Chapter 10: Health Problems of Infants

Question 1

A 3-month-old bottle-fed infant is allergic to cow’s milk. Which is the best substitute to teach the parents to use?

a. Goat’s milk
b. Soy-based formula
c. Skim milk diluted with water
d. Casein hydrolysate milk formula

Answer 1

d. Casein hydrolysate milk formula

The milk protein is broken down in casein hydrolysate milk formulas, making them a safe alternative for the infant who has an allergy to cow’s milk. The milk protein in goat’s milk cross-reacts with cow’s milk protein, and goat’s milk is therefore not a safe alternative. Soy-based formulas are avoided due to the cross-reaction with cow’s milk protein; they are not a safe alternative. Cow’s milk protein is contained in skim milk, making it an unsafe alternative.

Question 2

Parents have brought their 6 month old daughter in for a 1 week follow up for treatment of diaper dermatitis. The parents state that they have followed all directions but that it just doesn’t seem to be getting any better. The nurse examines the infant and finds no resolve of the condition. Based on this finding, the nurse suspects that:

a. The infant may also have a Candida infection
b. Additional teaching may be needed for the parents in order to validate that they followed through with instructions
c. Suggest to the parents that a heat lamp may be needed to resolve the problem
d. Have the parents continue their treatment as it may take more than 1 week to resolve

Answer 2

a. The infant may also have a Candida infection

Unresolved treatment for diaper dermatitis is likely due to a Candida infection. There is no reason to suspect that the parents are not implementing the directions that were previously given. Use of a heat lamp can cause damage to the perineal area and buttocks. If the situation has not resolved, then the nurse should be alert to the possibility of additional infectious processes.

Question 3

Infants most at risk for sudden infant death syndrome (SIDS) are those: (Select all that apply).

a. Who sleep supine
b. Who sleep prone
c. Who were preterm
d. With prenatal drug exposure
e. With a cousin that died of SIDS

Answer 3

b. Who sleep prone
c. Who were preterm
d. With prenatal drug exposure

Infants at increased risk for SIDS are low birth weight, have low Apgar scores, sleep prone, cosleep, were preterm, and have a mother who smokes. It is recommended that infants sleep supine to reduce the risk of SIESTA cousin dying of SIDS does not present an increased risk for the infant.

Question 4

The parents of a 5-month-old child complain to the nurse that they are exhausted because the infant will wake up as often as 1 to 2 hours during the night. When the child awakens, they change the diaper and the mother nurses the child back to sleep. Which should the nurse suggest to help the parents deal with this problem?

a. Put the child in the parent’s bed to cuddle
b. Start putting the infant to bed while still awake
c. Allow the infant to cry for 30 minutes, and then rock the infant back to sleep before putting the infant back in the crib
d. Give the infant a bottle of formula instead of breastfeeding so often at night

Answer 4

b. Start putting the infant to bed while still awake

Parents need to develop bedtime rituals that involve putting the child in bed when awake. This will allow the infant to become accustomed to falling asleep somewhere besides the parent’s arms or in the parent’s presence. Having the infant in bed with them may still interfere with their sleep and increases the risk of injury to an infant of this age. The extinction of crying episodes should be done progressively, beginning with checking on the infant every 5 minutes during the first night and extending this interval by 5 minutes on subsequent nights. This will allow the infant to learn to self-soothe. Providing formula in a bottle at night will contribute to bottle-mouth caries. Additionally, 5-month-old infants generally do not wake up during the night to feed but rather to be soothed. Using feeding as a mechanism to soothe begins a pattern that may lead to eating problems later in childhood.

Question 5

A child relates that every time he eats a certain food, he gets a stomach ache. No other discernible physical symptoms have been correlated with the food intake. Based on this information, the nurse would suspect that the child may be exhibiting?

a. Food refusal behavior
b. Food intolerance
c. Food allergy
d. Food preference

Answer 5

b. Food intolerance

Food intolerance occurs when a food substance elicits a reproducible reaction without an immunological basis. Food allergies would have discernable symptoms accompanying the food intake due to an immunological response. There is no information to suspect that the child is exhibiting a food preference or food refusal behavior as the description of the food event is noted as being the same each time.

