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What You Need to Know for IBCLC Exam Questions about Formula

Test questions and pencil

What’s that? Marie, you’re saying that a lactation exam could give us questions about formula?

Yes, that’s exactly what I’m saying.

If you look at the IBLCE’s IBCLC Detailed Content Outline, the words “Nutrition and Development” means that formula is FAIR GAME for the exam. In truth, I don’t think you’ll get more than one question on formula. But honestly, most of us lactation-types are a little weak on information related to formula. So here are five questions on formula you should ask yourself before you go to the exam.

Question on Formula #1: Under what circumstances is formula legitimately needed, either short-term, or long-term?

Long-term: Here’s the big one. If a baby has galactosemia, he does not have the enzyme to break down lactose, which is the main carbohydrate in human milk. The same is true for maple syrup urine disease, again, because of the valine, leucine, and isoleucine that the infant cannot break down.

Short-term: A baby who, for whatever reason, does not have access to his mother’s milk, or her milk is for some reason not safe at the moment (drugs, infection, environmental toxins, whatever) then yes. Also, the premature infant may need a formula product of some kind.

Question on Formula #2: What are the most well-researched, MAIN health consequences of formula feeding?

  • Nutrition: Obesity has been linked to formula-feeding, around the globe for term infants. (And obesity is related to development of diabetes.) For preterm infants, a major consequence of formula is necrotizing enterocolitis.
  • Safety: In some locales, contamination occurs because of the water, but contamination of the powder can and does happen anywhere. Diarrhea, so severe that it can cause death, is a possible consequence.
  • Infection: All sorts of infections are possible, but a the two most well-substantiated infections are diarrhea (and GI-related issues) and respiratory infections. 

Question on Formula #3: How are the components of human milk different from artificial milk?

Components differ mostly on what is absent, added, or present in different amounts between the two.

  • Protein content: Human milk is lower in protein than any other mammalian species. Cow’s milk, which of course is the basis for cow’s milk formula, contains more than twice as much protein as human milk. The human body just isn’t built to handle that. Not surprisingly, this is a common explanation for adverse reactions. (Some would say allergies; others would say food intolerance.) 
  • Protein type: In human milk, the main protein is alpha-lactalbumin. In cow’s milk, it’s beta-lactalbumin. Which means you’re putting a foreign protein — and a lot of it — into the human baby who wasn’t built for it in the first place.
  • Protein has both whey and casein. The whey-to-casein ratio changes as lactation progresses, but the whey component in human milk is more gut-friendly for the younger infant, compared to artificial milk.
  • Allergies: Okay, if you know that you’re putting a foreign protein in the body, you know that it’s a set-up for an allergic reaction. And that’s not to mention that soy-based formula is also a possible allergen.
  • Iron: There’s more iron in formula than human milk. That might seem like a good thing, but it’s not. The amount of iron in is greater in formula because it is less bioavailable than the iron in human milk.
  • Taurine is essential for brain and retinal development. It was added to formula sometime in the mid-1980s. But reading the label, it appears to me that the amount is not the same as in human milk.
  • Cholesterol is important for nerve myelination. Now here’s a little secret: There’s no cholesterol in formula. Why so? After striping animal fat, Because the animal fat has been stripped out and replaced with vegetable fat. No, I’m not kidding.
  • Zinc is important for brain function in the infant.

Question on Formula #4: In a Baby-Friendly Hospital, what is the requirement for the METHOD to teach parents who have elected to formula feed?

You need to teach parents one-on-one rather than in a group.

Question on Formula #5: When teaching about formula preparation, storage, and use, what are MAIN POINTS that you should include?

  • The World Health Organization has instructions for preparing infant formula (“PIF”) at home, as well as in the hospital. (Download that document!)
  • A few things stand out to me which seem like they would be easy targets for exam items:
    • World Health Organization says powdered formula should be prepared with water no cooler than 70 degrees Celcius, about 158 degrees Fahrenheit. (Note that formula will need to cool sufficiently; it should be lukewarm, not hot, before feeding)
    • After formula has been prepared, it should be left at room temperature NO LONGER than 2 hours.

Why do they give questions on formula on the IBCLC exam?

I have no inside information but … I can gander a guess.

If you were selling vacuum cleaners or athletic shoes or computers, you’d need to know the difference between your product, and the competitor’s product.

So we need to know a little about the competitor’s product.

Did you realize there would be questions on formula on the IBCLC exam? Have a friend taking the exam? Consider sharing this post to help your fellow candidates!

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    • Marie Biancuzzo

      Pam whoaaaaa! You are sharp, woman! Yes, indeed, I should have said 70 degrees Celcius, not Fahrenheit! Here’s the exact quote from the WHO document I gave the link for:

      Where sterile liquid infant formula is not available, preparation of PIF with water at a temperature of no less than 70 °C dramatically reduces the risk. Minimizing the time from preparation to consumption also reduces the risk, as does storage of prepared feed at temperatures no higher than 5 °C.

      For those of you who are wondering, 70 degrees C translates to about 158 degree F.

      5 degrees Celcius translates to about 41 degrees F.

      Pam, thank you! I try very hard to be careful, but I don’t always get it right. Thank you for having my back here!

  1. Janet DeWitt-Goodman

    I believe there is a typo in #5 above. The water should be no cooler than 70 degrees CELSIUS not Fahrenheit when making formula with powdered formula and water

    • Marie Biancuzzo

      That’s correct! The water should be no cooler than 70 degrees C, and then cooled sufficiently–lukewarm, not hot–before feeding.

      Thanks for your comment!

  2. Pam Warren

    I retested, successfully, in October. I attended the in person review in Boston. The practice exams were also very helpful!

    • Marie Biancuzzo

      Thank you so much for sharing, Pam! Congratulations to you! Thank you for coming to Boston. I always appreciate hearing from attendees and want to celebrate along with you!

  3. Karla

    Of course we should know about formula, and not JUST because it’s the competing “product”.

    As there are cases when humann milk just is not a possibility, what kind of professionals would we be, dropping our help completely at that point and not providing information on the next option?

    • Marie Biancuzzo

      Oh Karla, so true, so true! My colleagues have sometimes criticized me for trying to keep up with the literature on formula. (Notice I said “trying.”) My reply has always been along the lines of this: “Until 100% of these babies are fed human milk, I need to understand formula, and that 100% number isn’t a likely possibility.” Formula is inferior; no doubt. But in some cases, it is life-saving.

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