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Child health > Child Health > Flashcards

Child Health Flashcards

1
Q

Benefits of breastfeeding to neonates is on a ___ basis?

A

Dose-dependent basis (Long period –> more benefit)

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2
Q

Benefits of breastfeeding to mother? (4)

A

Reduced risk of breast cancer, ovarian cancer, T2DM, Osteoporosis

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3
Q

When should mothers avoid breastfeeding? What should be done if she wants to breastfeed?

A

HIV +ve.

Anti-viral tx should be taken before

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4
Q

What are HIV+ve mothers provided with to support them?

A

Supermarket card to buy formula for 1 year and baby feeding equipment

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5
Q

What is the reflex of milk ejection known as? Which hormone is responsible and from what stimuli?

A

Letdown reflex.

Oxytocin from infant’s suckling

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6
Q

What happens when areas of breast are not drained?

A

Feedback inhibition of lactation protein increases -> signals to breast to slow milk production

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7
Q

When is milk produced and when is it the fastest?

A

All the time.

Fastest when there is least milk.

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8
Q

What is needed for adequate milk production?

A

Frequent feeding/ expression

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9
Q

What does colostrum contain?

A 
Immunoglobulin (lactoferrin, Ab)
Laxative effect (pass meconium, prevents jaundice)
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10
Q

Does the composition of mature breast milk change?

A

Yes, over time

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11
Q

When does the volume of mature breast milk increase?

A

From 20-48hrs

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12
Q

What triggers release of milk with higher fat content?

A

Oxytocin

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13
Q

How does fat content vary in breastmilk?

A

According to extent at which breast is emptied - to empty to acquire fat and energy

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14
Q

How does mature breast milk look like?

A

Slightly bluish and translucent with thin cream layer on standing

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15
Q

What is the composition of mature breast milk at the beginning of feed?

A

High in water, sugars and protein

Low in calories and fat

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16
Q

How can milk be expressed? (3)

A 
Hand expression (squeeze behind areola)
Hand and electric pumps
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17
Q

What must be done before milk is expressed?

A

Wash hands

Wash containers in cold then hot soapy water then sterilized

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18
Q

What should be done for the milk container?

A

Close with tight fitting lid and label with date

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19
Q

What is the duration of storage in the following temperatures?

  1. 4 deg
  2. -18 deg
  3. Ice compartment of fridge
  4. Fridge >4deg
  5. Ice packs after cooling in fridge
A
  1. 5-8 days
  2. Up to 6 months (thaw overnight/ under cold running water)
  3. Up to 2 weeks
  4. Up to 3 days
  5. 24hrs
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20
Q

What should never be done to warm/ defrost milk?

A

Microwave/ stove

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21
Q

How should the infant be positioned for breastfeeding?

A

CHIN: Close, Head-free, In-line, Nose to nipple
Rub nipple against top lip and aim for roof of mouth with a large mouthful of breast
More areola should be visible above the top lip
Cheeks full and rounded

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22
Q

What can shallow attachemnt for breastfeeding lead to?

A

Decrease in milk production

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23
Q

What risk does a tongue-tie division for ankyloglossia have?

A

Lingual nerve (CN V3) damage

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24
Q

Should topical creams/ lotions be used in breast engorgement?

A

No -> can cause dermatitis.

Should only be used when there is nipple infection

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25
Q

What can be done to manage breastfeeding problems?

A

Express little milk before and between feeds, feed more frequently

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26
Q

What might indicate ankyloglossia?

A

Difficulty staying attached, hungry, slow weight gain, clicking sound when feeding

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27
Q

What is the protein content in mature breastmilk?

A

Lower - slow weight gain.

But immune protein same.

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28
Q

Frequency of breastfeeding in 1st week and first few weeks?

A

1st week - very often/ every hour –> starts to decrease with longer feeds
First few weeks: 8-12x/ day

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29
Q

Is it possible to overfeed a breastfed baby?

A

No

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30
Q

How long should infants be exclusively breastfed for?

A

First 6 months

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31
Q

When should solids be introduced?

A

Around 6 months of age

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32
Q

What kind of drinks should infants take at 6 months?

A

Only breastmilk, infant formula, water

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33
Q

Unmodified cow’s milk should not be given to infants under how many months?

A

12 months?

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34
Q

When is full fat cow’s milk, semi-skimmed milk and skimmed milk appropriate for introduction?

A

Full fat - 6-9 months small amounts in cooking
Semi-skimmed - 2 years
Skimmed - 5 years

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35
Q

What should not be added into baby’s food?

A

Sugar and salt

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36
Q

What should be done for potential food allergens?

A

To be introduced once at a time

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37
Q

When can babies start to take whole nuts and seeds?

A

After 5 years old

38
Q

Free sugars should take up how much of daily dietary energy intake?

A

=/<5%

39
Q

How often should teeth be cleaned when they appear and with what toothpaste?

A

2x/ day

1000ppm fluoride toothpaste

40
Q

How frequent should infants be fed in:
6-8 months
9-11 months
12-14 months

A

6-8 months: 2-3x/ day
9-11 months: 3-4x/ day
12-14 months: 3-4x/day + nutritious snack

41
Q

How much VitD supplements do pregnant & breastfeeding women need a day? How much if BMI >30?

A

10ug/day.

1000U or 25mcg

42
Q

How much VitD supplements do babies under 1 year need a day? When should supplements not be given?

A

8.5-10ug/day regardless if mother is taking supplement.

