Paediatrics/Infant Feeding

Question 1

When should breast-feeding begin?

Answer 1

Ideally, right after birth

Question 2

What are the intrinsic benefits of breast milk compared to infant formula? What additional benefits may be conferred to a breast-fed

Answer 2

• Composed of macro- and micronutrients specific and ideal for human babies
• breast milk provides maternal antibodies (decreasing infections)
• is less expensive, and more environment friendly

Other benefits

• Decreased incidence of SIDS, lymphoma and other malignancies, obesity, diabetes, and allergies/eczema
• increased IQ scores

Question 3

What additional benefits of breast-feeding may be conferred to mothers?

Answer 3

• Contracts uterus
• helps in returning to prepregnancy weight
• delay of menses
• “Feel-good” hormone release (oxytocin)
• decreased incidence of breast cancer, ovarian cancer, and osteoporosis later in life

Question 4

How often should a breast-fed infant feed?

Answer 4

8-12 times every 24 hours until 4 months of age

Question 5

How long should each feeding last?

Answer 5

10-15 minutes on each breast

Question 6

What is the current recommendation regarding breast-feeding in the developed world if the mother is HIV+?

Answer 6

Baby should be formula-fed because of risk for infection via breast milk.

Question 7

How can we promote breast-feeding?

Answer 7

Education pre- and postdelivery about the benefits of breast-feeding, reinforcement, and early lactation training (proper latch-on techniques)

Question 8

The American Academy of Pediatrics recommends breast-feeding for how long?

Answer 8

Exclusive breastfeeding for 6 months; then breastfeeding with appropriate complementary foods from 6 months to at least 12 months

Question 9

What can be used as a supplement or alternative to breast milk?

Answer 9

Formula (cow-milk or soy-milk based)

Question 10

The standard formula for a term infant has how many kilocalories per ounce?

Answer 10

20 kcal/oz

Question 11

How many ounces should a formula-fed baby feed in the first few months of life?

Answer 11

On average , 2-3 oz every 3-4 hours by 2 weeks of age, progressively increasing to 5-6 oz every 3-4 hours at 6 months of age

Question 12

How do you know if a baby is eating enough?

Answer 12

Plotting weight, length, and head circumference on a development curve

Question 13

According to the American Academy of Pediatrics (AAP), what is the recommended daily intake of vitamin D for all infants, children, and adolescents?

Answer 13

400 International Units (IU) per day

Question 14

What is the AAP’s recommendation regarding vitamin D supplementation for breastfed and partially breastfed term infants?

Answer 14

The AAP recommends supplementing with 400 IU of vitamin D beginning in the first few days of life and continuing until the infant consumes at least 1 L per day (or 1 quart per day) of vitamin D-fortified formula or whole milk (though whole milk should not be used until after 12 months of age).

Question 15

According to the AAP, what is the lower limit of normal for 25-hydroxyvitamin D concentrations in infants and children?

Answer 15

20 ng/mL

Question 16

What is the USPSTF recommendation regarding screening for iron deficiency anemia?

Answer 16

There is insufficient evidence to recommend for/against routine screening for iron deficiency anemia in asymptomatic children aged 6-12 months (I recommendation). However, the USPSTF recommends routine iron supplementation (ironfortified formula or iron supplements) for asymptomatic children aged 6-12 months who are at increased risk for iron deficiency anemia (B recommendation).

Question 17

What are the sequelae of iron deficiency anemia in children?

Answer 17

Psychomotor and cognitive abnormalities, poor school performance

Question 18

What are risk factors for iron deficiency anemia?

Answer 18

Prematurity, low birth weight infants

Question 19

How early can you introduce solid foods to babies?

Answer 19

4 months

Question 20

For how long may a baby’s nutritional needs be met by formula or breast milk alone?

Answer 20

6 months

Question 21

What are the signs that a baby is ready to eat solid foods?

Answer 21

Head control, loss of extrusion reflex, hunger that continues after consuming 32 oz of formula or nursing ten times per day

Question 22

What types of food are appropriate for an infant beginning to eat solids?

How should these foods be introduced?

Answer 22

• Food that is soft and easy to digest (rice cereal with iron).
• Slowly and no more than one new food every 3 days (helps monitor for allergic reactions)

Question 23

Do all babies spit up? Why?

Answer 23

• Generally, all babies will spit up at some time during feeds.
• Babies have low esophageal sphincter tone, and caretakers frequently overfeed or inadequately burp them.

Question 24

When is reflux in babies worrisome?

Answer 24

• Spitting up happens all of the time
• weight gain is inadequate
• reflux causes the baby to cry incessantly, cough, or wheeze

Question 25

What should be the primary source of nutrition for a baby up to 1 year of age?

Answer 25

Breast milk or formula (solids are only a supplement)

Question 26

What foods should be avoided in babies less than 12 months old?

Answer 26

• Potent allergens such as egg whites
• cow milk
• honey
• nut butters
• citrus fruit
• seafood (especially shellfish)

Question 27

Which of food can cause infant botulism poisoning?

Answer 27

Honey

Question 28

What types of food should be avoided in children less than 3 years old?

Answer 28

Anything that may cause the toddler to choke (peanuts, whole grapes, raw vegetables that snap into hard chunks, etc)

Question 29

What teeth are usually the first to erupt? When (on average)?

Answer 29

Mandibular central incisors

6-8 months

Question 30

What is the most common chronic childhood disease?

Answer 30

Dental caries

Question 31

At what age should caregivers begin to clean a child’s teeth?

Answer 31

As soon as the first teeth appear, a child’s teeth can be cleansed with a cloth (later advancing to a soft toothbrush).

Question 32

What is the USPSTF recommendation for fluoride supplementation?

Answer 32

The USPSTF recommends oral fluoride supplementation at recommended doses to preschool children older than 6 months of age whose primary water source is deficient in fluoride (B recommendation).

Question 33

Which water sources have inconsistent levels of fluoride?

Answer 33

Well water and bottled water

Question 34

Beginning at what age should a child’s toothpaste contain fluoride?

Answer 34

2 years

Question 35

Why is it important for young children to only use a small amount of fluorinated toothpaste and learn to rinse well and spit out as much toothpaste as possible when they are done brushing?

Answer 35

Swallowing large amounts of fluoride can cause a child’s permanent teeth to have white spots.