PBL 4

Question 1

what is the role of the health visitor

Answer 1

Offer regular health visitor checks for baby until they are 2

Provide family-focused service delivered either in GP practices, children centre’s or at home/over phone

Question 2

what does the health visitor offer advice on

Answer 2

Child growth and development

Vaccinations

Parenting support

Early detection of ill health

Help to make sense of conflicting media messages about healthy lifestyles

Advice on healthy eating and health promotion

Question 3

when are babies measured in the uk

Answer 3

In the UK, babies are weighed 2 weeks after birth, then once a month up until 6 months of age, once every two months from 6-12 months and once every 3 months over theage of one.

Question 4

where is Brad in a centile chart

Answer 4

Brad is in the 50th centile for his height and weight. The 50th centile means that 50% of babies at this age are heavier and 50% are lighter so the baby is normal. As Brad is thriving, we can say he is getting sufficient breast milk

Question 5

what do the WHO and UNICEF recommend

Answer 5

WHO & UNICEF recommend exclusive breastfeeding for first 6 months of baby’s life

Question 6

what are the steps that the WHO and UNICEF recommend

Answer 6

Initiate breastfeeding within 1st hour of life

Breast milk only without any food/drink, not even water

Breastfeeding on demand as often as child wants day and night

No use of bottles, teats, pacifiers

Question 7

what is breast milk made out of

Answer 7

Immunoglobulin A (IgA) – protection from infection

Proteins – allowing for growth and development, whey protein content high & easier to digest

Long chain fatty acids – supports brain and eye development

Enzymes e.g. lysozyme – aid baby’s digestion and immune system

Growth factors – support growth and development

Question 8

describe the development of the breast

Answer 8

Throughout pregnancy, oestrogen secreted by placenta this leads to growth of ductal system
Breast stroma increases in quantity
Progesterone from placenta stimulates the development of the lobule-alveolar system of the breast

Question 9

what inhibits the production of breast milk

Answer 9

However progesterone & oestrogen themselves inhibit breast milk production

Question 10

what produces prolactin

Answer 10

Prolactin is secreted from mother’s anterior pituitary gland

Question 11

describe how prolactin produces breast milk

Answer 11

Prolactin levels rise from 5th week of pregnancy till birth

Immediately following birth there is a loss of oestrogen & progesterone from the placenta

Prolactin can then work and produce increasing quantities of milk

Initially high-fat high-protein colostrum is produced

Question 12

where is oxytocin released from

Answer 12

Oxytocin is released from the posterior pituitary gland

Question 13

what does oxytocin stimulate

Answer 13

Oxytocin stimulates contraction of myoepithelial cells surrounding the lobules and lactiferous ducts = milk expression

Question 14

what does milk production depend upon

Answer 14

Milk production also depends on normal levels of growth hormone, parathyroid hormone, insulin and cortisol

Question 15

what is the difference between oxytocin and prolactin

Answer 15

Oxytocin =  milk expression
Prolactin = milk production (lactogenesis)

Question 16

what happens to prolactin after birth

Answer 16

Following birth the basal levels of prolactin return to normal

However, every time the mother nurses the baby an afferent neural stimulus to the hypothalamus stimulates oxytocin and prolactin production

Question 17

what are the benefits of breastfeeding to the baby

Answer 17

Promotes sensory and cognitive development

Protects infant against chronic and infectious diseases

Exclusive breastfeeding reduces infant mortality during common childhood infections e.g. diarrhoea or pneumonia

Promotes quicker recovery during illness

Reduces likelihood of atopic symptoms in children who are breastfed

Reduces risk of SIDS

Lower risk of obesity and cardiovascular disease in adulthood

Question 18

what in breast milk has high levels of IgA

Answer 18

colostrum

Question 19

what are the benefits fo breast feeding to the mother

Answer 19

Benefits to mother
Lowered risk of 
Breast cancer
Ovarian cancer
Cardiovascular disease
Obesity 
Prolonged breastfeeding prolongs inter-pregnancy period, form of (not 100% effective) natural contraception

Question 20

why might someone not want to breast feed

Answer 20

Personal reasons – embarrassment, body image issues, lack of confidence

Early return to work adds to stress of pumping or breastfeeding

Lack of breastfeeding support or resources when faced with difficulty

Previous unpleasant breastfeeding experience

Medical reasons that disallow breastfeeding e.g. radiotherapy for breast CA, mastectomy, HIV/HTLV infection, on medication incompatible with breastfeeding

