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ALPP CLC REAL ACTUAL EXAM 2025 CERTIFIED LACTATION
COUNSELOR REAL/AUTHENTIC PROCTORED EXAM COMPLETE
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breast feeding: a public health priority 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 less than $6 billion/year worldwide suboptimal breastfeeding accounts for more than 3,340 maternal and child deaths a year, 80% are maternal nursing a baby for a year or more decreases by 10-15% the risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease women who do not breastfeed 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 for increased breastfeeding initiation and duration in every country: promotion, protection, and support breastfeeding promotion focuses on advantages of breastfeeding on a personal, community, country, or global level breastfeeding protection
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. breastfeeding support focuses on the interaction of "helpers" with family as well as program development and implementation community expertise variety of community expertise is needed to promote, protect, and support breastfeeding International models for integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols CLC nationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competenct verified CLCs and IBCLCs health professionals who provide lactation support why is breastfeeding so difficult?
- unrealistic expectations
- lack of timely interventions unrealistic expectations lack of preparation for what the newborn period would look like lack of timely interventions mother's problems at 3 to 7 days posed as the greatest risk to stopping
the world breastfeeding trends initiative intended to track, assess, and monitor the implementation of the "global strategy" at the country and sub-country level what contributes to low rates of ebf globally?
- 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 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 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 myoepithelial cells, connective tissue, capillaries, anteriole, venule, alveolar cells anatomy of human breast 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
messages from the breast travel through the nervous system to the brain, then hormones travel to the breast through the blood system hormone pathways two separate hormone pathways, pituitary gland is important to both prolactin levels go down in between nursing and rise during nursing infrequent nursing leads to lower levels and less rise even with the same amount of nipple contact ongoing milk production positively associated with suckling within the first 2 hours after birth initiation for mothers of preemies initiation of milk expression before one hour resulted in significantly more milk when measured on days 7 and 42 triggering oxytocin mechanism # 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 # nipple stretching, happens with a proper latch triggering oxytocin mechanism # baby hand massage, each hand movement releases oxytocin hormones of lactation have an emotional/behavioral function as well as making and moving milk; aggression, protection, bonding & trust
secretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk lactogenesis III lactation, galactopoesis, prolactin from frequent nipple stimulation, frequent removal of milk, mature milk breastmilk composition human milk changes continually, makes it impossible to obtain a single representative sample of milk preterm milk 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 has significantly increased fat and energy contents fore vs hind milk 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
- over the course of lactation
- within the day
- within a feeding
- between feedings is also changes by the way it is taken
babyled feeding "the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice baby-led feeding" maximum fat levels 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 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 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
- 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
diarrhea mechanisms 8 - B12 binding factor reduces the amount of B12 in the intestines available to microbes diarrhea mechanisms 9 - lactoferrin 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 such as fibronectin and gamma interferon diarrhea mechanisms 11 - mucosal wall protectors 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 from the mothers skin and bacteria in the mother's breastmilk seed, the infant gut underscoring diarrhea mechanisms 13 - contaminants absence of contaminants (bottles, teats, water) and formula ingredients diarrhea mechanisms 14 - antibodies 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 promote induced insulin release and growth promoting effects in the gut gastrointestinal hormones - somatastin
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?
- sucking babies have cutaneous (touch) receptors in their mouths that respond to sucking starting at 27 weeks gestation
- species own milk
- decreased stress
- touch
- wellness adult GI hormones also impacted by suckling when mother suckles her gastrin and cholecystokinin go up. this increases the efficacy of insulin and increases the storage of ingested nutrients pregnancy & breastfeeding in re: to T2DM pregnancy itself may bring an increased risk for Type 2 diabetes in the mother, which breastfeeding can negate. compared with women who have not had children, childbearing women who do not breastfeed have a 50% increased risk of T2DM in later life weight loss in the BF neonate in first date after birth, most babies lose weight, some from normal diureses AAP weight loss stance in 2005 "weight loss in the infant of greater than 7% from birth weight indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible intervention to correct problems and improve milk production and transfer" AAP weight loss stance in 2012
- 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 hypernatremia is a common complication of inadequate milk transfer during breastfeeding
- completely preventable complication that seems to be relatively common hypernatremia weight loss difference 1.6% in healthy infants vs. 16.2% in hypernatremic addmited infants hypernatremia frequency of feeds difference 10.2 for healthy infants vs. 7.6 in the NHD admitted infants how has the AAP responded to hypernatremia?
- 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 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 there is not enough evidence to support increasing fluid intake beyond with breastfeeding mothers are likely to require to meet their physiologic needs MYTH - exercising or working too hard impacts supply
maternal exercise when breastfeeding was not related to changes in macronutrients or volume or infant weight gain or growth. rest is not associated with increased milk production. MYTH - not getting enough rest "fatigue" may be tiredness, but also may be a symptom of an underlying medical problem that could affect milk supply. MYTH? worry/stress?? increased worry/stress does not seem to directly diminish milk supply in humans, however...
