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Paediatrics > Infant Feeds > Flashcards

Infant Feeds Flashcards

1
Q

What are the different phases of childhood?

A
  • Neonate
    • <4 weeks
  • Infant
    • <12 months
  • Toddler
    • 1-2 years
  • Pre-school
    • 2-5 years
  • School age
  • Teenager/adolescent
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2
Q

What factors lead the growth in the following phases:

  • infant
  • child
  • pubertal
A
  • Infant
    • Nutrition led
  • Child
    • Growth hormone led
  • Pubertal
    • Sex hormone led
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3
Q

What is birth size and weight impacted by?

A
  • Maternal size
  • Placental function
  • Gestation
    • 95% of weight between 20-40 weeks
    • 10-16% of body weight as fat
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4
Q

What is the size of the average term infant?

A

3.3kg

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5
Q

What is energy required for?

A
  • Physical activity
  • Thermogenesis
  • Tissue maintained
  • Growth
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6
Q

Why are children at risk of inadequate nutrition?

A
  • Characteristic feature is need to fuel both rapid growth and maintenance
    • Infants can become rapidly malnourished
    • Dependent on carer
    • High demands for growth and maintenance
      • Infants 100kcal and 2g protein/kg/day
      • Adults 35kcal and 1g/kg/day
    • Low stores (fat and protein)
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7
Q

What is the average weight gain in g/week for:

  • 0 to 3 month old
  • 3 to 6 month old
  • 6 to 9 month old
  • 9 to 12 month old
A
  • 0 to 3 months
    • 200g
  • 3 to 6 months
    • 150g
  • 6 to 9 months
    • 100g
  • 9 to 12 months
    • 50 to 75
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8
Q

By when does a baby double its weight, and then triple?

A

Babies double weight by 6 months and triple by 1 year:

  • After 1 year, about 2kg and 5cm/year until puberty
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9
Q

What is growth monitred by?

A

Growth charts

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10
Q

How much calories and protein per day do:

  • children require
  • adults require
A
  • Infants 100kcal and 2g protein/kg/day
  • Adults 35kcal and 1g/kg/day
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11
Q

Why is weight maintenance for children like an adult losing weight?

A

With children, weight maintenance is like adults losing weight, as they should be growing

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12
Q

Why is breast feeding the best form of feed?

A
  • Well tolerated
  • Less allergenic
  • Low renal solute lead
  • Calcium, phosphate, iron, fatty acids
  • Improves cognitive development
  • Reduces risk of infection
    • Macrophages and lymphocytes
    • Interferon, lactoferrin, lysozyme
    • Bifidus factor
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13
Q

Compare and contrast breast milk and formula?

A
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14
Q

When is breast feeding recommended until?

A
  • Exclusively breast feeding to around 6 months
  • From 6 months, complementary breast feeding alongside solids is supported
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15
Q

What are some of the principles of UNICEF baby friendly “ten steps”?

A
  • Written breast feeding policies communicated with staff
  • Train all health care staff to implement policies
  • Inform all pregnant woman about the benefits of breast feeding
  • Help mothers initiate breastfeeding within a half hour of birth
  • Show mothers how to breast feed
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16
Q

What are standard formula milks prepared from?

A

Cow milk

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17
Q

What does specialised formula exist for?

A
  • Specialised formulas exist for cow milk protein allergy
    • Nutrient dense
    • Disease specific
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18
Q

When is cow milk not suitable as the main drink before and why?

A

Cows milk not suitable as main drink until 1 year as they contain no iron

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19
Q

What are some examples of available formula milk?

A
  • Pre-term formula
    • Typically higher in protein (2g vs 1.5g) and higher calorie (80kcal vs 67kcal) / 100ml
  • Nutrient dense formula
    • 100kcal/100ml
  • Cows milk protein allergy
  • Disease specific
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20
Q

Describe the normal feeding pattern (volume, times per day, suggested milk intake per day) for:

  • up to 2 weeks
  • 2 weeks to 2 months
  • 2 to 3 months
  • 3 to 5 months
  • 6 months
  • 7 to 9 months
  • 10 to 12 months
A
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21
Q

Cow’s milk protein allergy - epidemiology

A
  • Most common allergy in infants
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22
Q

Cow’s milk allergy - management

A
  • Nutramigen
    • First line feed of choice
  • Amino acid based feed
    • Second line based feed
    • Indications – severe colitis/enteropathy breast milk
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23
Q

What is the first and second line feeds for cow milk protein allergy?

