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Pediatric Primary Care Exam 1 > Newborn Feeding > Flashcards

Newborn Feeding Flashcards

1
Q

0-3 Months Weight, Height, and HC Gain (4)

A
  1. Weight: gain of 7-8 oz/week (25-35g/day)
  2. Height: 3.5cm/month
  3. HC: 2cm/month
  4. Regain BW by 2 weeks
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2
Q

3-6 Months Weight, Height and HC Gain (3)

A
  1. Weight: 5oz/week (12-21 g/day)
  2. Height: 2cm/month
  3. HC: 1cm/month
  4. BW doubles by 5 months
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3
Q

6-12 Months Weight, Height, and HC Gain (4)

A
  1. Weight: 3-4oz/day (10-15g/day)
  2. Height: 1.5cm/month
  3. HC: 0.5cm/month
  4. BW triples by 1 year
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4
Q

Pre-Term Gains

A

Should re-gain birth weight by 2 weeks and triple BW by 1 year

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5
Q

Energy and Protein Needs 0-6 months (3)

A

Calories: ~108cal/kg/day

Protein: 9.1g/day

Carbohydrates: 60g/day

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6
Q

Energy and Protein Needs 6-12 months (3)

A

Calories: ~90-95cal/kg/day

Protein: 11g/day

Carbohydrates: 75g/day

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7
Q

Energy and Protein Needs 0-1 year (2)

A

Calories: 90-120kcal/kg/day

Protein: 2.5-3.0g/kg/day

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8
Q

Breastmilk (7)

A
  1. Human breast milk is recommended exclusively for
    newborns and infants for first 6 months of life
    *Breastmilk is easier to digest and tolerated more than formula
  2. Ideally paired with complementary foods through 12
    months (so from 6-12 months there should be an addition of complimentary foods)
  3. Protein: 40% Casein/ 60% Whey
  4. Carbohydrate: Lactose
  5. Fat: Human milk fat
  6. Lacks vitamin D
  7. Newborns should feed ever 2-3 hours (8-12 times per day)
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9
Q

Formula (5)

A
  1. 20cal/oz (0.67calories / cc)
    * Similac recently changed to 19cal/oz
  2. Protein ratio of whey to casein varies
    * Try to mimic breastmilk
  3. Fat: ~50% calories from fat saturated and polyunsaturated fatty acids
  4. Carbohydrates: Lactose, beneficial effect on mineral absorption (ca, zinc, mg) and on gut flora
  5. Micronutrients: Higher vitamin and mineral content than HM
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10
Q

Protein In Formula

A
  1. Standard formula is whey
  2. Soy protein not recommended unless allergy such as lactose intolerance or galactosemia (soy protein is in enfamil prosobee and similac isomil)
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11
Q

Three Forms of Formula (3)

A
  1. Ready to feed – most expensive, no mixing; last 48- 72
    hours after opening
  2. Concentrate – requires mixing with water in equal parts
  3. Powder – requires mixing with water (least expensive)
    * Have to prepare correctly
    * Water first then add powder to mix (2oz water/1 scoop powder)
    * Bottled water ok, boiled ok but let cool, tap ok in most areas, well water not ok, bottled preferred in this case
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12
Q

DHA in Formula (5)

A
  1. Long chain fatty acid
  2. Docosahexaenioc acid
  3. For brain and eye development
  4. Found in fish, organ meats and fortified eggs
  5. Naturally occurring in breastmilk
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13
Q

ARA in Formula (3)

A
  1. LCFAcid- Omega 6 fatty acid
  2. Arachidonic Acid
  3. Supports brain growth
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14
Q

Probiotics (6)

A
  1. Live bacteria that colonize the GI tract and provide a
    health benefit
  2. Breastmilk promotes the colonization of bifidobacteria
    and lactobacilli
  3. Goal is to manipulate the bacterial colonization of
    formula fed infants to resemble that in breast fed infants
  4. Many formulas today have added probiotics in the US
  5. No known risk to infants
  6. Apple cider vinegar contains pectin, which has a similar effect to help balance the bacteria
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15
Q

Infant Intake At 1-2 months of life

A
  1. 2-3 oz every 2-3 hours
  2. ~10 minutes on each breast
  3. Feed 8-12 times/24 hours if breastfed
    * Best influx of milk on breast is w/i first 10 minutes
  4. Feed 6-8 times/24 hours if formula
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16
Q

PNP Recommendations for Feeding (5)