Question 6

The primary goal in the nutritional management of children with failure to thrive (FTT) are: (Select all that apply).

a. Allow for catch-up growth
b. Correct nutritional deficiencies
c. Achieve ideal weight for height
d. Restore optimum body composition
e. Educate the parents or primary caregivers on child’s nutritional requirements

Answer 6

a. Allow for catch-up growth
b. Correct nutritional deficiencies
c. Achieve ideal weight for height
d. Restore optimum body composition
e. Educate the parents or primary caregivers on child’s nutritional requirements

The goal is to provide sufficient calories to support “catch-up” growth, which is a rate of growth greater than the expected rate for age. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating any coexisting medical problems. Accurate assessment of the child’s initial weight and height are important as well as the daily recording of weight, food intake, and feeding behavior. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating coexisting medical problems to optimize body composition.

Question 7

The nurse is providing education to a parent of a 10-month-old infant with the diagnosis of cow’s milk allergy. What will be included in the teaching? Select all that apply.

a. Reading of all food labels to avoid products with milk
b. Use of milk to desensitize the child
c. Introduction of soy-based products to replace milk
d. Signs and symptoms associated with potential accidental ingestion of milk

Answer 7

a. Reading of all food labels to avoid products with milk

Reading of all food labels to avoid products with milk will be included in the teaching. This infant will not be desensitized to milk. Milk and milk-based products should be avoided with this child. Introduction of soy-based products to replace milk will be included in the teaching. Signs and symptoms associated with potential accidental ingestion of milk will be included in the teaching.

Question 8

A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for:

a. Rickets
b. Marasmus
c. Kwashiorkor
d. Pellagra

Answer 8

c. Kwashiorkor

Kwashiorkor is defined as primarily a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.

Question 9

In providing nutritional counseling for a family with children, which statement would indicate that the parents need additional teaching with regard to mineral balance?

a. “I will give my child fortified milk products and avoid cow’s milk.”
b. “I will avoid giving my children any mineral supplements so as to avoid the possibility of megadoses.”
c. “Spinach is not a very good source of iron when considering mineral balance.”
d. “I don’t have to worry about mineral balance since my child will be following a vegetarian diet.”

Answer 9

d. “I don’t have to worry about mineral balance since my child will be following a vegetarian diet.”

Vegetarian diets are high in soy and plant foods and as such contain phytates which can form insoluble complexes leading to mineral imbalance. Fortified milk products are recommended along with avoidance of cow’s milk. Mineral supplementation should be avoided in order to prevent megadose toxicity which can affect absorption of other minerals. Spinach while a source of iron has a high oxalate content which can affect absorption of minerals.

Question 10

A newborn who is suspected of having atopy would most likely have which diagnostic finding?

a. Small for gestational age (SGA)
b. Increased levels of IgE in umbilical cord blood
c. No family history of allergies
d. Precipitous delivery

Answer 10

b. Increased levels of IgE in umbilical cord blood

Newborns who have a hereditary component are more likely to present with atopy and as such would have increased levels of IgE noted in umbilical cord blood. SGA and a precipitous delivery would not be associated with atopy.

Question 11

A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse’s knowledge of breastfed infants, what type of stool is expected?

a. Dark brown and small hard pebbles
b. Loose with green mucus streaks
c. Formed and with white mucus
d. Semiformed, seedy, yellow

Answer 11

d. Semiformed, seedy, yellow

Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow. Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant. Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant. Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant.

Question 12

Which food combination will generally provide appropriate amounts of essential amino acids for an individual who is a vegetarian?

a. Grains and legumes
b. Grains and vegetables
c. Legumes and vegetables
d. Milk products and fruit

Answer 12

a. Grains and legumes

Grains and legumes form complete proteins when eaten together, providing appropriate amounts of essential amino acids. Grains should be eaten with milk products or legumes to provide appropriate amounts of essential amino acids. Legumes should be eaten with grains or seeds to provide appropriate amounts of essential amino acids. Milk products should be eaten with grains to provide appropriate amounts of essential amino acids.

