Which three assessment findings indicate that the breastfeeding client has achieved a proper latch?

A slurping or clicking sound as the infant sucks.

Audible swallowing.

Infant's tongue cups under the breast with lips flanged.

The mother can see a rhythmic sucking pattern.

Dimpling of the infant's cheeks while sucking.

Answer and Explanation

Correct Answer : B,C,D

Choice A rationale

A slurping or clicking sound indicates poor latching and is often associated with air entering the mouth due to improper seal or positioning of the infant. These sounds can reflect nipple misalignment or inadequate breast tissue placement into the infant's mouth, affecting milk transfer and leading to potential breastfeeding complications, such as nipple pain or reduced milk intake.

Choice B rationale

Audible swallowing confirms that the infant is successfully transferring milk and is properly latched. Proper latch allows efficient milk removal, which triggers swallowing reflexes. It reflects an absence of air entry and indicates that the infant is receiving milk without difficulty, promoting both nutritional intake and breastfeeding success.

Choice C rationale

The infant's tongue cupping under the breast with lips flanged ensures proper latch by creating a vacuum seal. This position prevents air leakage and allows effective milk transfer. Tongue cupping and lip flanging optimize compression of the lactiferous sinuses, supporting effective breastfeeding and minimizing discomfort for the mother.

Choice D rationale

Rhythmic sucking is a sign of coordinated latch and feeding. It reflects successful milk transfer and synchronization between suckling and swallowing. Rhythmic patterns reduce the risk of nipple trauma by ensuring proper placement and suction. This indicates that breastfeeding dynamics are efficient and beneficial.

Choice E rationale

Dimpling of the infant's cheeks occurs due to suction difficulties and often signifies improper latch or weak oral musculature. It leads to air leakage and insufficient milk removal. This finding may contribute to feeding inefficiencies and nipple trauma, indicating a need for latch correction.

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Correct Answer is A

Explanation

Choice A rationale

Performing a sharp hand clap near the infant activates the Moro reflex, a startle response present at birth that integrates by around six months of age. The reflex involves symmetric extension and abduction of the arms followed by flexion, demonstrating proper neurological function.

Choice B rationale

Placing a finger at the base of the newborn's toes elicits the plantar grasp reflex, not the Moro reflex. This reflex involves flexion of the toes when pressure is applied to the sole and is unrelated to startling the infant.

Choice C rationale

Holding the newborn vertically allowing one foot to touch the table surface elicits the stepping reflex, not the Moro reflex. This reflex involves simulated walking movements and is unrelated to assessing startle responses.

Choice D rationale

Turning the newborn's head quickly to one side elicits the tonic neck reflex (fencing reflex) rather than the Moro reflex. This reflex involves extension of the limbs on the side the head is turned and flexion on the opposite side. .

A. This position prevents stomach juice from going into the lungs. B. This position allows food to be easily digested by the stomach. C. This position helps my baby breathe better by opening the lungs. D. This position keeps pressure off the stomach.

Correct Answer is A

Explanation

Choice A rationale

Elevating the head reduces the risk of aspiration by preventing stomach contents, including gastric juices, from entering the lungs. This position is essential for infants with tracheoesophageal fistula due to the abnormal connection between the trachea and esophagus, which increases aspiration risk.

Choice B rationale

Facilitating food digestion is not the primary goal of this positioning. Gastric motility and digestion are unaffected by head elevation, making this rationale irrelevant to the question. Therefore, this is not the correct choice.

Choice C rationale

While head elevation can improve breathing by reducing diaphragm compression, the primary purpose in this context is to prevent aspiration. Lung expansion is a secondary benefit, but it is not the main reason for this position.

Choice D rationale

Reducing stomach pressure is not the key reason for elevating the head in this case. Although head elevation can minimize intra-abdominal pressure, this rationale does not address the critical concern of preventing aspiration in tracheoesophageal fistula. .

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Which three assessment findings indicate that the breastfeeding client has achieved a proper latch?

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