feeding + constipation Flashcards
cow’s milk protein intolerance/allergy (CMPI/CMPA)
both immediate (IgE mediated = allergy) and delayed (non-IgE mediated = intolerance) reactions are seen
presents in first 3 months of life in formula-fed infants
cow’s milk protein intolerance/allergy presentation
regurgitation + vomiting
diarrhoea
urticaria, atopic eczema
colic sx - irritable, crying
wheeze, chronic cough
(rarely angiodem + anaphylaxis)
“formula fed 3 month old” (rarer in breastfed)
cow’s milk protein intolerance/allergy diagnosis / investigations
diagnosis = often clinical (improvement with cows milk elimination)
- skin prick/patch testing
- total IgE + specific IgE (RAST) for cows milk protein
management of Cow’s milk protein intolerance/allergy
if sx severe (failure to thrive) = refer to paeds
formula fed
- mild/mod = extensive hydrolysed folmula (eHF)
- severe/allergic/no response to eHF = amino acid-based formula (AAF)
breastfed
- continue breastfeeding
- eliminate cows milk from maternal diet
- consider prescribing calcium supplements to prevent deficiency
use eHF when stop BF, until 12months of age for at least 6 months
cow’s milk protein intolerance/allergy prognosis
IgE mediated intolerance - 55% will be tolerant by 5yrs
non-IgE mediated intolerence - most tolerent by 3yrs
risk factors for GORD in kids
preterm delivery
neurological disorders
GORD presentation in kids
develops before 8wks
vomiting/regurg
- milky vomits after feeds
- occur after being laid flat
excessive crying, esp while feeding
GORD diagnosis + prognosis in kids
clinical
self limiting, sx begin before 8wks + resolve before 1yr in 90%
GORD management in kids
- position during feeds - 30degree head up
- dont overfeed, trial smaller more frequent feeds
- trial a thickened formula - rice starch
- trial alginate - Gaviscon
(thickened form + alginate should not be given together
! should still sleep on back
GORD complications in kids
- failure to thrive
- aspiration pneumonia
- dental erosions - in older kids
infantile colic
20% of infants, cause unknown
<3months old
excessive crying, pulling up of legs, worse in evenings
no mx
body weight of child in newborn period
normal for babies to lose weight in first few days of life
–> body fluid adjustment
weight loss stops at 3-4days of life, by 3weeks baby should have regained birthweight
weight loss >10% of birthweight = refer
how often should young kids be passing stools
<6months = 3 times per day
>3yrs = once a day
constipation diagnostic criteria for <1yrs
2 or more of -
- <3 complete stools per week
- hard large stool
- “rabbit droppings”
- distress on passing
- assoc bleeding
- straining
- prev ep of constipation
- prev/current anal fissure
constipation diagnostic criteria for >1yrs
2 or more of -
- <3 stools per feek
- overflow soiling (without sensation)
- “rabbit dropping”
- large, infrequent stools that block loo
- poor appetite that improve with passage of stool
- abdo pain with passage
- retentive posturing - straight leg, tiptoing
- straining / anal pain
causes of constipation in kids
dehydration
low fibre diet
over enthusiatic potty training
hypothyroidism
Hirschsprungs
hypercalcaemia
learning disabilities
red flags in constipation in kids
- reported from first few weeks of life
- passage of meconium >48hrs
- “Ribbon” stools
- faltering growth (amber flag)
- weakness in legs, locomotor delay
- abdo distension
before managing a child with constipation, what must be they be assessed for? how is this done?
faecal impaction
factors which suggest -
- symptoms of severe constipation
- overflow soiling
- faecal mass palpable in abdomen
(PR done be specialist only)
management of constipation if faecal impaction present
polyethylene glycol 3350 + electrolyes - using escalating dose regimen
- add stimulant laxative (senna) if no disimpaction after 2wks
can initially increase sx of soiling + abdo pain
maintenance therapy of child constipation
Movicol Paediatric Plain = osmotic laxative
- add stimulant laxative (Senna) if no repsonse
do NOT use dietary interventions alone as first line (but obvs encourage fluids + fibre)
management of constipation in infants
not yet weaned (<6months)
- bottle fed - extra water between feeds, abdo massage, bicycling legs
- breast fed - constipation unusual, consider organic causes
have been weaned
- water, dilute fruit juice + fruits
- if not effective, add lactulose
screening for malnutrition
MUST ( malnutrition Universal Screen Tool)
- done on admission/nursing homes or if there is concern
