Free CLC Exam Flashcards

Lactogenesis I begins mid-pregnancy, giving the breast the capacity to secrete colostrum. Lactogenesis II (secretory activation) is triggered by the drop in progesterone after placental delivery, starting ~30-40 hours postpartum, with copious milk typically arriving by days 3-5.

Prolactin drives milk SYNTHESIS for future feeds — its level after a feed predicts how much milk will be made next time, not how much is available now. Oxytocin drives milk EJECTION (let-down) of milk already made, and can be conditioned by cues like hearing the baby cry.

The Feedback Inhibitor of Lactation is a whey protein in milk that locally slows production once a breast is full. Because control is per-breast (autocrine), not just hormonal (endocrine), emptying one breast more often increases that breast's output independent of the other side.

The alveolus is the grape-like sac lined with lactocytes that synthesize milk. Myoepithelial cells surround each alveolus and contract in response to oxytocin, squeezing stored milk into the ducts — they don't make milk, they move it.

Colostrum is produced in small amounts (a few mL per feed on day 1) by design, not deficiency — it matches a newborn's tiny, non-distensible stomach capacity while delivering concentrated immunoglobulins and protein.

Fat content rises gradually as a breast empties during a feed. Switching to the second breast too quickly repeatedly can shift an infant toward lower-fat, higher-volume milk — one contributor to green, frothy stools and fussiness in some babies.

Small sebaceous glands on the areola that secrete an oily, antimicrobial fluid to lubricate and protect the nipple-areola complex. They are not milk-producing structures.

Storage capacity (how much milk a breast holds between feeds) varies widely between mothers, but it does not limit a mother's total 24-hour milk-making capacity. A mother with smaller storage capacity can still meet her infant's needs by feeding more frequently.

Widely spaced, tubular or conical breast shape, marked asymmetry, and little to no breast change during pregnancy can suggest insufficient glandular tissue. This is a risk factor for low supply even when latch and feeding frequency are optimal, and may warrant a supplementation plan.

Asymmetric latch with more areola visible above the lip than below, chin buried in the breast, lips flanged outward, and a wide mouth angle. A shallow latch instead produces clicking sounds and a pinched, lipstick-shaped nipple after feeds.

Nutritive sucking shows a slow, rhythmic suck-suck-swallow pattern with audible swallows, confirming milk transfer. Non-nutritive sucking is quick and fluttery with no swallow sound — normal for comfort, but not a substitute for confirming intake.

Cross-cradle hold supports the infant's head and shoulders with the arm opposite the feeding breast, giving extra head control useful for newborns still learning to latch. Cradle hold, cupping the head in the same-side arm, suits older infants with steadier head control.

Tucking the infant along the mother's side, feet toward her back, keeps weight off the abdomen after a cesarean birth and gives extra visibility/control for large breasts or twins fed simultaneously.

A reclined, gravity-assisted position that lets newborn reflexes (rooting, bobbing toward the breast) do more of the work. It's often recommended for babies who gag or choke with a fast, overactive let-down because gravity slows the milk flow.

True nipple confusion — a disorganized suck pattern when switched between breast and bottle — is uncommon. Far more often, infants develop a flow preference: they favor the faster, more consistent flow of a bottle after repeated exposure, which is why supplementation method matters.

Look for audible swallowing, breast softening during the feed, and the infant releasing the breast spontaneously and appearing satisfied — not just how many minutes were spent latched. Time at breast alone does not confirm adequate transfer.

Brief pain in the first 30 seconds of a latch that eases as the feed continues is common in the early days as tissue adjusts. Pain that persists throughout the feed, or that leaves cracked/bleeding nipples, signals a shallow or misaligned latch that needs correction.

Restricted tongue extension and lateral movement can prevent a deep latch, causing nipple damage, clicking sounds, and poor milk transfer despite good positioning technique. Suspected tongue-tie affecting feeding should be referred for clinical assessment.

A nipple shield can help with flat/inverted nipples or a very premature infant's weak suck. The risk is reduced nipple stimulation and milk transfer if used long-term without a monitoring and weaning plan, since it can mask ineffective feeding.

Engorgement is typically bilateral, diffuse breast fullness and firmness without fever. Mastitis usually presents unilaterally as a wedge-shaped area of redness and warmth, accompanied by fever and flu-like body aches.

Continue breastfeeding or expressing milk on the affected side rather than stopping — abruptly weaning that breast increases the risk of the infection progressing to an abscess. Frequent milk removal, rest, and antibiotics if no improvement in 24-48 hours are the standard approach.

A plugged (blocked) duct causes a firm, tender, localized lump without fever. Left unmanaged, the milk stasis behind the blockage can become inflamed and progress into mastitis, so early frequent removal from that area matters.

Vasospasm (Raynaud's-type) causes nipple blanching followed by blue/red color changes and burning pain after a feed, often triggered by cold. Candida (thrush) causes burning during and after feeds with shiny, pink nipples and deep, shooting breast pain, sometimes alongside infant oral thrush.

Block feeding (offering one breast for a set period before switching) can reduce oversupply, but must be introduced gradually — cutting removal too abruptly raises the risk of engorgement and mastitis rather than solving the problem.

