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Alpp Certified lACtAtion Counselor (ClC) 3 exAm newest 2026 with Complete Questions And CorreCt detAiled Answers (Verified Answers) |AlreAdy GrAded A+||BrAnd new Version!! women who do not breastfeed - CorreCt Answer-are at greater risk for myocardial infarction and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and ovarian cancer WHO and UNICEF three strategies - CorreCt Answer-for increased breastfeeding initiation and duration in every country: promotion, protection, and support breastfeeding promotion - CorreCt Answer-focuses on advantages of breastfeeding on a personal, community, country, or global level breastfeeding protection - CorreCt Answer-focuses on government, manufacturer, and social responsibility to assure breastfeeding's ability to compete with commercial interests; includes addressing improper marketing practices; the AAP advices not to provide formula, company gift bags, and industry-authored handouts; in the US, state and local breastfeeding legislation addresses breastfeeding in public, employment issues, jury duty, family law, mothers in prison, etc. breast feeding: a public health priority - CorreCt Answer-has been recognized as a public health priority in tropical climates since the 1930's, but not until the 1990's in the US costs to prevent needless deaths - CorreCt Answer-less than $6 billion/year worldwide suboptimal breastfeeding - CorreCt Answer-accounts for more than 3,340 maternal and child deaths a year, 80% are maternal nursing a baby for a year or more - CorreCt Answer-decreases by 10-15% the risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease
breastfeeding support - CorreCt Answer-focuses on the interaction of "helpers" with family as well as program development and implementation community expertise - CorreCt Answer-variety of community expertise is needed to promote, protect, and support breastfeeding International models - CorreCt Answer-for integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols CLC - CorreCt Answer-nationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competenct verified CLCs and IBCLCs - CorreCt Answer-health professionals who provide lactation support why is breastfeeding so difficult? - CorreCt Answer-1. unrealistic expectations
- lack of timely interventions unrealistic expectations - CorreCt Answer-lack of preparation for what the newborn period would look like lack of timely interventions - CorreCt Answer-mother's problems at 3 to 7 days posed as the greatest risk to stopping breastfeeding trends - CorreCt Answer-last 150 years or som rates have declined
what contributes to low rates of ebf globally? - CorreCt Answer-- caregiver and societal beliefs favoring mixed feeding
- hospital and healthcare practices and policies that are not supportive of BF
- lack of adequate skills and support
- aggressive promotion of infant formula and other breastmilk substitutes
- inadequate maternity/paternity leave legislation
- workplace policies
- lack of knowledge about dangers of not exclusively BF and proper BF techniques how to support ebf - CorreCt Answer-increase hospital and health system capacity regarding baby friendly hospital initiative
- provide community based strategies including campaigns tailored to local context
- strengthen monitoring and enforcement of the code
- enact at least 6 months paid maternity leave
- invest in training and capacity building in protection, promotion, support disparity of US breastfeeding trends - CorreCt Answer-according to the CDC, "black mothers are less likely than white to breast-feed their babies, and here's one possible reason why: hospitals in neighborhoods with many black residents do less to promote nursing than those in areas with more white residents" anatomy of milk cells - CorreCt Answer-myoepithelial cells, connective tissue, capillaries, anteriole, venule, alveolar cells anatomy of human breast - CorreCt Answer-glandular tissue made up of clusters of alveoli and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with several duct openings
making milk - CorreCt Answer-messages from the breast travel through the nervous system to the brain, then hormones travel to the breast through the blood system hormone pathways - CorreCt Answer-two separate hormone pathways, pituitary gland is important to both prolactin levels - CorreCt Answer-go down in between nursing and rise during nursing infrequent nursing - CorreCt Answer-leads to lower levels and less rise even with the same amount of nipple contact ongoing milk production - CorreCt Answer-positively associated with suckling within the first 2 hours after birth initiation for mothers of preemies - CorreCt Answer-initiation of milk expression before one hour resulted in significantly more milk when measured on days 7 and 42 triggering oxytocin mechanism #1 - CorreCt Answer-conditioned response - conditioned milk ejection (let down) reflex
- was probably given too much importance in the years we didn't understand the other mechanisms
- conditioned over time and lasts a lifetime
- is faster for women who already have one from previous breastfeeding