A
  1. Breast is best
  2. If formula for FT infant start with standard CM formula
    20cal/oz (19cal/oz)
  3. Unless parental request or strong family history of
    allergy use: EleCare , Neocate, Nutramigen AA
    *Cant tolerate hydrolyzed protein- easy to digest
    * Protein maldigestion, malabsorption, severe food allergies, short gut,
    *“hypoallergenic”- true IgE mediated cow’s milk allergy
  4. Observe tolerance and growth
  5. Preterm infants need more calories – 22 cal/oz
    * Neosure (increased calcium and phosphorus +)
    * EnfaCare
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17
Q

Special Formulas (7)

A
  1. Similac 60/40 (Whey/Casein) low minerals for renal impairment
  2. Similac sensitive
  3. Similac Expert Care
  4. Expert Care for diarrhea (soy)

Supplementation:

  1. Reguline (comfortable stools)
  2. Gentle-ease (fussiness/gas)
  3. Enfamil AR (spitting up) or Similac for spit up
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18
Q

Infant Requirements (4)

A
  1. Vitamin D 400 IU /day younger than 12 months
    * Starting days after birth
    * Until weaned or baby takes 32 ounces of Vitamin D fortified formula or CM
    * This is for breastfed infants
  2. For formula fed infants if taking less than 32 oz /day
  3. As baby gets older include foods with Vitamin D
    * Oily fish, eggs, fortified foods
  4. If not eating well at 1 year can increase to 600 IU/day
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19
Q

Iron Requirements (7)

A
  1. Breastfed Term infants starting at 4 months of life (AAP)
    * References may say 4-6 mths
  2. 1 mg/kg/day po liquid iron (Fer-In-sol)
  3. Formula fed infants (iron fortified) do not need supplementation for the first year
  4. Preterm infants 2mg/kg/day after 2 weeks of age (by 1 month)
  5. Do CBC at 12 months
  6. When foods introduced, add Iron Fortified Cereals
  7. Eventually Iron rich foods- (vit C helps Fe absorption)
    * Spinach, beef, turkey, chicken livers
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20
Q

Starting Solids (8)

A
  1. May be added at 4-6 months
    * AAP recommends 6 months exclusively breastfed
  2. Infant needs to require additional calories and be developmentally mature to start solids:
  3. Sit and support head
  4. Tongue thrust gone (4 months - by 6 months or abnormal)
  5. Taking more than 32 ounces an day and appears hungry
  6. Initial introduction still getting most of nutrition from
    breastmilk/formula
  7. Start with iron fortified rice (mix with BM or formula)
    * Typically rice cereal because does not contain gluten
    * Start with single grain cereals (rice, oatmeal, barley)
  8. Start with one “meal” a day and advance to 2-3/day
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21
Q

5-6 Month Old Solids

A
  1. Fruits and vegetables start after cereals
  2. Introduce 1 new food every 3 days and watch for signs of allergy/intolerance
  3. Meats may be introduced after 6 months only
  4. No juice under 6 months
    * Avoids dental carries
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22
Q

Potential Allergies when Introducing Foods (2)

A
  1. Most common presentations are vomiting, diarrhea and rash
  2. Take food away, wait a month, then reintroduce it to check if that food is causing the allergy unless there is a first degree relative with it (then don’t reintroduce it)
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23
Q

7-8 Month Old Solids (3)

A
  1. Start with a thin consistency (1 tbp cereal/2 oz liquid) – all foods pureed!
  2. – 4-6 tbp of cereal with thicker consistency – Smooth consistency/ mixed ingredients/ add meats
  3. Assess pincer grasp if improved start finger foods but most 9 months
24
Q

9-10 Month Old Solids (4)

A
  1. Courser texture foods
  2. Teeth
  3. Sit independently
  4. Begin self-feeding (introduce finger foods)- PINCER GRASP
    * Crackers, cheese, cheerios
25
Q

10-12 Month Old Solids (5)

A
  1. Pulls to stand / reaches for food
  2. Add soft table foods
  3. Allow to self feed
  4. REMEMBER NO HONEY UNDER 1 year of age – Spores can cause infant botulism! (bacterium Clostridium botulinum) – can be fatal
  5. Agave Nectar is a safe and good choice for infant cough or soothing!
26
Q

Vitamin D Requirements (4)

A
  1. Vitamin D 400 IU /day younger than 12 months
    * Starting days after birth
    * Until weaned or baby takes 32 ounces of Vitamin D fortified formula or CM
    * This is for breastfed infants
  2. For formula fed infants if taking less than 32 oz /day
  3. As baby gets older include foods with Vitamin D
    * Oily fish, eggs, fortified foods
  4. If not eating well at 1 year can increase to 600 IU/day
27
Q

Aspiration Risk Foods (4)

A
  1. Popcorn
  2. Gum
  3. Hard candy
  4. Raw carrots
28
Q

Prepared Foods (8)