Question 13

A 1-month-old infant is admitted to the hospital for failure to thrive (FTT) secondary to a cardiac condition. Based on the nurse’s knowledge of the different types of FTT, this type of FTT is categorized as:

a. Nonorganic
b. Organic
c. Idiopathic
d. Generalized

Answer 13

b. Organic

Organic FTT is the result of a physical cause, such as a cardiac condition, neurologic condition, renal failure, endocrine system disorder, or other possible chronic or acute disease process. Nonorganic FTT is most often the result of psychosocial factors, such as inadequate nutritional information by the parent. Idiopathic FTT is unexplained by the usual organic and environmental etiologies. Generalized FTT is not a recognized term.

Question 14

The nurse is providing education to parents of an infant diagnosed with colic. What would the nurse include in the discharge teaching?

a. The child will have to be watched for gastrointestinal issues in the future
b. The symptoms of colic typically disappear by 3 months of age
c. Providing juice at the start of the fussy period will help decrease the length of the crying episodes
d. The feeding method needs to be changed to a hypoallergenic formula

Answer 14

b. The symptoms of colic typically disappear by 3 months of age

The symptoms of colic typically disappear by 3 months of age. The child will not have to be watched for gastrointestinal issues in the future, because colic is not related to long-term gastrointestinal problems. Providing juice at the start of the fussy period will help decrease the length of the crying episodes. There is no evidence that juice will decrease the length of crying in colicky babies. Changing the feeding method to a hypoallergenic formula is not typically recommended for the infant with colic.

Question 15

Macrominerals refer to those minerals with daily intake requirements greater than 100 mg. Which is a macromineral?

a. Iron
b. Calcium
c. Fluoride
d. Selenium

Answer 15

b. Calcium

Calcium is a macromineral. Iron, fluoride, and selenium are microminerals.

Question 16

Which strategy might be recommended to increase caloric intake in an infant with failure to thrive?

a. Use developmental stimulation by a specialist during feedings
b. Avoid solids until after the bottle is well accepted
c. Be persistent through 10 to 15 minutes of food refusal
d. Vary the schedule for routine activities on a daily basis

Answer 16

c. Be persistent through 10 to 15 minutes of food refusal

Calm perseverance is important. Parents often cannot persist through the child’s refusals, but they should be encouraged to do so and supported. Feeding should take place in a non stimulating environment so that the focus is on feeding, enhancing the chances of increasing caloric intake. Solids should be introduced slowly to decrease dependence on the bottle, beginning at 6 months of age. The feeding schedule should be structured for the infant to have consistency and develop a routine for feeding.

Question 17

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant?

a. Vitamin B
b. Vitamin D
c. Vitamin C
d. Vitamin K

Answer 17

b. Vitamin D

The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 400 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency. Vitamins B, C, and K are not needed.

Question 18

Which is the most descriptive of kwashiorkor?

a. Kwashiorkor has a multifactorial etiology
b. Kwashiorkor occurs primarily in breastfed infants
c. Kwashiorkor results from excessive amounts of vitamin K
d. Kwashiorkor is related to inadequate calories, not adequate protein

Answer 18

a. Kwashiorkor has a multifactorial etiology

Cultural, environmental, and infectious components contribute to kwashiorkor, a deficiency of protein with an adequate supply of calories. Kwashiorkor occurs in infants and children who are beyond the age of breastfeeding. There is no correlation between excessive amounts of vitamin K and kwashiorkor. Kwashiorkor is a disorder in which there are adequate calories but a deficiency of protein.

