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ALPP CLC Exam 1 Actual Exam 2026 /202 7 Questions And
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Which of the following is true about weight gain from birth through the first two months in exclusively breastfed infants? a) most babies will lose around 10% of their birth weight within the first three days of life, b) infants should regain their birth weight by 10-14 days of age, c) between 2 and 6 weeks, the average daily weight gain is 24-26 grams, or d) an infant who is gaining 10 grams per day in considered FTT - ANSWER-b) infants should regain their birth weight by 10-14 days of age What temperature should water that is to be mixed with powdered formula be to kill the Cronobacter sakazkii bacteria? a) boiled water cooled to body temperature, b) room temerature, c) at least 158 deg F, or d) boiling - ANSWER-c) at least 158 deg F Which of the following would most likely be the best treatment for a yeast infection of the nipples? a) oral antifungal prescription medication, b) antifungal ointment, c) coconut oil, or d) eliminate yeast foods from her diet - ANSWER-b) antifungal ointment
Which of the following elements is increased in the milk of mothers who deliver preterm infants? a) LCPUFAs, b) lactose, c) calories, or d) calcium - ANSWER-a) LCPUFAs Polly tells you that April has really been fussy at feeds, and though she is gaining well, Polly is just sure there is something wrong. Of the following, which is the most important for you to do during the assessment? a) oral digital exam, b) before and after feeding weights, c) infant hydration status, or d) observation of behavior during the feed - ANSWER-d) observation of behavior during the feed Lindsey, 7 months pregnant, has just been diagnosed as an insulin- dependent diabetic. She is concerned that she will not be able to breastfeed. What information will be most helpful to her? a) after the delivery she may have to decrease her caloric intake, b) after delivery she may find her insulin needs are decreased, c) it's going to be in her best interest to not breastfeed, or d) when she weans her baby, her insulin levels will vary - ANSWER-b) after delivery she may find her insulin needs are decreased breast feeding: a public health priority - SOLUTION=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 - SOLUTION=less than $6 billion/year worldwide
breastfeeding promotion - SOLUTION=focuses on advantages of breastfeeding on a personal, community, country, or global level breastfeeding protection - SOLUTION=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. community expertise - SOLUTION=variety of community expertise is needed to promote, protect, and support breastfeeding International models - SOLUTION=for integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols CLC - SOLUTION=nationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competenct verified CLCs and IBCLCs - SOLUTION=health professionals who provide lactation support
why is breastfeeding so difficult? - SOLUTION=1. unrealistic expectations
- lack of timely interventions breastfeeding support - SOLUTION=focuses on the interaction of "helpers" with family as well as program development and implementation unrealistic expectations - SOLUTION=lack of preparation for what the newborn period would look like lack of timely interventions - SOLUTION=mother's problems at 3 to 7 days posed as the greatest risk to stopping breastfeeding trends - SOLUTION=last 150 years or som rates have declined international code of matketing of breastmilk substitutes (the code) - SOLUTION=an international health policy framework to regulate the marketing of breastmilk substitutes in order to protect breastfeeding
- published by the WHO in 1981
- internationally agreed voluntary code of practice
- written in response to the marketing activities of the infant feeding indurstry which were promoting formula feeding over breastfeeding,
- 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 the code - SOLUTION=regulates the marketing of breastmilk substitutes which includes infant formulas, follow-on formulas, and any other food or drink, together with feeding bottles and teats, intended for babies and young children; sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries how to support ebf - SOLUTION=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 - SOLUTION=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 - SOLUTION=myoepithelial cells, connective tissue, capillaries, anteriole, venule, alveolar cells anatomy of human breast - SOLUTION=glandular tissue made up of clusters of alveoli and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with several duct openings hormone pathways - SOLUTION=two separate hormone pathways, pituitary gland is important to both prolactin levels - SOLUTION=go down in between nursing and rise during nursing infrequent nursing - SOLUTION=leads to lower levels and less rise even with the same amount of nipple contact
