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Child health > Gastro - nutrition > Flashcards

Gastro - nutrition Flashcards

1
Q

Can formula milk be given to breastfed babies?

A

Should not be given, unless medically indicated (NICE)

In general, an environment for breastfeeding should be encouraged and commercial formula packs should not be distributed.

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2
Q

At what time after birth should breastfeeding be encouraged?

A

As soon as possible, ideally within the first hour after birth! Same with skin-to-skin contact.

Avoid separating baby and mother for routine checks, unless indicated.

In the future, unrestricted breastfeeding frequency and duration should be encouraged.

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3
Q

What should be done if the infant is not taking sufficient milk from the breast?

A

Expressed breast milk should be given as supplementation

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4
Q

What are indicators of good attachment and positioning for breastfeeding?

A

Mouth wide open
Chin touching breast, lower lip rolled down, nose free

No Pain

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5
Q

What are indicators of successful feeding in babies?

A

Audible and visible swallowing

Sustained rhythmic suck

Relaxed arms and hands

Moist mouth

Regular soaked/heavy nappies

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6
Q

What are indicators of successful breastfeeding in women?

A

Breast softening
No compression of nipple at the end of feed
Woman feels relaxed and sleepy

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7
Q

What are symptoms of mastitis?

A

Flu-like symptoms
Red, tender and painful breast

Needs to report to healthcare professional immediately

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8
Q

What advise is given if the patient has mastitis?

A

Continue breastfeeding + gentle massage to overcome blockage and effectively remove milk.

Analgesia compatible with breastfeeding eg. paracetamol.

Increase fluid intake

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9
Q

What are the advantages of breastfeeding?

A

Enhances relationship

Reduced gastro-intestinal infections (especially developing countries).

Reduced incidence of necrotising enterocolitis in preterm infants

Ideal nutrition for 4-6 months.

Reduced incidence of obesity, DM and HTN in later life.

There is a reduction in breast cancer in mothers who breast-feed.

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10
Q

When is breastfeeding challenging?

A

In twins.
Rarely possible in triplets and higher orders.

Milk needs to be expressed from the breast for PRE-TERM babies, until they can suck.

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11
Q

What is COLOSTRUM?

A

Produced in the first few days of breast-feeding.

Much higher content of IG and protein than milk. It has low volumes.

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12
Q

What are semi-hydrolised milk formulas?

A

The proteins are partially broken down, which is supposed to help digestion and prevent colic and constipation. However, there is no evidence for that.

Not suitable if cow or goat milk allergy.

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13
Q

Which formula option is given to babies with cow milk allergy?

A

Hypoallergenic formula which contains completely hydrolysed proteins.

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14
Q

Which proteins are present in cow’s milk formula?

A

Casein
Whey

1st infant formula is based on whey, as it is thought to be more easy to digest. Baby can drink it even after solid foods are introduced for the first year.

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15
Q

How is mild and severe failure to thrive defined?

A

Mild = fall across two centile lines due to inadequate weight gain when plotted on centile chart.

Severe = fall across 3 lines.

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16
Q

Which centile weight should always trigger an evaluation?

A

A weight below the 0.4th centile.

If below 2nd, child may still be normal.

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17
Q

What are the non-organic causes of failure to thrive?

A

psychosocial and environmental.

Ca. 5-10% with failure to thrive are on a child protection register. A larger proportion may have socioeconomic deprivation.

Often organic is also present with undernutrition.

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18
Q

What are the important aspects of history in failure to thrive?

A

Dietary (inc food diary)
Feeding
Well? Energy?
Symptoms? (D+V, cough, lethargy)

Premature/IUGR at birth?

FH and growth of members

Development normal?

Psychosocial problems at home?

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19
Q

Which features should examination focus on in failure to thrive?

A

Signs of organic disease:
Dysmorphia
Malabsorption (distended abdomen, thin buttocks, misery)

Chronic resp disease (chest deformity, clubbing)

Signs of heart failure and nutritional deficiencies

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20
Q

Which investigations may be useful in some children with failure to thrive?

A

FBC and seru, ferritin for IDA.

Usually secondary to inadequate to Iron intake

21
Q

What are the causes of failure to thrive?

A

Inadequate intake
Inadequate retention

Malabsorption

Failure to utilise nutrients

Increased requirements

22
Q

What are the causes for inadequate intake? (failure to thrive)

A

Psychosocial
Neglect/abuse

Impaired suck/swallow (cerebral palsy, cleft palate)

Chrohn’s disease, chronic renal failure, CF, liver disease

23
Q

What are the causes for inadequate retention causing failure to thrive?

A

Vomiting

Severe gastro-oesophageal reflux

24
Q

What are the causes of malabsorption leading to failure to thrive?

A 
Coeliac
CF
Cow's milk protein intolerance
Cholestatic liver disease
Post-necrotising enterocolitis
25
Q

Which syndromes lead to failure to utilise nutrients and thus failure to thrive?

A

Down’s, IUGR, extreme prematurity

Congenital hypothyroidism, storage disorders

26
Q

Which conditions lead to increased requirements and thus failure to thrive?

