Common Behaviours + Presentations in Infancy Flashcards
What are the 3 types of milk provided to the baby from birth till stopping of breastfeed
Explain about each
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
List 3 advantages and disadvantages of breastfeeding
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
List 3 pieces of advise you can give for a baby who who possets or regurgitates
- Burp the baby often during a feed.
- Keep the baby upright for a half hour or so after a feed (to let gravity help out).
- 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.
How is GORD diagnosed in a infant?
If reflux is causing significant problems:
- Discomfort and pain, due to acid-filled stomach contents irritating oesophagus
- Breathing problems - gagging, choking, coughing, due to inhalation and aspiration of stomach contents into lungs
- Poor growth, due to loss of much nutrition from vomiting
What advise is given for an infant with GORD
- Positional advice and smaller more frequent feeds
- Treatment can also include medication and very rarely surgery
What is the pathophysiology of Projectile vomiting in an infant?
Treatment?
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
Progression of Projectile vomiting in an infant?
- Begin bringing up small amounts of milk after feeding
- Over a few days this worsens until baby can no longer keep any milk down
- Vomiting may become so forceful that milk may be projected for several feet out of baby’s mouth
- Babies are very hungry, but losing weight
Findings on examination of an infant with projectile vomiting
During feeding you can palpate a hard lump on the right side of the abdomen, prior to forceful “projectile” vomiting
What age and gender does projectile vomiting in an infant most commonly occur
5x more common in boys than girls
Commonly occurs between 2 weeks - 2 months of age in a previously well baby
What is our immediate concern regarding an infant with projectile vomiting?
Dehydration, babies can become dehydrated very quickly
Cause and treatment of sticky eyes in babies
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
List 3 potential causes of Nappy rash?
- Prolonged exposure to faeces/urine
- A reaction to cleansers
- Following the use of antibiotics
Treatment of Nappy Rash?
- Frequent changing and cleaning with water
- Allowing baby to lie on a towel with bottom exposed to fresh air for a length of time before replacing napp
- A thin layer of barrier cream may help
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?
Candida nappy rash as it is:
- Erythematous
- The skin flexures are involved
- Satellite pustules visible
List 2 ddx for a nappy rash which is not improving
- Fungal infection such as candida
- Bacterial infection on top of eczema
Describe “abnormal crying” in a baby
High pitched, weak or continuous:
Can be signs of an acutely ill baby (possibly the most obvious)
How is a diagnosis of Colic made
(Hint: many use the rule of 3’s)
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
What is Colic and how does it present?
What age group is most commonly affected?
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
What age group is most commonly affected in Colic and what is the diural pattern seen?
Cause?
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
What is Intussusception?
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
What is the biggest risk of Intussusception
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
How does intussusception present?
- 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
How is Intussusception diagnosed and treated?
Confirmed by ultrasound
Treated by air enema, pushing the bowel back, or surgery.
What is the best confirmation that a baby is failing to thrive
A progressive fall in the weight centile with a constant head circumference on a growth chart
List 4 causes of faltering weight in an infant
Deficient intake of food or excessive loss from malnutrition or metabolic disease
The commonest cause is reduced milk intake, mainly from feeding problems.
A baby appears yellowish in colour on his 3rd day after birth, is this normal?
Explain
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
List 4 risk factors for neonatal jaundice (hyper bilirubinaemia)
- Babies less than 38weeks gestational age
- Previous sibling requiring Rx for neonatal jaundice
- Exclusively breast fed babies
- Bruising
List 4 instances when neonatal jaudice is pathological and the cause of each
- Onset in first 24 hrs ➞ haemolytic with risk of kernicterus
- Jaundice still present at 14 days in term baby (21 days in premature) ➞ multiple underlying causes
- ↑ conjugated serum bilirubin, pale stools, dark urine ➞ obstruction/ metabolic
- Jaundice in an unwell baby ➞ sepsis screen
How would you assess neonatal jaundice
List 4 overt signs you need to look out for in an unwell baby (especially if they are quiet)
- difficulty breathing, fast breathing, grunting while breathing, subcostal recession.
- very pale, mottled, cyanosed or ashen
- high pitched, weak or continuous cry ie. different from usual
- not drinking for more than eight hours