Should not be given if fed >500mL of infant formula a day

43
Q

When should the mother take medication?

A

Immediately after breastfeeding and single dose before baby’s longest sleep period

44
Q

How long should breastfeeding be avoided for after taking a dose of medication?

A

1-2hrs

45
Q

Are leaflets sufficient for antenatal information?

A

No

46
Q

What should be encouraged within the first hour of birth?

A

Unrestricted & uninterrupted responsive feeding - avoid prolonged separation

47
Q

Soya-based milk is not recommended in infants under?

A

6 months

48
Q

Rice milk should not be given to infants less than?

A

5 years of age

49
Q

Dried milk powder should be added to freshly boiled water above what temp?

A

above 70 deg.

*Do not cool in lidded kettle for >30min and use vacuum flask if feeding outside

50
Q

What should be done if infant has botulism?

A

Culture batch of formula

51
Q

What are the 2 most dangerous bacteria in dried milk powder?

A

Salmonella and Cronobacter

52
Q

What are the 2 forms of infant formula?

A

Dried power

Sterile UHT-treated ready to feed liquid

53
Q

Does water or milk powder go in first?

A

Water

54
Q

When can bottled water be used to prepare milk? Must it still be boiled?

A

When it complies with tap water regulation (Na<200mg/L, Sulfate <250mg/L).

Yes

55
Q

Sterilizing is important until infant is?

A

12 months

56
Q

What are the methods of sterilization? (4)

A

Chemical, steam, microwave with special steamer, boiling water (10min of full immersion)

57
Q

Leftover feeds should be discarded within?

A

2 hours

58
Q

How many feeds should be prepared at any 1 time?

A

1 bottle

59
Q

What to follow when feeding the baby?

A

His/ her natural pauses

60
Q

What does gulping indicate when baby is feeding?

A

Coping with fast flow

61
Q

How should the milk bottle be held when feeding?

A

Close to horizontal

62
Q

What should be used to know when to feed the baby?

A

Hunger cues

63
Q

What to offer when infant-fed baby is thirsty?

Do breastfed baby need this?

A

Plain, cooled, boiled water.

No - composition changes according to needs

64
Q

What are the consequences for over-concentrating infant formula (4)?

A

Constipation, hypernatraemia, vomiting, excess weight gain

65
Q

What is the consequence for under-concentrating infant formula?

A

Delayed growth and development

66
Q

What should be done if infant-formula needs to be stored?

A

Keep constantly below 5deg, use within24hrs

Use cool box with ice bricks

67
Q

How should infant-formula be warmed?

A

Stand in jug of hot water for a few mins

68
Q

Why is microwaving not recommended for infant-formula?

A 
Will continue to heat after removal
Hot spots (uneven heating)
69
Q

What is the risk if there is high unabsorbed iron in the gut?

A

Risk of infection

70
Q

How many centiles do infants drop in first week? Why?

A

1-2 centiles.

Postnatal diuresis and excretion of bowel contents

71
Q

Infants drop 1-2 centiles in the first week. When is intervention needed?

A

> 2 centiles below birth centiles

72
Q

How much protein and energy is needed in preterm infant?

A

3-3.6g protein/kg for every 100kcals/kg

73
Q

When is neonatal parenteral nutrition needed?

A

Born <1.25kg
<30 weeks gestation
Non-functioning GI system SBS
Takes time to reach full enteral feeds

74
Q

How much trophic feeds is needed? (Min. enteral feed when on parenteral nutrition)

A

=/<24ml/kg/day

75
Q

When is breastmilk fortifier needed additionally?

A

When <1.5kg at birth

76
Q

If both maternal and donor breastmilk are unavailable, what are the 2 things that can be given?

A 
Preterm formulas (<2kg at birth)
Nutrient-enriched post-discharge formula milks (>2-2.5kg)
77
Q

When can breastfeeding be used as an extension of kangaroo care in preterms?

A

From 28 weeks

78
Q

When does transitional milk switch to mature milk?

A

2-3 weeks after delivery

79
Q

Mothers should be supported to express breastmilk within how long after delivery? Through what mode?

A

Within 1-6hrs.

Hand expressing.

80
Q

How long should gaps be between milk expression?

A

Not longer than 6hrs

81
Q

When should bottle feed be attempted in pre-terms?

A

34 weeks gestation - able to coordinate suck-swallow-breathe

82
Q

Preterm infants should be supplemented with what minerals?

A

Phosphorus, sodium, iron and vitamin at 4 weeks

83
Q

What mineral does breastmilk fortifier not contain?

A

Iron

84
Q

What are the risk factors for jaundice? (5)

A

Prematurity, Maternal Ab (Anti-D), blood group differences, bruising at delivery, infection

85
Q

What does early (<24hrs of age) and late jaundice indicate?

A

Early: Infection, haemolysis
Late: Obstructive jaundice

86
Q

When is jaundice considered prolonged?

A

Term: >14 days
Preterm: >21 days

87
Q

What must be ruled out in high conjugated bilirubin?

A

TRO biliary atresia - surgery in 6 weeks of life

88
Q

When is infant ready to be discharged?

A

Stable temp & BG
Feeding well
Not jaundiced

89
Q

What ix can be done for jaundice?

A

Bilirubin level

If need tx: Group and direct Ab test, FBC

90
Q

Jaundice mx (2)

A

Phototherapy (blue light), exchange transfusion

Child health (1 decks)

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