PBL 4 Flashcards
what is the role of the health visitor
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
what does the health visitor offer advice on
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
when are babies measured in the uk
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.
where is Brad in a centile chart
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
what do the WHO and UNICEF recommend
WHO & UNICEF recommend exclusive breastfeeding for first 6 months of baby’s life
what are the steps that the WHO and UNICEF recommend
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
what is breast milk made out of
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
describe the development of the breast
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
what inhibits the production of breast milk
However progesterone & oestrogen themselves inhibit breast milk production
what produces prolactin
Prolactin is secreted from mother’s anterior pituitary gland
describe how prolactin produces breast milk
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
where is oxytocin released from
Oxytocin is released from the posterior pituitary gland
what does oxytocin stimulate
Oxytocin stimulates contraction of myoepithelial cells surrounding the lobules and lactiferous ducts = milk expression
what does milk production depend upon
Milk production also depends on normal levels of growth hormone, parathyroid hormone, insulin and cortisol
what is the difference between oxytocin and prolactin
Oxytocin = milk expression Prolactin = milk production (lactogenesis)
what happens to prolactin after birth
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
what are the benefits of breastfeeding to the baby
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
what in breast milk has high levels of IgA
colostrum
what are the benefits fo breast feeding to the mother
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
why might someone not want to breast feed
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
what are the alternative to milk
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
when can babies be given cows milk
from age 1 onwards
what damage can cows milk do
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
what is tetany
Tetany a condition marked by intermittent muscular spasms
describe physiologically what cows milk does to you
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.
what is soy milk infant formula used for
- it is used for babies with cows milk allergy
what does soy milk infant formula contain
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
when should you start weaning
Introduction to solid foods/ complementary feeding starts when baby is around 6 months old
describe how you should wean
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
what does cleft lip affect
Cleft lip may affect one side of lip or both
describe what cleft palate is
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
describe how the development log the face happens
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
what causes cleft lip
Cleft lips result when the maxillary prominences do not fuse correctly with themedialnasal prominences
what causes cleft palate
Cleft palates are caused by the palatine shelves not fusing correctly
what is the face derived form
Frontonasal prominence
Mandibular and maxillary prominences (1st pharyngeal arch)
what does the nose develop form
Between 4th to 6th week of embryonic development
when does embryological development of the face take place
- Nose develops from nasal placodes on both sides of frontonasal prominence
- Placodes invaginate to form nasal pits, and then medial and lateral nasal prominences
when does a child need further assessment of growth
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.