Herbal or prescription galactogogues should only be considered after correcting the more common causes of low supply — infrequent or ineffective milk removal and latch problems. Reaching for a galactogogue before fixing removal frequency treats the wrong problem.

A technique that gently pushes areolar swelling (engorgement-related edema) back toward the chest wall immediately before latching, making the nipple easier to grasp. It targets the edema itself, unlike pumping alone, which can sometimes worsen areolar swelling.

Late preterm infants (about 34-36 weeks) can look full-term but tire quickly at the breast, have less coordinated suck-swallow-breathe patterns, and carry higher jaundice risk — often requiring supplemental pumping to protect maternal supply while feeding stamina develops.

Breastfeeding (suboptimal-intake) jaundice appears days 2-4 from inadequate milk transfer and is corrected by improving feeding frequency/effectiveness. Breast milk jaundice appears later (after day 5-7), can last weeks, and occurs in a thriving, well-gaining baby — it rarely requires stopping breastfeeding.

Weight loss up to about 7% of birth weight is generally within normal limits if the infant regains birth weight by 10-14 days. Loss beyond that threshold should prompt a feeding assessment and consideration of a supplementation plan.

Holding the bottle horizontally with frequent pauses lets the infant control the pace, mimicking breastfeeding flow. Standard fast, continuous bottle feeding risks overfeeding and reinforces a preference for the bottle's faster flow.

Most maternal medications are compatible with breastfeeding; risk depends on factors like infant age, drug lipid solubility, and protein binding rather than a blanket rule. The default should be checking a reliable reference (e.g., LactMed) rather than automatically recommending weaning.

When a preterm or NICU infant cannot yet feed directly at the breast, starting hand expression or pumping within the first few hours after birth — and continuing frequently — is critical to establishing an adequate milk supply for later.

Genuine contraindications include classic infant galactosemia, untreated active maternal tuberculosis, and certain chemotherapy or radioactive isotope treatments. A common cold, mastitis, and most medications are NOT contraindications, despite being common myths that lead to unnecessary weaning.

WHO growth standards describe how breastfed infants SHOULD grow as the norm. CDC charts are based on a mixed feeding-method reference population. Plotting an exclusively breastfed infant on CDC charts can make normal growth look like falling off the curve.

By day 4-5 and beyond, expect roughly 6+ wet diapers per day and a transition to yellow, seedy stools. Fewer wet diapers or continued dark stools past day 5 signals a possible intake problem needing feeding assessment.

Clusters of unusually frequent feeding at common ages reflect a temporary increase in infant demand, not a failing supply. Mistaking this normal pattern for insufficient milk is a leading reason mothers introduce unnecessary formula supplementation.

Solid foods are introduced around 6 months alongside continued breastfeeding — as a complement to milk, not a replacement for it, since breast milk remains a major nutrition source well into the second year.

Human milk is naturally low in vitamin D, so exclusively (and partially) breastfed infants need a vitamin D supplement starting soon after birth — this is a supplementation need, not a sign that breast milk is deficient overall.

Most well-nourished breastfeeding mothers do not need to eliminate entire food groups or follow a special diet. Unnecessary elimination diets can reduce maternal nutrient intake without resolving the infant fussiness they were meant to fix.

Once an infant has regained birth weight (typically by 10-14 days), steady ongoing weight gain is the benchmark counselors track to judge whether feeding is adequate — not just the initial regain milestone alone.

Lactation increases maternal energy needs only modestly above baseline; most well-nourished mothers do not require significant dietary changes or restrictive eating to support milk production.

The International Code of Marketing of Breast-milk Substitutes restricts how formula companies market their products — for example, prohibiting free samples to mothers and idealizing imagery. Counselors should recognize Code-violating materials rather than pass them along.

A WHO/UNICEF framework of hospital practices — including early skin-to-skin contact, rooming-in, and avoiding unnecessary supplementation — shown to increase breastfeeding initiation and exclusivity rates compared with standard hospital routines.

A CLC provides breastfeeding education, basic problem-solving, and counseling support. Complex clinical management — such as evaluating suspected tongue-tie for revision or persistent poor weight gain — falls outside CLC scope and should be referred to an IBCLC or physician.

Active, non-directive listening — reflecting back what a mother says rather than immediately offering solutions — builds trust and often surfaces the mother's own concerns and goals, which is more effective than leading with unsolicited advice.

Open-ended questions ("What are you hoping breastfeeding will look like for you?") elicit a mother's own goals and ambivalence, in contrast to closed yes/no questions that shut down conversation and reveal little about her actual concerns.

Immediate skin-to-skin contact supports newborn thermoregulation, colonization with maternal skin flora, and initiation of the first breastfeed within the first hour of life — all associated with higher rates of exclusive breastfeeding.

Effective counseling adapts to a family's cultural context around infant feeding — for example, involving extended family in decisions or acknowledging traditional practices — rather than applying one standard script to every client.

A CLC's role is to counsel and support, not to pressure. When a mother makes an informed decision not to breastfeed or to combination-feed, respecting her autonomy without judgment is part of ethical practice.

Refer to an IBCLC or physician when problems persist despite good counseling — for example, poor infant weight gain despite an apparently effective latch, suspected tongue-tie limiting feeding, or maternal mastitis with signs of abscess.