A
  • Nutramigen
    • First line feed of choice
  • Amino acid based feed
    • Second line based feed
    • Indications – severe colitis/enteropathy breast milk
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24
Q

At what age do babies begin the milk ladder?

A

When babies reach one year begin milk ladder:

  • Slowly introduce more dairy into diet
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25
Q

What are indications for lactose free milks?

A
  • Lactose intolerance
26
Q

What can lactose intolerance be secondary to?

A

Can occur primary or secondary, due to:

  • Short lived conditions such as post-gastroenteritis
27
Q

What are possible complications of soya milk usage?

A

They are high in phytoestrogens, complications:

  • Which can be concerning in infants under 6 months
  • Cross reactivity with cows milk
28
Q

What are indications for soya milk?

A
  • Milk allergy when hydrolysed formula refused
  • Vegan families, if not breast fed
  • Consider for children > 1 year still on milk free diet
29
Q

What are some non-formula milks other than cow milk?

A
  • Soya milk
  • Lactose free milk
  • Rice milk
    • Not advice for children under 5 years
  • Goats and sheeps milk
    • Not suitable for under 1st
    • Many children react
  • Oat and nut milk
  • Organic versions
    • Are not calcium fortified
30
Q

How do organic/unsweetended versions of cow milk compare in calories and calcium to cow milk?

A

Full fat cows milk:

  • 65kcal/100ml and 120mg calcium/100ml
  • Organic/unsweetened milk substitutes low in calories
  • Organic milks have no calcium supplemented
31
Q

How much calcium fortified milk is required to meet calcium requirements?

A

Need 400-500ml of calcium fortified milk to meet calcium requirements:

  • Supplement if <500ml calcium fortified substitute
    • Alliance calcium liquid or if >3 years calcium softies
    • Breast feeding mums Accrete or Cacit D3
32
Q

When should a calcium supplement be given?

A
  • Supplement if <500ml calcium fortified substitute
    • Alliance calcium liquid or if >3 years calcium softies
    • Breast feeding mums Accrete or Cacit D3
33
Q

When do solids start getting used?

A

Used in complementary feeding in the transition from milk to mixed diet:

  • Nutritional and developmental changes

Starts around 6 months of age (17-26 weeks):

  • Look for signs of readiness
    • Head control, interest in food
34
Q

What are signs of readiness to try solids?

A
  • Head control, interest in food
35
Q

Why introduce solids to a babies diet?

A
  • Milk alone inadequate
  • Encourage tongue and jaw movements in preparation for speech and social interactions
  • Neophobia
    • To reject novel or unknown foods in childhood, increase acceptance by repeatedly offering a variety of foods
    • Common
36
Q

What is neophobia?

A
  • Neophobia
    • To reject novel or unknown foods in childhood, increase acceptance by repeatedly offering a variety of foods
    • Common
37
Q

What is weaning?

A

Weaning = introducing babies to solid food

38
Q

What should you wait until before you start weaning?

A

Wait until they can support there own head

39
Q

What solids can be given to babies of the following ages:

  • 17 weeks to 6 months
  • around 6 months
  • 6 to 9 months
  • 9 to 12 months
  • 12 months
  • 18 months
A
40
Q

Why is vitamin D often low?

A
  • Dark skinned children at risk
  • Diet is a poor source, most comes from the sun
41
Q

How much vitamin D should be given as supplement for:

  • birth to 1 year
  • everyone over 1 year
A
  • Birth to 1 year
    • 8.5-10ug
    • Not required if infant formula >500ml
  • Everyone over 1 year
    • 10ug
42
Q

What are the different kinds of reflux?

A
  • GOR
    • Effortless passage of gastric contents into oesophagus with or without regurgitation and vomiting
  • GORD
    • When the reflux of gastric contents causes troublesome symptoms and/or complications
43
Q

What is GOR and GORD?

