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Clinical 1 (Part B) > 20 - Infant Care > Flashcards

20 - Infant Care Flashcards

1
Q

Describe a normal umbilicus

A
  • Clean and dry
  • Slightly moist/sticky with slight mucoid discharge and odor
  • Falls off 5-15 days after birth
  • Small amount of blood on separation
  • Small amount of mucoid material on separation
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2
Q

Describe a umbilical cord with signs of infection (Omphalitis)

A
  • Erythema, edema & tenderness
  • Extending beyond 5 mm
  • If accompanied by: fever, lethargy, and/or poor feeding
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3
Q

Describe umbilical cord care

A

Keep cord clean & dry:

  • Wash hands with soap & water before and after touching it
  • Clean around base of cord with water on cotton tipped applicator or with a soft washcloth after bathing & at diaper changes
  • Fold diaper below cord stump
  • Expose to air or cover with loose clothing
  • Avoid buttons and bandages over naval
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4
Q

Should we use alcohol or antimicrobials on the umbilical cord?

A

No - delays healing, dries out cord

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5
Q

Describe the care of a circumcised penis

A
  • Ensure effective pain relief: topical or local anesthesia during procedure, consider acetaminophen for 24-48 hours post-procedure
  • After circumcision gauze is applied. Remove and replace with every diaper change for 24 hours (use non-stick gauze and apply petrolatum to prevent sticking)
  • Gently wash with warm water (+/- mild soap) 1-2 times a day
  • Continue to apply petrolatum for 3-5 days (no gauze)
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6
Q

What is the normal progression of a circumcised penis?

A
  • small amount of blood
  • redness & swelling for a few days
  • yellow discharge/scab develops and then decreases with healing
  • complete healing in 7-10 days
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7
Q

Red flags of a circumcised penis

A
  • bleeding > quarter size on diaper
  • worsening redness/swelling (not starting to decrease within 48 hours)
  • fever
  • lethargy/poor feeding
  • no urination within 12 hours of procedure
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8
Q

Describe the care of an uncircumcised penis

A
  • Foreskin gradually separates
  • Not fully retractable until 3-5
  • Foreskin should not be forced back
  • Penis should be washed regularly during bathing, mild soap may be used
  • As the foreskin naturally retracts, cleaning and drying underneath the foreskin can be performed
  • As for the foreskin retracts skin cells are shed which may appear as white, cheesy lumps (smegma)
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9
Q

Breastfeeding:

Always preferred method of nutrition for the first ______ and beyond

A

6 months

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10
Q

Breastfeeding:

Vitamin __ supplementation recommended

A

D

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11
Q

Describe cow’s milk allergy (CMA)

A
  • develops in 2-4% of infants, generally occurs in first few months of life
  • Sx: vomiting, wheezing, hives, rash, bloody diarrhea, skin rashes
  • this is NOT lactose intolerance (lactase deficiency) as this develops later in life
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12
Q

Lactose-free cow milk based formula:

Any advantages?

A

No

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13
Q

Lactose-free cow milk based formula:

Not recommended for ____ __________

A

acute gastroenteritis

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14
Q

Lactose-free cow milk based formula:

Not appropriate for which conditions

A
  • galactosemia

- congenital lactase deficiency

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15
Q

Lactose-free cow milk based formula:

Effective for colic?

A

No

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16
Q

Lactose-free cow milk based formula:

Why should we not give this unless we have to?

A

Because lactose is important for mineral absorption and maintenance of normal gut flora

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17
Q

Soy-based formula:

Who is it indicated for?

A
  • Vegan diets
  • Galactosemia or congenital lactase deficiency
  • People who cannot consume dairy-based products for cultural or religious reasons
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18
Q

Partially Hydrolyzed Protein Formula:

Benefit over other products?

A

little evidence for any benefit

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19
Q

Extensively Hydrolyzed Protein Formula:

Who is it indicated for?

A
  • Physician-confirmed food allergies
  • Those that cannot tolerate cow milk or soy protein
  • Malabsorption syndromes (short bowel syndrome, liver disease, cystic fibrosis)
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20
Q

Amino Acid Based Formula:

Who is it indicated for?