A

Stages by developmental age

  1. Start with puree (stage1) and advance
    * Stage 1 – no egg, milk, wheat, citrus
  2. Read labels and see if single or mixed foods
  3. Home made baby foods
  4. Wash thoroughly
  5. Be aware of root vegetables may be high in nitrates
  6. Cause methemoglobinemia – decreases oxygen carrying capacityanoxic injury – death
  7. Danger with well water
  8. Blue baby
29
Q

Weaning From Bottle (7)

A
  1. Usually occurs between 6-12months
  2. May be delayed to 18 months
  3. 12 months may change to Homogenized, Vitamin D fortified Cow’s milk
  4. Whole milk
    * NO fat free, low fat (1%) until 2 years of age
  5. Dental caries and dentation
  6. Difficult transition
  7. Introduce ‘cup’ 6-9mths to start
30
Q

Persistent Tongue Thrust (3)

A
  1. Reverse swallow or immature swallow
  2. Should disappear by 6 months to allow for the ingestion of food
  3. Macroglossia, tongue tied –> Angelmans syndrome (deletion on maternal 15), Prader Willi (deletion on paternal 15), CP
31
Q

Tongue Tied: Ankyloglossia (7)

A
  1. Tethers the bottom of the tongue’s tip to the floor of the mouth
  2. Difficulty lifting tongue or past front lower teeth
  3. Difficulty breastfeeding may occur
  4. Can affect oral development, eating, speech development (certain sounds T,D,Z,S, TH) and swallowing
  5. Can interfere with intake and weight gain
  6. Treatment is controversial (right away or watch and wait?)
  7. Frenulectomy – ENT snip and may breastfeed right away
32
Q

Swallowing Disorders (3)

A

Dysphagia

Can occur at three phases:
1. Oral = sucking,chewing,moving food or lqd in mouth
2. Pharyngeal = starting to swallow, squeezing food down
the throat and closing off the airway to prevent aspiration
3. Esophageal = relaxing and tightening the esophagus
pushing food into stomach

33
Q

Causes of Dysphagia (6)

A
  1. Cerebral palsy
  2. GI conditions GER/short gut
  3. prematurity
  4. Autism,
  5. hypotonia
  6. parent-child mealtime problems
34
Q

Symptoms of Swallowing Disorders (11)

A
  1. Arching, stiff during feeds
  2. Irritable during feeds
  3. Refusing food or liquid
  4. Failure to accept different textures (only pureed or only crunchy)
  5. Long time to feed
  6. Difficulty breastfeeding
  7. Coughing, gagging to choking with feeds
  8. Excessive drooling
  9. Hoarse voice
  10. Frequent spitting up
  11. Dia Poor weight gain
35
Q

Diagnosing Swallowing Disorders (3)

A
  1. Speech language pathologist can perform a swallow study
  2. Barium swallow to observe
  3. ENT- endoscopy
36
Q

Swallowing (1, 3F)

A
  1. Change foods, increase calories and consistency
  2. Behavioral management techniques
  3. Speech Language Pathologist or Feeding Specialist
    A. Strengthen muscles
    B. Increase tongue movement
    C. Improve chewing
    D. Increase acceptance of different foods
    E. Sucking and drinking ability
    F. Alter food textures to ensure safe swallowing
37
Q

Sensory Processing Disorders (6)

A
  1. Sensory Disorders (Sensory processing disorder)-SPD
    * Controversial
  2. Nervous system difficulty adapting
    * Sensory integration dysfunction - Infants cannot effectively process information from their senses
    * Resulting in delays in motor skills, problems with self-regulation, attention and behavior issues
  3. Child who has difficulty eating, sleeping and is
    very irritable
  4. Can be hypersensitive or hyposensitive to stimuli in their surroundings
  5. May occur alone or with ADHD
  6. Autism (70%)
38
Q

Management of Sensory Processing Disorders (3)

A
  1. Evaluation (OT/PT)
  2. Fun, play based interventions in “sensory-rich”
    environments
  3. Family centered
39
Q

Sensory Integration Therapy (3)

A
  1. Improve over time with therapy
    * Help cope with difficulties they have processing sensory input
  2. Wilbarger brushing therapy
  3. Watch growth curve/FTT
40
Q

Teething (4)

A
  1. 20 primary (deciduous teeth)
  2. Erupts at approximately 6-36 months
  3. 1st to erupt - lower central incisors (6-10 months)
  4. May present with bluish discoloration over gum (erupt hematoma)
41
Q

Rules of Thumb with Teething (5)

A
  1. 1st at 6months
  2. 1 every month until 24 – 30 months
  3. Incisors, molars, canines, second molars
  4. “forward-forward-back-forward-back” – (incisor-incisor-first molar-cuspid-secomd molar)
  5. VARIATION in timing of eruption
42
Q

