# A nurse teaches a first-time parent about breastfeeding a healthy term newborn. Which statements are accurate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=368590&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: HPM

## Question

A nurse teaches a first-time parent about breastfeeding a healthy term newborn. Which statements are accurate? Select all that apply.

1

Wash the nipples with antibacterial soap immediately before and after every feeding, then scrub away dried milk and allow the skin to air-dry to prevent mastitis

2

Give formula after most feedings during the first 2 weeks because a healthy term newborn usually cannot obtain adequate nutrition from exclusive breastfeeding

3

If the newborn falls asleep within 5 minutes of latching, end that feeding and skip the next planned feeding so uninterrupted sleep can conserve energy

4

Look for a wide-open mouth, flanged lips, chin touching the breast, a deep asymmetric latch, rhythmic sucking, and audible swallowing

5

Expect sharp pain to persist throughout feedings for several weeks, and delay assessment until the nipples toughen and the newborn naturally improves the latch

6

Choose a comfortable feeding position, support the newborn at breast level, and keep the ear, shoulder, and hip aligned

## Explanation

A deep latch with a wide-open mouth, flanged lips, chin contacting the breast, and rhythmic sucking with swallowing supports effective milk transfer (Choice 4). Cradle, cross-cradle, football, and side-lying positions can all work when the newborn is brought to breast level with the body aligned and supported (Choice 6). Routine soap use can dry and damage nipple skin; ordinary bathing is sufficient (Choice 1). A healthy term newborn generally breastfeeds 8 to 12 times per 24 hours, and routine formula supplementation can reduce breast stimulation; supplement for a clinical indication or informed feeding plan (Choice 2). A newborn who repeatedly sleeps soon after latching needs feeding and latch assessment and may need gentle waking, especially before feeding is well established (Choice 3). Persistent sharp pain is not an expected adaptation and warrants prompt latch and clinical assessment (Choice 5).

## In-depth explanation

Effective Latch — Signs
1. Wide-open mouth (≥120° angle)
2. Lips flanged outward (fish-lips)
3. Chin touching the breast
4. Most of the areola in the baby's mouth, more on the underside
5. Rhythmic suck-swallow with audible swallowing
6. No clicking sounds, no dimpling cheeks
7. Mother feels gentle pulling, no sharp/persistent pain

LATCH Assessment Tool (0-2 each, total 0-10)
- Latch
- Audible swallowing
- Type of nipple (everted, flat, inverted)
- Comfort (breast/nipple)
- Hold (positioning)

Common Positions
- Cradle (most common)
- Cross-cradle (preemies, latch problems)
- Football/Clutch (post-cesarean, twins, large breast)
- Side-lying (rest, post-cesarean, night)
Pillows bring baby to breast level. Ear-shoulder-hip alignment. Bring BABY to BREAST.

Frequency
- 8-12 feedings per 24 hr in newborn
- Feed on demand and on hunger cues (rooting, hand-to-mouth)
- Wake baby if sleeping >3-4 hours during the day in early weeks
- 5-7 wet diapers and ≥3-4 stools/day by day 4-5 indicate adequate intake

Common Misconceptions to Correct
- Persistent sharp pain = normal → NO; check latch
- Skip feedings to let baby sleep → NO; wake and feed
- Antibacterial soap → NO; warm water and air-dry
- Routine formula supplementation → NO unless medically indicated; reduces supply

Memory Tip
"Wide mouth + Flanged lips + Chin to breast + Areola (more under) + Audible swallow"

## Clinical scenario

Scenario
First-time mother, newborn, breastfeeding teaching.

Teaching Bundle
1. Effective latch signs: wide mouth, flanged lips, chin to breast, areola (more under), rhythmic suck-swallow + audible
2. Positions: cradle, cross-cradle, football, side-lying — bring BABY to BREAST
3. Frequency 8-12/day; wake if sleeping too long; respond to hunger cues early
4. Nipple care: warm water + air-dry; NO antibacterial soap
5. Formula only for medical indications; routine supplementation reduces supply
6. Output: 5-7 wet diapers + 3-4 stools/day by day 4-5

Avoid
- "Push through" persistent pain
- Skip feedings for sleeping baby
- Antibacterial soap on nipples
- Routine formula supplementation

## Key concepts

- **Effective Latch Signs** — Indicators of effective latch and milk transfer: wide-open mouth (≥120° angle), lips flanged outward, chin touching the breast, most of the areola in the baby's mouth (more on the underside given the asymmetric latch), rhythmic suck-swallow pattern with audible swallowing, no clicking sounds, no dimpling cheeks, and mother feels gentle pulling without sharp persistent pain. Validated tools include the LATCH score (Latch, Audible swallowing, Type of nipple, Comfort, Hold; each scored 0-2 for total 0-10).
- **Common Breastfeeding Positions** — Cradle: most common; baby across the lap supported by the same-side arm. Cross-cradle: opposite-side arm supports the baby; useful for preemies and latch problems. Football (clutch): baby tucked under the arm on the same side; useful after cesarean, with twins, or large breasts. Side-lying: mother and baby lying on their sides facing each other; useful for rest and post-cesarean. Universal principles: bring the BABY to the BREAST (not vice versa), use pillows to raise the baby to breast level, and align the baby's ear, shoulder, and hip in a straight line.
- **Common Breastfeeding Misconceptions to Correct** — Persistent sharp pain throughout feeding is NOT normal — it indicates poor latch and requires assessment; brief initial sensitivity often resolves with correct latch. Newborns should feed 8-12 times/24 hr — DO NOT skip feedings; gently wake a sleepy newborn at the breast or for daytime feedings if longer than 3-4 hours. Avoid antibacterial soap on nipples — it removes natural lubricants and protective bacteria; warm water and air-drying are recommended. Routine formula supplementation in the early weeks reduces breastfeeding stimulation and decreases milk supply; formula should be reserved for medical indications.

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