Remember: 8 or more in 24 (number of feedings/day, except for possibly first 24
hours)
- some cluster feeding, some longer intervals in between
- good, quality sucking: more about quality than quantity (not all about the length of
feedings)
- rhythmical sucking with swallowing (audible) & breathing: suck/swallow/breathe
pattern
- several sucking bursts accompanied by occasional pausing
- baby's mouth wide open
- deep, ASYMMETRICAL latch (jaw pressed to breast, nose up and out)
- mother reports: fatigue, thirst, cramping
- nose & toes of infant pointing same direction
- ears, shoulders, hips of infant lined up
Once milk comes in:
- infant should appear sleepy after feeds
- 1.5- 2 hour intervals between feeds
Describe normal infant stools:
Mec: First 2 - 3 days
Transitional (greenish): Days 3- 4
Yellow/seedy: By Day 5
Remember, 3 scoopable (good sized) poops/day by day 4
what is cholecystekinin (CCK)
a GI hormone that enhances digestion & causes sedation and feeling of well being;
is released to both mother and baby within 10- 30 mins of end of feed
what is important to remember when promoting breastfeeding?
breastfeeding is normal, not sexual
- every feed counts (do not focus on rules/exclusivity)
- engagement/education (early) in pregnancy is important
- help mothers feel confident with breastfeeding
- tell the truth about BF: it can be challenging
- encouraging partner support & education for support person
- health care providers need to support BF
- breastfeeding classes, prenatal classes, etc.
List the 11 steps to SUCCESSFUL breastfeeding?
1A. Comply full with International Code of Marketing & WHA resolutions
1 B. Have a written evidence-based breastfeeding policy that is routinely
communicated to ALL health care staff (keep short & simple so they are
implementable)
1C. Establish ongoing monitoring and data-management systems in your facility
(TJC req.)
- Educate staff- Ensure they have sufficient knowledge, competence, and skills to
support breastfeeding (this includes ALL interdisciplinary team members in a facility)
& evaluate staff attitudes towards BF
- Prenatal education- discuss importance & management of BF with pregnant
women and and their families at prenatal visits and classes/tours
- Skin to skin- immediately & uninterrupted for at least 60 minutes
- Maintain lactation & essential education- positioning & latching, prevention of sore
nipples & engorgement, how to tell infant is "getting something", nutritional concerns
- Breastfeed Exlusively- nothing other than breast milk unless medically indicated
- Rooming in- remain together 24 hours a day, decrease interruptions on PP unit
(cluster cares)
- Breastfeed on cue- recognize hunger cues & respond, do not feed "according to a
clock"
- No bottles/pacis- prevent nipple and/or flow confusion
- Support groups & follow ups- discharge planning for follow-up, breastfeeding
support groups & resources within 3 weeks or less
- Interventions- decrease the use of interventions during the labor process; honor
& support mother's wishes & birth plan & offer nonpharm pain relief methods when
possible
What baby-friendly practices & initiatives can help initiate & protect against early
termination of breastfeeding?
- Breastfeed within first hour
- Give only breast milk (exclusive breastfeeding)
- Rooming in
- Breastfeed on demand
- No pacifier use
- Provide info on BF support on discharge
What are some birthing practices that HCPs and CLS's can delay to promote
bonding and breastfeeding between mothers & infants?
- infant physical exam in L&D
- infant weight
- suctioning
- eyes (after first feed) & thighs (within 4 hrs)
- painful procedures
- swaddling
- maternal-infant separation
Are L&D interventions for mothers, such as IVs, EFM, pitocin, and eating/drinking
restrictions evidence-based?
No! Often they are encouraged by HCPs because L&D is associated with risk and
danger.
What is the trouble with epidurals in labor?
- often cause a cascade of events which can impact ease of breastfeeding
- change mother's muscular status, which makes delivery harder and increases
length of second stage of labor
- lead to lower oxytocin levels during and following labor
- pain meds (ie fentanyl) significantly decrease likelihood of baby suckling while skin
to skin during first hour
- epidural medications CAN get into baby via blood, etc.
what are some negative effects of using synthetic oxytocin (pitocin) during labor?
- antidiuretic effect: edema in moms breasts causing latch issues due to firm nipples
(babies also retain water weight from IV therapy during labor causing inaccurate birth
weight, and often excessive diuresis in first 12-24 hours)
- lower apgar scores
- unexpected NICU admissions
- neonatal jaundice
- the longer epidural medications & pitocicin runs with inductions, pp, etc., the
lower the moms own endogenous oxytocin levels during breastfeeding,
causing difficulties with establishing BF