hormones of lactation - SOLUTION=have an emotional/behavioral function as well as making and moving milk; aggression, protection, bonding & trust milk composition - SOLUTION=is complex - each species of mammal milk is different
- milk is "species specific" carry, follow, or hibernate - SOLUTION=mammal species with hither water content milk have more frequent feeds carry = koala follow = elephants hibernate = bears our culture - SOLUTION=wants us to be nesters when it comes to feeding, but our milk composition indicates that we should be carriers the brain - SOLUTION=most rapidly developing organ in human newborns; human milk is the ideal fuel for brain growth nursing pattern - SOLUTION=should be frequent to accommodate human milk composition
stages of making human milk - SOLUTION=lactogenesis I, lactogenesis II, lactogenesis III lactogenesis I - SOLUTION=secretory differentiation, placental hormones, colostrum lactogenesis II - SOLUTION=secretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk lactogenesis III - SOLUTION=lactation, galactopoesis, prolactin from frequent nipple stimulation, frequent removal of milk, mature milk nest or cache - SOLUTION=mammal species with high fat/protein and low water content = infrequent feeds nest = bunnies cache = deer breastmilk composition - SOLUTION=human milk changes continually, makes it impossible to obtain a single representative sample of milk preterm milk - SOLUTION=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
milk composition, milk action - SOLUTION=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 - SOLUTION=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 mechanisms by which ebf protects from diarrhea - SOLUTION=1. ph of gut
- low iron in gut
- presence of bifidus factor
- presence of hormones
- antibodies such as SIgA
- white blood cells
- cell wall disrupters
- B12 binding factor
- lactoferrin
- antimicrobial activity boosters
- mucosal wall protectors
- microbes
- absence of exposure to contaminants
- antibodies
- synergistic effect diarrhea mechanisms 1 - ph of the gut - SOLUTION=breastfed babies' gut is more acidic while formula-fed babies' guts are more neutral/basic gut bacterial colonies (the microbiome) of mixed fed babies are similar to exclusively formula fed babies diarrhea mechanisms 2 - low iron in the gut - SOLUTION=relatively low iron content in human milk diarrhea mechanisms 3 - presence of bifidus factor - SOLUTION=promotes intestinal presence of lactobacillus bifidus that maintain the low pH and crowd out pathogenic organisms diarrhea mechanisms 4 - presence of hormones - SOLUTION=hormone like factors and growth factors that stimulate growth and development of the GI tract and GI motility, such as:
diarrhea mechanisms 7 - cell wall disrupters - SOLUTION=kill microbes by destroying the cell walls, these include fatty acids and lysozymes diarrhea mechanisms 8 - B12 binding factor - SOLUTION=reduces the amount of B12 in the intestines available to microbes diarrhea mechanisms 9 - lactoferrin - SOLUTION=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 - SOLUTION=such as fibronectin and gamma interferon diarrhea mechanisms 11 - mucosal wall protectors - SOLUTION=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 - SOLUTION=from the mothers skin and bacteria in the mother's breastmilk seed, the infant gut underscoring diarrhea mechanisms 13 - contaminants - SOLUTION=absence of contaminants (bottles, teats, water) and formula ingredients
diarrhea mechanisms 14 - antibodies - SOLUTION=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 - SOLUTION=promote induced insulin release and growth promoting effects in the gut gastrointestinal hormones - somatastin - SOLUTION=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 what increases gastrin and decreases somatostatin in babies? - SOLUTION=- sucking babies have cutaneous (touch) receptors in their mouths that respond to sucking starting at 27 weeks gestation
- species own milk
- decreased stress
- touch
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? - SOLUTION=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? - SOLUTION=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 - SOLUTION=- 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 - SOLUTION=hypernatremia is a common complication of inadequate milk transfer during breastfeeding
- completely preventable complication that seems to be relatively common hypernatremia weight loss difference - SOLUTION=1.6% in healthy infants vs. 16.2% in hypernatremic addmited infants hypernatremia frequency of feeds difference - SOLUTION=10.2 for healthy infants vs. 7.6 in the NHD admitted infants how has the AAP responded to hypernatremia? - SOLUTION=- 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 35 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