A
  • GOR
    • Effortless passage of gastric contents into oesophagus with or without regurgitation and vomiting
  • GORD
    • When the reflux of gastric contents causes troublesome symptoms and/or complications
44
Q

GOR - epidemiology

(how common, age)

A
  • Vomiting common in babies
  • Peaks at 3-4 months
45
Q

DOR - management

A
  • Reassurance over natural course
  • Advice on feeding, check if overfed
  • No specific treatment
  • Thickened formula
    • Infant Gaviscon sachets
    • Carobel
  • If no improvement
    • Trial or milk free diet
46
Q

What are examples of thickended formulas that can be given for GOR?

A
  • Thickened formula
    • Infant Gaviscon sachets
    • Carobel
47
Q

What are red flag signs for reflux?

A
  • Weight loss or poor weight gain
  • Recurrent or bilious vomiting
  • GI bleeding
  • Persisting diarrhoea
  • Dysphagia
  • Stridor/cough/hoarseness
48
Q

Who are high risk groups of reflux?

A
  • Preterm babies
  • Neurological impairment
  • Chronic respiratory illness
  • Anatomical
  • Genetic disorders such as down syndrome
49
Q

GORD - treatment

A
  • Acid suppression
    • Reduced gastric acid may increase risk of pneumonia, gastroenteritis and candidiasis
  • Trial of milk free diet
  • Continuous NG/jejunal feeds
  • Consideration of anti-reflux surgery
  • Drug therapy
    • Gaviscon liquid – 1st line
    • H2 receptor antagonist (Ranitidine)
    • Proton pump inhibitors (Omeprazole/Lansoprazole)
    • Pro-kinetics (Domperidone to promote gastric emptying, or low dose erythromycin)
      • Only short term
    • Anti-histamine (Alimemazine)
50
Q

What drug therapy can be used for GORD?

A
  • Gaviscon liquid – 1st line
  • H2 receptor antagonist (Ranitidine)
  • Proton pump inhibitors (Omeprazole/Lansoprazole)
  • Pro-kinetics (Domperidone to promote gastric emptying, or low dose erythromycin)
    • Only short term
  • Anti-histamine (Alimemazine)
51
Q

What are the normal crying times for:

  • 0 to 6 weeks
  • 10 to 12 weeks
A
52
Q

What are common issues that cause feeding problems?

A
  • In bread fed baby
    • Functional lactose overdose
  • All babies
    • Cows milk protein allergy
    • Psychosocial issues
    • Maternal health issues
    • Colic
53
Q

What is colic?

A

Inconsolable crying in a baby:

  • <3 months of age, >3 hours/day, >3 days/week
  • For at least a week

No red flag symptoms

54
Q

What is the criteria to be colic?

A

Inconsolable crying in a baby:

  • <3 months of age, >3 hours/day, >3 days/week
  • For at least a week
55
Q

Colic - treatment

A
  • Explanation and reassurance
  • Probiotics
  • Trial of cows milk protein avoidance
  • Lactase drops
  • Anti spasmodics
56
Q

Iron deficiency - aetiology

A
  • Breast fed/pre term
  • Cow’s milk
    • Not fortified with iron like formula
  • Too much juice
  • No structure to meals/snacks
  • Constipation
57
Q

Iron deficiency - epidemiology

(how common)

A
  • Most common deficiency in the world
58
Q

Iron is particularly important for development of what organ?

A

Iron important for brain development, periods of peak brain development:

  • Neonatal period
  • 6 months to 3 years
59
Q

When are periods of peak brain development?

A
  • Neonatal period
  • 6 months to 3 years
60
Q

What are examples of nutritional issues beyond infancy:

  • toddler and pre-school
  • school age
  • adolescent
A
  • Toddler and pre-school
    • Picky eaters/excess milk
    • Dependent on carer
    • Frequent illness
  • School age
    • Learning to be independent
    • Chronic disease
    • Obesity
  • Adolescent
    • Independent
    • Puberty
    • Eating disorders

Paediatrics (37 decks)

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