HD: PBL 4 (Infant Feeding)

Question 1

What are child health clinics?

Answer 1

Clinics run by health visitors and doctors to offer regular health and development reviews, vaccination and advice and support

Question 2

What is the aim of the healthy child programme?

Answer 2

Help families avoid illness and stay healthy, offering screening and developmental checks of children also

Question 3

When will a health visitor first visit a new mother?

Answer 3

Around 10 days after baby’s birth

Question 4

What does 50th centile represent?

Answer 4

That 50% of babies are heavier at this age, and 50% are lighter

Question 5

What are the current Department of Health guidelines on breastfeeding?

Answer 5

Exclusive breastfeeding is recommended for at least the first 6 months of infant life and unmodified cow’s milk shouldn’t be given until 12 months of age as the main milk drink

Question 6

Why is unmodified cow’s milk unsafe to give to infants under 12 months?

Answer 6

Excessive protein levels are present which are metabolised to urea and this can cause dehydration due to increasing lumen osmolarity, excess sodium is present which also contributes to dehydration as well as excessive phosphate levels which lead to hypocalcaemia, tetany and convulsions

Question 7

What are the advantages of breastfeeding over using infant formula?

Answer 7

Fewer GI and respiratory infections, reduced allergic symptoms, benefits on cognitive development, possible reduction in risk of sudden infant death syndrome suppresses fertility and prolongs inter-pregnancy interval

Question 8

How does infant formula differ from unmodified cow’s milk?

Answer 8

Infant formula consist of cow’s milk where macronutrient content has been modified to make it more like human milk

Question 9

Why shouldn’t soya-based infant formula be given?

Answer 9

Contains phytoestrogens (similar to oestrogen) and there is concern that these could affect the development of reproductive organs; and it contains glucose which is more harmful to babies’ teeth than lactose in infant formula made with cow’s milk

Question 10

Why may mothers stop breastfeeding?

Answer 10

Sore nipples, inadequate milk supply, infant having difficulties, and perception that infant is not satiated

Question 11

When should weaning take place?

Answer 11

Around 6 months of age

Question 12

Describe the process of weaning

Answer 12

Should introduce a baby to a variety of different tastes in the form of pureed food or convenience baby foods, and these should all be salt, sugar and gluten free (avoids development of a taste for sweet/salty food which can impact diet in later life)

Question 13

What is weaning?

Answer 13

The introduction of solid foods to an infant’s diet

Question 14

Why should gluten-containing food be avoided until an infant is at least 6 months of age?

Answer 14

May reduce the risk of coeliac disease and other allergic diseases

Question 15

When should potentially allergenic foods, such ass eggs, be introduced into an infant’s diet?

Answer 15

After 6 months (including gluten)

Question 16

When should a baby be given food containing small lumps?

Answer 16

7-8 months

Question 17

When should a baby be given ‘finger food’?

Answer 17

8-9 months

Question 18

When should a baby be given family food and similar meal to parents?

Answer 18

9-12 months

Question 19

What is the absolute maximum amount of milk an infant should be receiving at 1 year of age?

Answer 19

1 pint a day (~500ml)

Question 20

What is the current milk recommendation for milk consumption at 1 year?

Answer 20

300ml per day

Question 21

Name some components that are present in breast milk in a higher concentration than in formula milk, and what is the advantage of these to the infant?

Answer 21

IgA antibodies - defence against infection
Long chain fatty acids - brain development
Whey proteins - more easily digestible
Lysozyme - contributes to and influences bacteria in the GI tract

Question 22

Describe the process of breast feeding

Answer 22

Baby’s lips press firmly against areola and seal the oral cavity anteriorly –> soft palate rises up and back and contacts the pharyngeal walls to seal the oral cavity posteriorly –> as tongue and jaw drop during suckling, oral cavity increase in size and suction is generated –> draws milk into the baby’s mouth

Question 23

What is the let-down reflex?

Answer 23

The letdown reflex, also called the milk ejection reflex, is set off by the hormone oxytocin. It stimulates the muscle cells in your breasts to squeeze out milk

Question 24

Describe the physiology behind breastfeeding

Answer 24

When a baby suckles –> sensory impulses from the nipple to the brain –> anterior lobe of pituitary secretes prolactin (production of milk) and posterior lobe secretes oxytocin (milk ejection from nipple/let-down reflex)

Question 25

Describe the role of prolactin in breastfeeding

Answer 25

In pregnancy levels of prolactin markedly increase to stimulate growth and development of mammary tissue in preparation for milk production
After delivery - level of prolactin increases and stimulates production of milk by alveoli (as oestrogen and progesterone levels decline), which is important to make milk for the next feed, levels peak 30 minutes into a feed

Question 26

Why don’t women lactate during pregnancy?

Answer 26

Oestrogen and progesterone block the milk-production component of prolactin

Question 27

Describe the role of oxytocin in breastfeeding

Answer 27

Makes the myoepithelial cells around the alveoli contract which makes the milk (collected in the alveoli) flow along and fill the mammary ducts and is ejected in fine streams

Question 28

How is oxytocin production stimulated?

Answer 28

When a mother expects a feed as well as when the baby is suckling and this can become conditioned so that touching, smelling or seeing her baby or hearing another baby cry can stimulate oxytocin release and thus lactation

Question 29

Why may an infant with cleft palate struggle to breastfeed?

Answer 29

May struggle to produce sufficient amount of suction to draw milk from the nipple as babies with cleft palate or cleft lip and palate, struggle to adequately separate the nasal and oral cavities during feeding

Question 30

What is infant reflux?

Answer 30

Reflux is often normal in babies and involves regurgitation of stomach contents due to the immaturity of the lower oesophageal sphincter and oesophagus generally

Question 31

What is normal and abnormal in terms of infant reflux?

Answer 31

Normal - reflux usually stops at 12-14 months when the LOS fully develops
Abnormal - abnormal if reflux continues after 18 months and could e a sign of GORD, milk allergy or a blockage

Question 32

What is a cleft palate?

Answer 32

When the roof of the mouth contains an opening into the nose

Question 33

What can be the consequences of cleft lip and/or palate?

Answer 33

Speech problems, feeding problems, hearing problems and frequent ear infections

Question 34

What is the treatment for cleft lip and palate?

Answer 34

Surgery; for cleft lip this is done in the first few months of life (no scarring) and before 18 months for clef palate

Question 35

What are the risk factors for the development of cleft lip and palate in infants?

Answer 35

Smoking during pregnancy, diabetes, older mother, obesity, some seizure medications

Question 36

What causes cleft lip?

Answer 36

Failure of the fusion of the maxillary and medial nasal processes (failed formation of the primary palate)

Question 37

What causes cleft palate?

Answer 37

Failure of the fusion of the lateral palatine processes, the nasal septum and/or the median palatine processes (failed formation of the secondary plate)