- to condition response.. smell, touch, hear the stimulus triggering oxytocin mechanism #2 - CorreCt Answer-nipple stretching, happens with a proper latch
nursing pattern - CorreCt Answer-should be frequent to accommodate human milk composition stages of making human milk - CorreCt Answer-lactogenesis I, lactogenesis II, lactogenesis III lactogenesis I - CorreCt Answer-secretory differentiation, placental hormones, colostrum lactogenesis II - CorreCt Answer-secretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk lactogenesis III - CorreCt Answer-lactation, galactopoesis, prolactin from frequent nipple stimulation, frequent removal of milk, mature milk breastmilk composition - CorreCt Answer-human milk changes continually, makes it impossible to obtain a single representative sample of milk preterm milk - CorreCt Answer-appears to have a different composition for the first 5- 7 weeks after delivery independent of gestational age at delivery
- appears to be higher in protein, fat, and electrolytes than term milk
- if baby is SGA, LGA, or AGA, does not make a difference in milk composition after 1 year of lactation - CorreCt Answer-has significantly increased fat and energy contents fore vs hind milk - CorreCt Answer-foremilk is milk at the beginning of a feed, hindmilk is at the end of a feed
- used to think that hindmilk contained more fat content but it is more complex than originally described
- foremilk does not mean "low fat" and hindmilk is not always highest in fat
- sometimes foremilk and hindmilk have equal amounts of fat and we should not give mothers tules based on the ideas of fore and hindmilk breastmilk composition changes - CorreCt Answer-- over the course of lactation
- within the day
- within a feeding
- between feedings is also changes by the way it is taken babyled feeding - CorreCt Answer-"the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice baby-led feeding" maximum fat levels - CorreCt Answer-obtained 30 mins post-feed
- mothers of male infants seem to produce milk that has 25% greater energy content than mothers of female infants milk composition, milk action - CorreCt Answer-milk composition is complex, milk action is redundant
- milk is more than nutrition, bioavailability of nutrients is higher in human milk than in other foods or supplements less diarrhea - CorreCt Answer-most readily acknowledged advantage od breastfeeding, ebf makes the biggest difference in rates and severity
- 86% of diarrhea-associated infant deaths occurred among LBW infants
- if breastfed baby does get diarrhea, keeping breastfeeding makes a difference in maintaining the microbiota
diarrhea mechanisms 3 - presence of bifidus factor - CorreCt Answer-promotes intestinal presence of lactobacillus bifidus that maintain the low pH and crowd out pathogenic organisms diarrhea mechanisms 4 - presence of hormones - CorreCt Answer-hormone like factors and growth factors that stimulate growth and development of the GI tract and GI motility, such as:
- GI hormones
- prolactin
- EGF (epidermal growth factor)
- prostaglandins diarrhea mechanisms 5 - antibodies - CorreCt Answer-such as SIgA bind to microbes in the baby's intestinal tract and prevent them from being absorbed into the rest of the body. mother's IgA has been found to protect against the development of NEC in preterm infants. maternal IgA shapes the host-microbiota relationship of pretern neonates that IgA in maternal milk is critical and necessary factor for the prevention of NEC diarrhea mechanisms 6 - white blood cells - CorreCt Answer-kill microbes directly or mobilize other defenses diarrhea mechanisms 7 - cell wall disrupters - CorreCt Answer-kill microbes by destroying the cell walls, these include fatty acids and lysozymes diarrhea mechanisms 8 - B12 binding factor - CorreCt Answer-reduces the amount of B in the intestines available to microbes diarrhea mechanisms 9 - lactoferrin - CorreCt Answer-deprives bacteria of iron, disrupts the integrity of the outer membrane of bacteria, assists in intestinal maturation and in the recovery of the intestine from injury and other mechanisms
diarrhea mechanisms 10 - antimicrobial activity boosters - CorreCt Answer-such as fibronectin and gamma interferon diarrhea mechanisms 11 - mucosal wall protectors - CorreCt Answer-such as mucins and oligosaccharides, which also function as food for beneficial bacteria, adhere to microbes binding them so that they can't attach to the gut wall diarrhea mechanisms 12 - microbes - CorreCt Answer-from the mothers skin and bacteria in the mother's breastmilk seed, the infant gut underscoring diarrhea mechanisms 13 - contaminants - CorreCt Answer-absence of contaminants (bottles, teats, water) and formula ingredients diarrhea mechanisms 14 - antibodies - CorreCt Answer-a. when a mother is exposed to organisms she makes antibodies and secretes them into her milk b. another way baby is protected - cells go from the baby's mouth into the breast and antibodies are made in the breast the process of breastfeeding has effects beyond the components of the milk. breastfeeding changes both I'mmune system gastrointestinal hormones - gastrin, chloecystokinin - CorreCt Answer-promote induced insulin release and growth promoting effects in the gut gastrointestinal hormones - somatastin - CorreCt Answer-inhibits GI secretion, inhibits motility in the GI tract and the release of most GI hormones. inhibits the secretion of HGH from the pituitary and inhibits cellular growth and proliferation In the gut