- worry/stress may alter behavior, which may alter supply maternal stress breastfeeding mothers may perceive less stress compared to formula fed mothers, breastfeeding mothers:
- had more positive moods
- reported more positive events
- perceived less stress stress & hormones stress + male hormones = fight or flight stress + oxytocin + female hormones = tend and befriend postpartum post traumatic stress disorder (PP-PTSD) up to 9% of PP women met the DSM-5 criteria for PTSD after childbirth two conditions that increase odds of PP-PTSD
- depressive symptom scores
- total number of physical symptoms experienced since birth MYTH - its about the types or amounts of foods eaten during laction 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
c) Soy d) Eggs c) Soy Julie, a first time mom, tells you that her baby was very fussy last night, which was the baby's second night. You know that this is most likely due to: a) Her milk isn't in yet, and the baby is hungry b) She's exhausted and is magnifying the situation c) The mom is uptight and transmitting her nervousness to the baby d) Overwhelming CNS stimulation in the baby d) Overwhelming CNS stimulation in the baby Alyssa reports that Ethan falls asleep whenever the nurses bring him to here to breastfeed. Which of the following would be the most helpful advice? a) Room-in with Ethan, watching him for feeding cues b) Wake him by washing his face with a cool, damp cloth c) Make sure the nurses bring him in as soon as he cries d) Coax him to the breast using drops of glucose water on the nipple a) Room-in with Ethan, watching him for feeding cues Babies who have early contact with their mothers and who were provided with postpartum support are more likely to: a) Have a faster weight gain than babies who are separated from mom b) Be able to sleep in their own room by one month c) Be breastfed long enough to meet the mother's goals d) Breastfeed more frequently at night d) Breastfeed more frequently at night On the physical exam of a 28-week preterm infant , which of the following is likely to be found? a) Lanugo all over the body b) Dry and peeling skin c) Palpable breast buds d) Ability to coordinate suck, swallow, and breathe a) Lanugo all over the body
Cherie, a new mother, with a 4-week-old infant, visits you for a breastfeeding evaluation. In the process of taking her history, you find that Cherie eats mostly chips, cookies and soda "because she is just too busy to prepare anything". Your MOST IMPORTANT concern with Cherie's diet is: a) The quality of her breast milk b) The quantity of her breast milk c) The health of the baby d) The depletion of Cherie's nutrient stores d) The depletion of Cherie's nutrient stores Halli is now 2-hours-old and still has not shown any interest in nursing. You do a blood sugar test on Halli, and find that it's 38 mg/dL, which is lower than your hospital standard of 40 mg/dL. What should you do first? a) Put her under the warmer as she is most likely hypothermic b) Give her 1 oz. of formula by finger-feeding c) Have mom hand express colostrum and feed her with a spoon d) Wait about 30 seconds and use a second reagent strip to check the glucose d) Wait about 30 seconds and use a second reagent strip to check the glucose Mothers with breastfeeding problems may be hesitant to seek help from a professional for the following reason: a) Lack of insurance coverage for lactation services b) Having to leave her home to seek help c) Stress of having to repeat "her story" to multiple people d) Having problems is in conflict with the image of being a super-mom, which she wants to portray d) Having problems is in conflict with the image of being a super-mom, which she wants to portray A type of research that focuses on relationships among variables is called: a) Qualitative b) Quantitative c) Statistically significant d) Randomized controlled trials b) Quantitative
suggestion will you make first? a) You need to make sure the feedings are finished within 45 minutes so both of you can get rest b) Reuben needs a supplement, which will provide him with additional calories c) You need to use a nursing supplementer to give Reuben the extra calories he needs and provide some breast stimulation at the same time d) To increase your milk supply, you are going to need to pump with a quality breast pump and take some galactogogues b) Reuben needs a supplement, which will provide him with additional calories Infants who have a higher than average number of bowel movements during the first 3 DOL will probably exhibit which of the following: a) Dehydration as evidenced by poor skin turgor b) Later transition to yellow stools c) Higher bilirubin levels on day 5 d) Weight loss greater than 10% on day 4 d) Weight loss greater than 10% on day 4 For a mother to have adequate levels of vitamin D in her milk in order to pass at least 400 IU to the baby, she needs to: a) Use a sun screen of less than SPF 30 when out in the sun b) Have a 25-(OH)-D serum level of at least 58 ng/mL c) Take 400 IU of vitamin D each day of her pregnancy d) Drink 3, 8 oz. glasses of vitamin D fortified milk a day and have fish high in vitamin D 2x/week b) Have a 25-(OH)-D serum level of at least 58 ng/mL A "nursing strike" may occur because of: a) Introduction of solid foods b) Infant no longer has an interest in the breast c) Start of mother's menses d) Mother starts a food reduction program c) Start of mother's menses
Florence birthed Josh at 32 weeks of gestation. Which of the following would be the first thing to include as a part of her pumping plan? a) Begin expressing within the first hour post-birth b) Determine her nipple size to provide her with the appropriate flange c) Use a hospital grade breast pump d) Pump using a double pumping system a) Begin expressing within the first hour post-birth Increased rates of autism spectrum disorders (ASD) are seen in children who: a) Received less than 1 hour of skin-to-skin after birth b) Received formula supplements in the first week of life c) Were formula-fed from the beginning of life d) Were exclusively breastfed for less than 3 months c) Were formula-fed from the beginning of life Which of the following statements about lactose in human milk is true? a) Lactose provides 60% of the calories in human milk b) Lactose is essential for CNS development c) Lactose is decreased in human milk when the mother eliminates dairy d) Lactose concentration decreases from 2-16 weeks b) Lactose is essential for CNS development Daisy, who is 21 days postpartum, is seen in the outpatient clinic with burning, painful, red nipples for the last 4 days. Which of the following is most likely to be a cause of her sore nipples? a) Baby has a shallow latch b) Allergic reaction to lanolin c) Her infant is tongue tied d) She has a yeast infection d) She has a yeast infection Hope is 3 weeks postpartum and doesn't have enough breast milk. Her history and exam haven't yielded any reason for the low supply. Which test would you want to have done first to possibly provide a reason for low milk supply? a) Thyroid levels
