Lactation Pre-Evaluation

The Missouri Department of Health and Senior Services is offering this program to update health providers about breastfeeding. This survey provides a baseline assessment. Please take a few minutes and complete the few questions below on your knowledge of breastfeeding.

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1. The addition of complementary foods to breastfed infants is recommended at:
a. 2 months
b. 4 months
c. 6 months
d. 12 months

2. The most common cause of poor weight gain among breastfed infants during the first four weeks after birth is:
a. infant metabolic disorders
b. infrequent or ineffective feedings
c. maternal endocrine problems
d. maternal nutritional deficiencies

3. Physiologic jaundice is most improved by:
a. breastfeeding frequently (at least 8 times in 24 hours)
b. giving glucose water after breastfeeding
c. giving water after breastfeeding
d. temporarily stopping breastfeeding and formula feed infant

4. Hospital policies that promote breastfeeding include:
a. encourage maternal rest to allow mother's milk supply to build up
b. unlimited access of mother to baby
c. use of a dropper for routine water supplementation
d. use of pacifiers to prevent sore nipples

5. The largest drop out period for breastfeeding mothers occurs at:
a. 7-10 days postpartum
b. 6-8 weeks postpartum
c. 3-4 months postpartum
d. 6-12 months postpartum

6. A breastfeeding mother with a 3-month old infant has a red tender wedge-shaped area on the outer quadrant of one breast. She has flu-like symptoms and a temperature of 39° C. Your management includes all of the following EXCEPT:
a. antibiotics for 10 days
b. extra rest
c. suspend breastfeeding for 48 hours
d. moist heat to the involved region

7. Nipple candidiasis can be associated with all of the following EXCEPT:
a. burning pain in the breast
b. fever and malaise
c. oral thrush in the infant
d. pink and shiny appearance of the nipples

8. A mother with a three-day old baby presents with sore nipples. The problem began with the first feeding and has persisted with every feeding. The most likely source of the problem is:
a. baby's suck is too strong
b. feeding too long
c. lack of nipple preparation during pregnancy
d. poor attachment

9. Which of the following is most likely to have the greatest effect on the volume of milk a woman produces?
a. maternal caloric intake
b. maternal fluid intake
c. maternal weight for height
d. supplementation of the infant with formula

10. Which of the following would you suggest to a woman with inverted nipples during the third trimester?
a. cut holes in the bra to allow the nipples to protrude
b. no intervention
c. use breast shells while awake
d. use Hoffman's maneuver four times a day

11. Which nutrition practice statement is true concerning a well-balanced diet for breastfeeding mothers?
a. poor maternal dietary intake is a contraindication for breastfeeding
b. focus on high carbohydrate intake
c. consume mainly high protein foods
d. distribute food intake according to the food pyramid

12. Which of the following is a benefit of breastfeeding, according to the American Academy of Pediatrics guidelines.
a. decreased risk of respiratory infections
b. decreased risk of otitis media
c. increased bonding with mother
d. all of the above

13. The primary goal for sharing breastfeeding information with new mothers is to:
a. talk them into breastfeeding their infants
b. ensure they can problem solve any breastfeeding challenge
c. instill confidence in the mother's ability to breastfeed

14. American Academy of Pediatrics cites the following as obstacles to successful breastfeeding EXCEPT
a. MD apathy
b. disruptive hospital practices
c. maternal illness or exhaustion
d. formula provided in hospital discharge pack

15. In the United States, women who breastfeed are more likely to be
a. in higher income bracket
b. in lower to mid income bracket

16. Ideally baby should be put to breast immediately in the delivery room.


17. Baby will room in with mom while in the hospital.


18. Baby will breastfeed as frequently as he wishes around the clock while in the hospital.


19. Breastfeeding is superior to formula feeding for infant/maternal health.


20. I would want my own children to be breastfed.


21. Breastfeeding is a priority topic for health care providers to understand.


22. Who do you think is the most important person for making health care decisions related to breastfeeding?
       If other, then who:

23. Skills you feel you need to develop related to breastfeeding.

Questions 24-29 follow JC, a 22 year-old G1P0 (one pregnancy, no deliveries) through pregnancy, delivery, and caring for her child in the early months. Please read each question and select the best response from those provided.

24. JC is in clinic for her 13-week prenatal visit. Her clinic course in unremarkable. When asked about infant care, she responds, "I have heard breastfeeding is better for the baby. Is there really any difference how I feed my baby?" As JC's health professional, how would you respond?

a. Explain that both formula feeding and breastfeeding have pros and cons.
b. Provide clear messages that breastfeeding is best.
c. Refer JC to a lactation consultant.

25. JC is at 32 weeks gestation and her clinic course remains unremarkable. She asks about preparing for labor and delivery. She also states, "my mom says I should toughen my nipples. Do I need to do something to get ready to breastfeed?" As JC's health care provider, how would you respond?

a. Explain to JC that breastfeeding is a natural process that requires no special physical preparation.
b. Instruct JC to use nipple shells to help her nipples to protrude.
c. Instruct JC to roll her nipples to toughen them.

26. At her 32 week visit, JC also asks if there are certain foods she needs to include or avoid in her diet during breastfeeding? As her health care provider, what guidance would you give JC?

a. Follow the food guide pyramid for a healthy diet.
b. Instruct her to drink plenty of milk to aid in milk production.
c. Suggest JC focus on high protein food sources.

JC delivered a healthy male with no congenital abnormalities at 38-5/7 weeks. He weighed 3.17 kg (7.0 lb) and was 51 cm (20 in) long. JC breastfed the first time in the delivery room. Her son had no problems with latch on, and fed every 2-4 hours while in the hospital. The hospital staff was helpful and answered her questions. JC and her son were discharged 48 hours postpartum. At 7 days postpartum, JC calls expressing concern about the adequacy of her milk supply. She reports her baby is fussy, her breasts are no longer enlarged, and she is very tired. Her baby seems hungry much of the time. Her mother has suggested she supplement her breastmilk with formula.

27. JC asks if she needs to supplement with formula. Assuming the baby is growing well, as her health care provider, what area would you address with JC?

a. Provide guidance on growth spurts.
b. Provide information on physiological engorgement.
c. Reassure JC that her milk is adequate for her baby.
d. All of the above.

28. JC asks if her breastmilk is inadequate and she should just formula feed. As her health care provider, how would you respond?

a. Reassure JC that she can produce adequate milk for her baby.
b. Have JC start to express her milk and measure the amount the baby is eating.
c. Give JC some tips on what to look for to assure her baby is getting enough milk: # wet diapers, # stools, weight gain, etc.
Both a and c.

29. JC is at her son's 9-month well baby check. JC states she does not want to breastfeed her son too long. When does she need to wean him?

a. Tell JC that the American Academy of Pediatrics recommends breastfeeding for 12 months.
b. Explain to JC that there is no set time to wean; she can nurse her son as long as it is mutually desired.
c. Tell JC that she will need to wean her son when he starts to get teeth.