Common Behaviours + Presentations in Infancy

Question 1

What are the 3 types of milk provided to the baby from birth till stopping of breastfeed

Explain about each

Answer 1

Colostrum (first few days)

• thin, yellowy “liquid gold”
• very frequent feeding
• high in immunoglobulins and protein

Transitional milk

• lower levels of immunoglobulins and proteins
• more lactose, fat and calories

Mature milk (10 days - 2wks)

• looks very watery but ideal nutrients

Question 2

List 3 advantages and disadvantages of breastfeeding

Answer 2

Advantages:

• Ideal nutrition for the first 4-6 months
• Reduction in some types of breast cancers
• Reduces maternal and childhood obesity

Disadvantages:

• Mother to baby infection transmission
• Transmission of drugs

Question 3

List 3 pieces of advise you can give for a baby who who possets or regurgitates

Answer 3

1. Burp the baby often during a feed.
2. Keep the baby upright for a half hour or so after a feed (to let gravity help out).
3. Make sure there’s no pressure on the stomach after a feed. Eg. wait at least 30 minutes after feeding before putting the baby car seat.

Question 4

How is GORD diagnosed in a infant?

Answer 4

If reflux is causing significant problems:

1. Discomfort and pain, due to acid-filled stomach contents irritating oesophagus
2. Breathing problems - gagging, choking, coughing, due to inhalation and aspiration of stomach contents into lungs
3. Poor growth, due to loss of much nutrition from vomiting

Question 5

What advise is given for an infant with GORD

Answer 5

1. Positional advice and smaller more frequent feeds
2. Treatment can also include medication and very rarely surgery

Question 6

What is the pathophysiology of Projectile vomiting in an infant?

Treatment?

Answer 6

Caused by a hypertrophy of the muscle of the pyloric sphincter at the lower end of the stomach causing pyloric stenosis

Treatment is surgical pyloromyotomy, under GA

Question 7

Progression of Projectile vomiting in an infant?

Answer 7

1. Begin bringing up small amounts of milk after feeding
2. Over a few days this worsens until baby can no longer keep any milk down
3. Vomiting may become so forceful that milk may be projected for several feet out of baby’s mouth
4. Babies are very hungry, but losing weight

Question 8

Findings on examination of an infant with projectile vomiting

Answer 8

During feeding you can palpate a hard lump on the right side of the abdomen, prior to forceful “projectile” vomiting

Question 9

What age and gender does projectile vomiting in an infant most commonly occur

Answer 9

5x more common in boys than girls

Commonly occurs between 2 weeks - 2 months of age in a previously well baby

Question 10

What is our immediate concern regarding an infant with projectile vomiting?

Answer 10

Dehydration, babies can become dehydrated very quickly

Question 11

Cause and treatment of sticky eyes in babies

Answer 11

Happens because their tear ducts can be slow to fully develop and open

Treatment is to wipe away the secretions with damp cotton wool moistened with sterile water

Problem should clear on its own. If still a problem at 12 months, referral to ophthalmology for probing of the duct

Question 12

List 3 potential causes of Nappy rash?

Answer 12

1. Prolonged exposure to faeces/urine
2. A reaction to cleansers
3. Following the use of antibiotics

Question 13

Treatment of Nappy Rash?

Answer 13

1. Frequent changing and cleaning with water
2. Allowing baby to lie on a towel with bottom exposed to fresh air for a length of time before replacing napp
3. A thin layer of barrier cream may help

Question 14

A mother presents to you as she is worried about a nappy rash which does not seem to be improving despite all her effort. An image of the rash is attached below.

What is your most likley diagnosis and why?

Answer 14

Candida nappy rash as it is:

• Erythematous
• The skin flexures are involved
• Satellite pustules visible

Question 15

List 2 ddx for a nappy rash which is not improving

Answer 15

1. Fungal infection such as candida
2. Bacterial infection on top of eczema

Question 16

Describe “abnormal crying” in a baby

Answer 16

High pitched, weak or continuous:

Can be signs of an acutely ill baby (possibly the most obvious)

Question 17

How is a diagnosis of Colic made

(Hint: many use the rule of 3’s)

Answer 17

If he or she is “otherwise healthy and well-fed,” but has fits of “irritability, fussiness, or crying” that takes:

• >3 hours/day for
• >3 days /week for
• 3 or more weeks

Question 18

What is Colic and how does it present?

What age group is most commonly affected?

Answer 18

Excessive, frequent crying in a baby who appears to be otherwise healthy

Baby’s face becomes red and flushed when they cry, often clenching their fists, drawing up their knees and arching their back

Question 19

What age group is most commonly affected in Colic and what is the diural pattern seen?

Cause?

Answer 19

Normally starts at few weeks old and stops by 4-6 months

Occurs in the late afternoon or evening and lasts several hours

Cause unknown

Question 20

What is Intussusception?

Answer 20

When the proximal portion of the intestine telescopes INTO a distal segment of the intestinal tube.

Commonly involves the ileum and the proximal colon at the ileocolic junction

Question 21

What is the biggest risk of Intussusception

Answer 21

As it cuts off the blood supply to the affected part of bowel, it can lead to necrosis if left untreated

This can subsequently lead to bowel perforation

Question 22

How does intussusception present?

Answer 22

• Sudden severe episodic abdo pain, lasting 2-3 minutes, gradually becoming more severe and constant
• Ashen, white face with knees drawn up
• Vomiting may lead to dehydration
• Blood/mucus (redcurrant jelly) stools

Question 23

How is Intussusception diagnosed and treated?

Answer 23

Confirmed by ultrasound

Treated by air enema, pushing the bowel back, or surgery.

Question 24

What is the best confirmation that a baby is failing to thrive

Answer 24

A progressive fall in the weight centile with a constant head circumference on a growth chart

Question 25

List 4 causes of faltering weight in an infant

Answer 25

Deficient intake of food or excessive loss from malnutrition or metabolic disease

The commonest cause is reduced milk intake, mainly from feeding problems.

Question 26

A baby appears yellowish in colour on his 3rd day after birth, is this normal?

Explain

Answer 26

Yes, 9/10 babies develop a degree of jaundice in the first week of life, onset usually from day 2-4

Haemolysis of foetal Hb leads to ↑ production of bilirubin. Immature liver function unable to covert unconjugated (fat soluble) to conjugated (water soluble) fast enough

Question 27

List 4 risk factors for neonatal jaundice (hyper bilirubinaemia)

Answer 27

1. Babies less than 38weeks gestational age
2. Previous sibling requiring Rx for neonatal jaundice
3. Exclusively breast fed babies
4. Bruising

Question 28

List 4 instances when neonatal jaudice is pathological and the cause of each

Answer 28

1. Onset in first 24 hrs ➞ haemolytic with risk of kernicterus
2. Jaundice still present at 14 days in term baby (21 days in premature) ➞ multiple underlying causes
3. ↑ conjugated serum bilirubin, pale stools, dark urine ➞ obstruction/ metabolic
4. Jaundice in an unwell baby ➞ sepsis screen

Question 29

How would you assess neonatal jaundice

Answer 29

Question 30

List 4 overt signs you need to look out for in an unwell baby (especially if they are quiet)

Answer 30

1. difficulty breathing, fast breathing, grunting while breathing, subcostal recession.
2. very pale, mottled, cyanosed or ashen
3. high pitched, weak or continuous cry ie. different from usual
4. not drinking for more than eight hours