infants lose more weight in the first postpartum days... - CorreCt Answer-- when labor meds are used... but perhaps not at a baby-friendly hospital
- when more intrapartum fluids have been given
- when there was no labor prior to cesarean however, supplementation rates for weight loss decreased with routine use of 24 hr weight and did not increase untoward effects during the hospital stay what do we know about breastfed babies who become dangerously undernourished? - CorreCt Answer-report by cooper & colleagues identified a significant increase in the incidence of malnutrition and hypernatremia in breastfed infants
- 5 sentinel cases in ohio began a chart review of the prior 4 years
- chart review babes were 23% below birth weight on average on readmission and showed clinical signs of dehydration and hypernatremia
- babies were: not d/c early, nursing q 3-4 or 4-6 hrs, scheduled, both breasts, 5-10. min a side, SLEEPY
- researchers found: the class was inadequate, inadequate follow up in the community post- partum how do you know about breastfeeding adequacy? - CorreCt Answer-fewer than 4 soiled diapers on day 4 when used in conjunction with delayed onset of lactation may indicate breastfeeding inadequacy
- four on four... and each day after cooper findings re: weight loss findings - CorreCt Answer-- babies were not identified before 10% weight loss
- a "contented" (sleepy) baby is NOT a well-fed baby (calorically deprived babies are sleepy)
breastfeeding associated hypernatremia - CorreCt Answer-hypernatremia is a common complication of inadequate milk transfer during breastfeeding
- completely preventable complication that seems to be relatively common hypernatremia weight loss difference - CorreCt Answer-1.6% in healthy infants vs. 16.2% in hypernatremic addmited infants hypernatremia frequency of feeds difference - CorreCt Answer-10.2 for healthy infants vs. 7.6 in the NHD admitted infants how has the AAP responded to hypernatremia? - CorreCt Answer-- ensure formal evaluation and documentation of breastfeeding by trained caregivers (including position, latch, milk transfer, examination) at least for each nursing shift
- all breastfeeding newborn infants should be seen by a pediatrician at 3-5 days of age, which is within 48-72 hours after discharge from hospital
- evaluate: hydration (elimination patterns), body weight gain (body weight loss no more than 7% from birth and no further weight loss by day 5), discuss maternal/infant issues
- observe feeding MYTH - size of the breast relates to the amount of milk - CorreCt Answer-the proportion of glandular and fat tissue and the number and size of the ducts are not related to milk production. for health providers, perceptions of who will have difficulty with breastfeeding may be related to breast size. MYTH - not getting enough fluids impacts volume of milk - CorreCt Answer-there is not enough evidence to support increasing fluid intake beyond with breastfeeding mothers are likely to require to meet their physiologic needs
MYTH - its about the types or amounts of foods eaten during laction - CorreCt Answer- humans have breastfed and are breastfeeding under conditions we can't even imagine. this is possible because:
- lactation has a lower energy cost for humans compared to other mammals
- number of kcal/day for lactation is much less than previously believed
- the body adapts with physiological mechanisms in favor of lactation in humans when the infant suckles from the breast... - CorreCt Answer-there is an outpouring of 19 different GI hormones in both the mother and the infant, including cholecystokinin, which cycles to the kidneys, and gastrin, which stimulates growth of the baby and mother's villi, increasing surface area and absorption of calories with each feeding how is it possible for humans to make milk with such a small amount of energy expenditure? - CorreCt Answer-- maternal plasma prolactin concentration generally increases under conditions of negative energy balance, which may serve to protect lactation
- changes in maternal processes can spare energy.. this may account for a third to half of the total costs of milk synthesis
- together with the low cost of human lactation and large fat reserves from pregnancy, may account for human ability to breastfeed our infants under nutritional conditions which are often far from ideal how do we assure an adequate milk supply? - CorreCt Answer-- universal understanding of how breastfeeding works
- early initiation and adequate breastfeeding (10-12x/daily)
- appropriate breastfeeding assessment
- improved and early breastfeeding support to decrease "lactastrophes"
- appropriate HCP and LCP follow-up in the postpartum (see reasons to refer)
- admitting theres no magic bullet
end - CorreCt Answer-1B