A

Thyrotoxicosis
CF
Malignancy

Chronic infection (HIV, immune deficiency)

Congenital heart disease
Chronic renal failure

27
Q

What is the commonest cause of failure to thrive?

A

inadequate food intake

28
Q

What is the MUST tool?

A

Malnutrition universal Screening Tool.

For adults.
Recommended by NICE and British Dietetic Association

29
Q

How can malnutrition in children be screened for?

A

Mix of:

Weight for height plus Anthropometry (usually mid upper arm circumference - related to skeletal muscle mass <115mm is severe)

Especially useful fr screening in the community.

Laboratory investigations: low plasma albumin, Vitamins and minerals can be low

Dietary Diary

Immunodeficiency (low lymphocyte count)
Impaired cell-mediated immunity

30
Q

How does marasmus present?

A

Severe protein-energy malnutrition.

<70% weight for height (more then 3 standard deviations below median)

Wasted, wizened appearance. No oedema. Skinfold thickness and mid-arm circumference markedly reduced.

Often withdrawn and apathetic.

31
Q

What is kwashiorkor? How does it present?

A

Severe protein malnutrition. Energy intake relatively well maintained (eg. high starch diet)

Generalised oedema. Severe wasting. Weight may not be severely reduced because of the oedema.

Plus there may be:
Flaky-pain skin rash with hyperkeratosis.
Distended abdomen.
Hepatomegaly (fatty infiltration).
Angular stomatitis.
Sparse, depigmented hair.
Diarrhoea, hypothermia, bradycardia, hypotension.

Low plasma albumin, potassium, glucose and magnesium

32
Q

What are the signs of overfeeding?

A 
Greater than average weight/height.
>8 heavily wet nappies per day.
Frequent, sloppy, foul-smelling bowel motions.
Extreme flatulence.
Large belching.
Milk regurgitation.
Irritability.
Sleep disturbance.

Many of these are symptoms of reflux, milk-protein allergy/intolerance, colic. However, in these conditions the baby is usually NOT overweight

33
Q

What are the possible symptoms of cow milk protein allergy?

A

Variety of symptoms, involving different systems, usual onset 1 week after starting feeding

Pruritus
Erythema
Acute angioedema
Oral pruritus

Nausea
Colicky abdo pain
V + D

34
Q

What are the treatment options for cow’s milk protein intolerance

A

Hydrolyzed formulas work in 90%

Otherwise formulas that only contain amino acids

90% resolves by 6 years of age. 75% by 3 years

35
Q

Disadvantages of breastfeeding

A

Unknown quantity
Transmission of some disease/drugs/contaminants
Less flexible than formula
Risk of breast-milk jaundice

36
Q

Where to obtain advice regarding breastfeeding

A

Info pack should be given to her within 24h
Healthcare professional support with first feed
Midwives can always if in hospital
In the community there are community nurses and health visitors

37
Q

Which foods should be avoided if weaning takes place < 6 months (not necessarily recommended)

A

Wheat
eggs
fish

High salt, sugar
Any honey (risk of botulism)
38
Q

Which vitamins is formula milk deficient in?

A

A, C, D and iron

need supplement

39
Q

When is specialized formula milk indicated (from soya etc)

A

Cow’s milk protein intollerance
Lactose intolerance
CF
Neonatal cholestatic liver disease

40
Q

Causes of failure to thrive

A

Inadequate intake: environmental (availability, abuse)
impaired suck/swallow (eg. cleft lip)

Inadequate retention (vomiting, severe GOR)

Malabsorption (coeliac, CF, cow’s milk intolerance)

Failure to utilize nutrients (syndromes, congenital infection)

Increased requirements (thyrotoxicosis, CF, malignancy, chronic infection, congenital heart disease)

41
Q

What is meant by the term nutrition

A

is the intake of food considered in relation to the body’s dietary needs

42
Q

5 steps for MUST tool (malnutrition universal screening tool)

A
  1. get BMI
  2. note percentage unplanned weight loss
  3. establish acute disease effect and score
  4. add scores from 1, 2, and 3 together to obtain risk of malnutrition
  5. use management guidelines
43
Q

Recommended intake for infants 6-12 months old

A

Breast milk is not enough at this point
Wean onto solid foods: fruit, vegetables, cereal, dairy, meat, fish, eggs

If breast milk is the only drink, supplement Vitamins A, C, and D in the diet

44
Q

How should weaning be begun?

A

Puried foods
Mix with a little of the usual milk
Increase frequency gradually

Main nutrition still comes from milk at this stage (500-600ml per day)

45
Q

How to know when baby is ready for weaning?

A 
Shows interest in food
Able to sit up
Wants to chew and put objects in mouth
Able to reach
Seems hungry after milk feed
46
Q

7-9 months nutrition

A

Introduce a variety of foods, textures and tastes (wheat and range of proteins)

47
Q

9-12 months nutrition

A

3 meals a day
Add healthy snacks

Chopped food, mashed and include all groups of food

48
Q

Avoid these foods during weaning (top 10, you won’t believe number 9!!!)

A 
Salt
Sugar
Honey
Shark, swordfish
Raw eggs
Whole nuts

Child health (51 decks)

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