Generalized Symptoms with Teething (5)

A
  1. Fussiness
  2. Drooling
  3. Sleep disruption
  4. Loose stools
  5. No fever
43
Q

Hypodontia

A

Fewer than normal teeth

44
Q

Anodontia

A

Absent teeth

45
Q

Natal teeth

A

Familial, syndrome

46
Q

Dental Varnish (4)

A
  1. Dental caries/tooth decay is the most common disease in children in the US
  2. Start dental hygiene before teeth erupt!
  3. A ‘silent disease’
  4. Disproportionally affects poor, young and minority populations
47
Q

Dental Varnish Recommendations (6)

A
  1. Flouridated toothpaste all children starting from eruption
  2. A ‘smear’ up to 3 years
  3. over 3 yrs – pea sized / supervised
  4. No flouride swishes…can swallow and level is high
  5. Flouride varnish is recommended in the PCP office every 3-6 months starting at tooth eruption
  6. Avoid crunchy. Chewy and sticky items for 4 hours after
48
Q

Infant Depression (9)

A
  1. Two signs: babies not exhibiting a lot of emotion and babies may have trouble eating or sleeping and is iritable
  2. Depression or predisposition may be inherited
  3. Dysfunctional regulation possibly due to neurological
    deficiency or mother’s stress-related hormones
  4. Compromised bonding and care
  5. Lack of eye contact, gaze or seeking comfort from caregiver
  6. Failure to achieve social-emotional milestones
  7. Exposure to maternal negative thoughts, behaviors and affect
  8. Stressful life
  9. Can present as feeding difficulty or FTT
49
Q

Treatment for Infant Depression (6)

A
  1. Identify Mother’s with postpartum depression or at risk
  2. Support of entire family
  3. Music therapy (mother and baby)
  4. Massage therapy (mother and baby)
  5. Stress relieving intervention may enable mother to be more receptive and infant responds to improved interactions
  6. Drug therapies (evaluate risk vs benefit with breastfeeding)
50
Q

Partial or Semi-Vegetarians (3)

A
  1. Avoid some but not all animal products
  2. They may eat chicken or fish and dairy products but no meat
  3. Some eat fish but no poultry
51
Q

Lacto-ovo vegetarians (3)

A
  1. Eat eggs and dairy products but avoid all flesh
  2. Avoid foods with a face
  3. Lactovegetarians do not eat eggs
52
Q

Benefits of vegetarian diet (3)

A
  1. Provide more fruits, vegetables and fibers
  2. Less fat and cholesterol than mixed diet
  3. May have lower levels of cholesterol and body fat than nonveg
53
Q

potential risks of vegetarian diet (3)

A
  1. Diets that include milk, milk products and eggs are generally high in essential nutrients and do not pose health risks
  2. Vegan diets (all animal excluded) may place infants at
    nutritional risk
  3. Fortify or supplements are needed – vegans lack vitamin B12 and vitamin D
54
Q

Animal foods are rich in… (5)

A
  1. Protein
  2. Iron
  3. Calcium
  4. Zinc
  5. Vitamin B12, A and D
  • Overly strict diets can result in malnutrition
  • Lack of protein/calories can lead to FTT, rickets, IDAnemia
55
Q

PNP Role in Diet (6)

A
  1. Fat should not be restricted in infants in children younger than 2 years of age (oils, avocados, seeds, nuts, nut butters)
  2. Proteins (legumes introduced first as part of the protein group, lentils and tofu, egg yolks, yogurt if allowable)
  3. BM is an ideal protein for first 2 years of life
  4. Calcium – soy milk, OJ fortified, breads, blackstrap mollasses, vegetables- brocolli, collard greens, kale, spianch)
  5. Vitamin D- sunlight exposure 1 minute/day infants – supplements (400iu)
  6. B12- (growth, red cell maturation and CNSystem functioningcereals, soy milk and supplements)
56
Q

Baby Led Weaning (5)

A
  1. A method of adding complimentary foods to a baby’s
    diet/BM/formula
  2. A method of food progression
  3. Facilitates the development of age appropriate oral-motor control while maintaining a positive experience
  4. Babies control their solid food consumption by “self feeding” from the beginning
  5. Hand them food-suitable sizes-if they like it they eat it if not they don’t
57
Q

Baby Led Weaning 5 Advantages vs. 1 Disadvantage

A

Advantages:

  1. No puree
  2. No ‘mush’
  3. No ice cube trays
  4. Positive experience
  5. Natural progression – developmentally capable at 6 months

Disadvantages:
1. Choking

Pediatric Primary Care Exam 1 (7 decks)

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