A

for those with severe allergies and malabsorption disorders that do not tolerate extensively hydrolyzed formulas

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21
Q

Describe Modified Formulas

-what they contain/benefits

A

Thickened formula:

  • Reduce regurgitation by 0.6 episodes/day
  • Associated with weight gain issues

Addition of essential fatty acids (EFA’s):
-Evidence lacking for benefit

Nucleotides:
-No evidence for benefit

Pre/Probiotics:
-Evidence lacking for benefit

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22
Q

Describe therapeutic formulas

A
  • High MCT (medium chain triglycerides) and higher energy for pre-term infants
  • Low PRSL (potential renal solute load) formula for renal insufficiency
  • Human milk fortifiers (HMF): Added to mother’s milk in premature infants
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23
Q

Recommended pediatric daily dose for Vitamin D?

A

400 IU/day

24
Q

Recommended pediatric daily dose for Vitamin D between October and April for those:

  • North of the 55th parallel
  • North of the 40th parallel in those with deficiency risk factors (ex. non-white race, anti epileptic therapy, malabsorption conditions)
A

800 IU/day

25
Q

What is the current recommended upper intake level for infants up to 12 months?

A

1000 IU/day

26
Q

How much Vitamin D is in breast milk?

A

<25-78 IU/L in women supplemented with 400 IU daily

27
Q

How much Vitamin D is in infant formula?

A

400 IU/L or more

28
Q

How much Vitamin D is in supplements?

A

400 IU/mL in D-Vi-Sol & others

400 IU/drop Kids D drops & others

29
Q

1 oz = ___ mL

A

30

30
Q

A Filipino father approaches you at the pharmacy counter. He has heard that some babies need Vitamin D drops and he is wondering if he should be giving them to his child. He has a 2 month old healthy, full-term daughter who is exclusively bottle fed using Similac Advance formula. She drinks about 6, 5 oz bottles of formula a day.

Does she need vitamin D?
If so, how much?

A

30 oz of formula/day = 900 mL of formula/day

400 IU/ L
x IU / .9 L

x = 360 IU daily

*Filipino race so she needs 800 IU daily

I would recommend giving one D-drop, that way she is at 760 IU/day which is probably enough.

Or you could do 1.1 mL of the D-Vi-Sol (440 IU) to equal exactly 800 IU, but that would be difficult to measure.

31
Q

_____ = most common nutrient deficiency in children

A

Iron

32
Q

What is an iron deficiency associated with?

A

diminished mental, motor, and behavioural functioning (these effects are long-lasting despite correction of deficiency)

33
Q

What are some symptoms of iron deficiency?

A

pallor (pale appearance)
irritability
poor appetite
delayed growth/development

34
Q

Iron stores accumulated during _____

A

gestation

35
Q

How long is the iron stores accumulated during gestation sufficient for?

A

up to 4 months in healthy full-term infants

*often lacking in pre-term infants

36
Q

How much iron does breast milk contain?

A

0.3-1.0 mg/L

37
Q

Bioavailability of iron in breast milk?

A

50%

*high bioavailability

38
Q

How much iron does infant formula contain?

A

4-13 mg/L

39
Q

Bioavailability of iron in infant formula?

A

4-6%

*a lot lower than breast milk

40
Q

List some strategies for preventing iron deficiency

A

Breastfeeding is preferred

Use iron-fortified formulas:
-No difference between low and standard-iron formulas in the frequency of fussiness, cramping, colic, regurgitation, flatus, or stool characteristics (except a darker color)

Start iron-rich foods @ 6 months (iron-fortified cereals, meats)

Do not introduce cows milk until after 1 years of age

Breastfed pre-term & low birth weight and infants with certain medical conditions may require supplementation

41
Q

Infant ____ = benign, self-limiting condition

A

colic

42
Q

When does infant colic resolve?