Babies with cleft lip/palate, premature – can eventually go on to breastfeeding with time

Question 21

what are the alternative to milk

Answer 21

Infant formula is the only suitable alternative in the first 12 months of baby’s life
- Treated cow’s milk-based formula to make it more suitable for babies

Question 22

when can babies be given cows milk

Answer 22

from age 1 onwards

Question 23

what damage can cows milk do

Answer 23

Low iron content

Higher protein content than necessary = excess urea excreted in urine = risk of dehydration

High solute (sodium content) = increased [urine]. Insufficient renal concentrating ability of infants can be insufficient to maintain water balance = dehydration

Excess phosphate = bind Ca2+ = hypocalcaemia = tetany

Question 24

what is tetany

Answer 24

Tetany a condition marked by intermittent muscular spasms

Question 25

describe physiologically what cows milk does to you

Answer 25

Infants fed cow’s milk receive much more protein and minerals than they need. The excess has to be excreted in the urine. The high renal solute load leads to higher urine concentration during the feeding of cow’s milk than during the feeding of breast milk or formula. When fluid intakes are low and/or when extrarenal water losses are high, the renal concentrating ability of infants may be insufficient for maintaining water balance in the face of high water use for excretion of the high renal solute. The resulting negative water balance, if prolonged, can lead to serious dehydration.

Question 26

what is soy milk infant formula used for

Answer 26

• it is used for babies with cows milk allergy

Question 27

what does soy milk infant formula contain

Answer 27

Contain phytoestrogen (similar to oestrogen hormone) – may affect baby’s reproductive development

Contains glucose instead of lactose (milk sugar), more likely to harm baby’s teeth

Should only be used if recommended by health visitor/GP

Question 28

when should you start weaning

Answer 28

Introduction to solid foods/ complementary feeding starts when baby is around 6 months old

Question 29

describe how you should wean

Answer 29

Need solid food alongside breast milk/infant formula

Require small amount of solid food once a day when starting – pureed or convenience baby foods

Avoid adding salt, sugar and gluten – avoid developing taste preferences and risk of coeliac disease

After 6 months of age, eggs and glutens (potential allergens)

Can move from puree to small lumps to finger foods once baby is more used to chewing

By 12 months can have the same food as family – take care to avoid spice

Question 30

what does cleft lip affect

Answer 30

Cleft lip may affect one side of lip or both

Question 31

describe what cleft palate is

Answer 31

Cleft palate can be an opening at the back of the mouth or split in palate that goes all the way to front of mouth

Question 32

describe how the development log the face happens

Answer 32

The development of the face begins with five mesenchymal swellings originating from the neural crest
2 mandibular processes
2maxillary processes
Frontonasal prominence

Two nasal placodes (blue and yellow circles) then develop from ectoderm tissue which then invaginate to form nasal pits and the medialand lateral nasal prominences

The mandibular prominences fuse together to form the mandible

The maxillary prominences (orange) move grow medially and fuse with the lateral nasal prominences to form the nasolacrimal groove, nasolacrimal duct and lacrimalsac

The maxillary prominences (orange) also fuse with the medial nasal prominences (yellow) to form the midline of the nose and the philtrum of theupper lip

Fusion of the two medial nasal prominences forms the primary palate and the secondary palate is formed by the palatine shelves growing out from the maxillary prominences

Question 33

what causes cleft lip

Answer 33

Cleft lips result when the maxillary prominences do not fuse correctly with themedialnasal prominences

Question 34

what causes cleft palate

Answer 34

Cleft palates are caused by the palatine shelves not fusing correctly

Question 35

what is the face derived form

Answer 35

Frontonasal prominence

Mandibular and maxillary prominences (1st pharyngeal arch)

Question 36

what does the nose develop form

Answer 36

Between 4th to 6th week of embryonic development

Question 37

when does embryological development of the face take place

Answer 37

• Nose develops from nasal placodes on both sides of frontonasal prominence
• Placodes invaginate to form nasal pits, and then medial and lateral nasal prominences

Question 38

when does a child need further assessment of growth

Answer 38

Where weight or height or BMI is below the 0.4th centile, unless already fully investigated at an earlier age.

If the height centile is more than 3 centile spaces below the mid-parental centile.

A drop in height centile position of more than 2 centile spaces, as long as measurement error has been excluded.