Just remember that questions on the exam can be disputed. And questions are often thrown out. To me, pictures are not enough. There needs to be a lot of data besides just a look-see when analyzing a situation.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Karin de Graaf
Sent: Thursday, July 23, 2009 2:33 PM
Subject: exam practice L. Smith
I'm due to take my 10th anniversary exam Monday, and I am practicing with Linda Smith's book (latest edition). I find I become a little frustrated at times. Just now I am looking at a baby and the correct answer tells me that this baby's position is fine and needs no change. With the following question I see the very same baby (sibling in the background), in the very same position, only difference is that the eyes are open. This time the correct answer tells me that the position is incorrect and needs adjusting!!
One question shows me a crying baby on a nappy change pillow (how do you call this in English?), and asks me what to do first. My answer of having the mother take the baby up skin to skin to sooth was wrong, because the baby needs to be put to the breast immediately. Okay, I know this now, so when 40 questions later I see another crying baby lying on the scales, I think I know now what to do first; have the mother feed. Guess what: wrong!
Baby should first be calmed down with skin to skin!
I find that I have quite some problems with the questions that do not seem to be related with a lack of knowledge from me. For example, one question shows a baby sitting fully unsupported on a surface playing with a toy. I assume that a baby at this stage of development is minimum 6 months of age.
Guess what; the answer tells me this baby is 4 months old. Some baby's are hardly visible on the photo while they are feeding, so I find it difficult to estimate the age. Jet this is crucial for the question.
Another photo shows me a happy healthy thriving baby sitting on his mother's lap, facing the camera and giving up some milk that pours down his chin (no force behind it). Mum looks worried, but baby doesn't. The only information I get is that the baby is exclusively breastfed. As many baby's that are completely normal do give up some milk occasionally, I didn't opt for reflux and allergy. Also vigorous burping was not shown on the photo, so I chose the option that baby can feed too much, and give some milk back. Again:
wrong! The correct answer is allergy! In the answer an explanation is given, telling that this baby is FREQUENTLY spitting up. How the hell would I know that if it isn't stated in the information? Apart from the idea whether the spitting is normal or pathologic, I have another problem with the correct answer. Nowhere on the photo or in the information is any clue given to allergy. There is no rash seen on baby or mother, or any other symptom. The only thing you can see is the spitting up. If there is any pathology visible on the photo, then it must be reflux. As we all know, half of the cases of reflux are caused by allergy, and reflux is one of the symptoms you find.
But as long as there is no information given, why would I tell the mother about allergy? In real life I would ask this mother if she or her partner have any signs of allergy. I would check the baby's skin. I would ask mum if she finds he has often plugged or runny nose or ears or discharge from the eyes. I would ask for colic signs, etc etc. Only when it is appropriate I would suggest mother to start a diet, not only because baby shows reflux. Am I so strange or what is this? If this was only rarely the case, but I find I make "wrong answers" quite regularly. Not that I am worried about not passing the exam: my score will be no problem for passing, but it is just frustrating that the way I think, doesn't match the correct answer at times.
Sorry for bothering you with this; thanks for letting me ventilate this way,
Greetings
Karin de Graaf
Karin de Graaf IBCLC private practice
The Netherlands, Europe
www.borstvoedinghulp.nl
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