A

Resolves in 60% of infants by 3 months, 80-90% by 4 months

43
Q

Describe Wessel’s “rule of three” - crying for no apparent reason

A
  • Lasts > 3 hours per day
  • Occurs on > 3 days per week
  • Persists for > 3 weeks (this point is often excluded)
44
Q

Differential diagnosis for infant colic

A

Distinguishing from normal crying:

  • Paroxysmal (not a sudden attack)
  • Qualitative - louder, higher, more variable pitch, more turbulent (distressed/urgent)
  • Hypertonia (increase in muscle tension, unable to release muscles)
  • Difficulty consoling

Otitis media, thrush, constipation

45
Q

When would you refer infant colic?

A
  • Breathing difficulties (wheezing, cyanotic episodes)
  • Watery stools/blood in stools
  • Fever
  • Poor weight gain
  • Signs of dehydration
  • Excessive vomiting:
    • “Happy” spitter - normal, generally outgrow by 18 months
    • Warning signs: spitting up blood/coffee grounds, green or yellow spit up, breathing difficulties, poor weight gain, fever, diarrhea, signs of dehydration
46
Q

Goals of therapy for infant colic

A
  • Decrease crying
  • Minimize parental stress/frustration & strengthen coping skills
  • Minimize impact on infant-family relationship
47
Q

What is the first-line management for infant colic?

A

1) Parental support
2) Feeding techniques
3) Soothing techniques

48
Q

Describe feeding techniques

A

2) Feeding techniques:
- feed baby in a vertical position
- use the correct bottle and nipple size for the baby’s age
- curved bottles allow infant to be fed while sitting up
- bottles with a collapsible bag may decrease air swallowing
- changing the nipple to one with a smaller hole or anti colic design may decrease colic attacks
- burp baby in an upright position, with baby being held over the shoulder in a gentle chin grasp
- burping should be encouraged after every 30-60 mL of formula ingested or after every 5-10 mins of breastfeeding

49
Q

Describe soothing techniques (physical)

A

Massage the baby
-could do just the belly or whole body

Gently push the baby’s legs back and forth in a bicycle motion if they demonstrate gastric distress by pulling their legs up and arching their backs.

Warm baths may relieve GI spasm

50
Q

Describe soothing techniques (behavioural)

A

A colic diary that document’s the crying patterns throughout the day

A routine schedule for feeding, holding, and playtime

Caregiver must take rest breaks to relieve frustration

51
Q

Describe soothing techniques (environmental)

A

Providing white noise is a possibility (not shown to work for everyone)

Increased carrying, car rides or baby swings are NOT effective for managing colic

52
Q

Describe parenteral support that pharmacists can provide

A

Acknowledge: difficulty of situation, they are doing their best

Reassure: not a sign of rejection, common condition not caused by the caregiver

Take breaks and have a “rescue plan” if overwhelmed

Feelings of frustration, anger, exhaustion, guilt and helplessness are normal

Educate that colic is common and resolves on it’s own by 3-4 months of age

53
Q

Are pharmacological agents effective for managing colic?

A

No good evidence for any given agent.

Consider placebo effect and risk vs. benefit:

  • Probiotics: studies show possible benefits with lactobacillus reuteri (BioGaia), more studies needed, requires 2-4 weeks of continuous treatment to show effect
  • Concentrated sucrose: short-acting pain relief?
  • Simethicone: antiflatulent?
  • Gripe water (various formulations: herbs, fennel, bicarbonate, ginger, chamomile, dill) - make sure does not contain alcohol !!
54
Q

When is dietary management indicated?

A

Only indicated in cases of confirmed allergies, should see physician for assessment

55
Q

What type of symptoms would appear for you to suspect allergies?

A
  • severe symptoms
  • positive family history
  • additional atopic symptoms (eczema, wheezing, allergic rhinitis)
  • additional GI symptoms (vomiting, diarrhea)
56
Q

When should breastfed infants have a consult with a dietician?

A

when they’re old enough to talk, LOL, JUST JOKES

*when there is maternal avoidance/hypoallergenic diet (no eggs, milk, nuts or wheat)

57
Q

How long do dietary managements need to be trifled for to see effectiveness?

A

7-14 days

Clinical 1 (Part B) (11 decks)

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