Question 19

The parents of a 9-month-old infant tell the nurse that they are worried about their baby’s thumb sucking. What should the nurse’s replay be based on?

a. A pacifier should be substituted for the thumb
b. Thumb sucking should be discouraged by age 12 months
c. Thumb sucking should be discouraged when permanent teeth begin to erupt
d. There is no need to restrain non nutritive sucking during infancy

Answer 19

c. Thumb sucking should be discouraged when permanent teeth begin to erupt

Thumb sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Evidence is inconclusive over whether a pacifier or a thumb better satisfies sucking needs and what the impact of either is on tooth eruption. Thumb sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Nonnutritive sucking reaches its peak at about 18 to 20 months of age. Most toddlers give up nonnutritive sucking on their own.

Question 20

According to evidence based practice in a recent Cochrane database, which statement is most accurate with regard to the relationship between vitamin A and measles?

a. It is correlated with an increased risk of blindness
b. Vitamin A supplementation should not be provided to children who have measles
c. There was no correlation between blindness in children who had measles and who also had vitamin A deficiency
d. Vitamin A supplementation in children with measles will lead to blindness

Answer 20

c. There was no correlation between blindness in children who had measles and who also had vitamin A deficiency

Current research in the Cochrane database reveals there is no relationship between ocular morbidities (blindness) and vitamin A deficiency in children who have measles. Research indicates that vitamin A supplementation can be given to children who have measles with no adverse outcomes.

Question 21

Which infant is at risk for developing vitamin D-deficient rickets?

a. Lacto-ovo vegetarians
b. Those who are breastfed exclusively
c. Those using yogurt as a primary source of milk
d. Those exposed to daily sunlight

Answer 21

c. Those using yogurt as a primary source of milk

Yogurt may not be supplemented with vitamin D; therefore, the infant may be at risk for the development of rickets. Individuals who follow this diet include milk and its products and therefore receive vitamin D. Breast milk provides sufficient vitamin D to the infant if the mother is not deficient in this vitamin. Lack of sunlight contributes to vitamin D–deficient rickets.

Question 22

Which statement best describe colic to parents who are inquiring as to whether their infant is experiencing this alteration?

a. The infant will experience periods of abdominal pain, which result in weight loss
b. Periods of abdominal pain and crying occur in infants primarily over age 6 months
c. Infants with colic have paroxysmal abdominal pain or cramping manifested by episodes of loud crying
d. Colic is usually the result of poor or inadequate mothering

Answer 22

c. Infants with colic have paroxysmal abdominal pain or cramping manifested by episodes of loud crying

Colic, or paroxysmal abdominal pain, occurs primarily in infants under the age of 3 months and is manifested by episodes of excessive crying and the infant drawing the legs up toward the abdomen. The infant with colic experiences abdominal pain but gains weight and usually thrives. Colic most commonly occurs in infants under 3 months of age. There is no identified relationship between mothering behavior and the development of colic.

Question 23

A 9-month-old infant is seen in the emergency department after developing urticaric rash with cough and wheezing. When collecting the history of events prior to the sudden onset of the rash with cough and wheezing, the mother states they were “feeding the baby new foods.” Which food is the possible cause of this type of reaction in the infant?

a. Potatoes
b. Green beans
c. Spinach
d. Peanut butter

Answer 23

d. Peanut butter

Nuts of any type, including peanuts, have a high allergy index in children and infants. The infant has demonstrated the cutaneous and respiratory type of reaction after possible ingestion of peanut butter. Potatoes are not a highly allergenic food. Green beans are not a highly allergenic food. Spinach is not a highly allergenic food.

Question 24

Which intervention lowers the risk of sudden infant death syndrome (SIDS)?

a. Keeping the window open if one is smoking near the infant
b. Placing the infant in the supine position for sleeping
c. Letting the infant sleep with the parents instead of alone in the crib
d. Making certain the infant is kept very warm while sleeping

Answer 24

b. Placing the infant in the supine position for sleeping

The Back to Sleep Campaign is credited with reducing the rate of SIDS in the United States. Smoking increases the risk of SIDS by exposing the infant to pulmonary irritants. Having the infant sleep with the parents (co-sleeping) increases the risk of SIDS. Overheating increases the risk of SIDS.