Pregnancy, breastfeeding & paediatrics Flashcards
What is a key strategy to manage fussy eating in children?
Avoid delaying lumpy foods, try offering foods 10 times, and model healthy eating habits.
How long should meals last for fussy eaters?
20–30 minutes per meal.
What is the purpose of plotting growth on charts for children
To compare growth against a healthy population of the same age and sex, ensuring proportional growth.
Which charts are used for kids aged 0 - 2 years?
WHO growth charts, based on data from healthy, breastfed infants.
What are the BMI cutoffs for children ages 2 - 18 years according to CDC guidelines?
<5th percentile: Underweight.
5–84th percentile: Healthy weight.
85–94th percentile: Overweight.
95th percentile: Obese.
What is a Z-score, and why is it useful for growth assessment?
A Z-score shows how far a value is from the population median in standard deviations, ideal for assessing malnutrition and population studies.
How much weight should a child gain in the first 3 months?
210 - 240g/week
What is the expected length increase for infants by 1 year?
Length increases by 50% of birth length by 1 year.
When should the growth of premature infants be plotted for corrected for age?
Until 2 years if born <37 weeks gestation.
What are the 2 main growth spurts in children?
Infancy (birth–1–2 years)
Puberty (10–11 years for girls, 12–13 years for boys).
What are the weight gain recommendations during pregnancy based on BMI?
Underweight: 12.5–18kg
Normal: 11.5–16kg
Overweight: 7–11.5kg
Obese: 5–9kg
How much weight should a pregnant woman gain weekly during the 2nd and 3rd trimesters?
~400g/week in the 2nd trimester
~500g/week in the 3rd trimester
What is the goal of baby-friendly hospital initiative?
Global initiative by UNICEF & WHO.
Promotes breastfeeding by removing hospital practices that hinder it.
Includes staff training, immediate breastfeeding initiation, “rooming in,” exclusive breastfeeding support, and post-discharge care.
What additional nutrient requirements exist during pregnancy?
Folate: 500 mcg/day (400 mcg supplemented)
Iron: 11 mg
Iodine: 220 mcg (150 mcg supplemented)
Vitamin C: 85 mg
Calcium: 1000 mg
Fibre: 25 g/day
What are the stages of breast milk, and how do they differ?
Colostrum: 1st milk, high in protein, low in fat, yellow, rich in antibodies (2–5 days postpartum).
Transitional milk: Higher fat, lactose, and water, white, produced ~2–14 days postpartum.
Mature milk: Bluish-white, balanced mix of nutrients, foremilk (low fat) transitions to hindmilk (high fat).
What are the kcal & macro contents of breast milk?
~70 kcal/100 ml
~4.2 g fat (~3–5%)
~1.3 g protein (~1%)
~7 g carbohydrates (lactose) (~7%)
Common signs of insufficient milk production
Lethargy or excessive sleepiness
Irritability during feeds
Poor weight gain
Persistent jaundice
Infrequent wet or dirty nappies
When is BF contraindicated?
Very low birth weight (<1500 g)
HIV infection in the mother
Active tuberculosis (not on treatment)
Substance abuse or chemotherapy
Key considerations for storing breast milk
Room temperature (<25°C): 6–8 hours
Refrigerated (<4°C): 3 days
Freezer (-18°C): 3–6 months
Deep freezer (-20°C): 6–12 months
What are the energy requirements for children at different ages?
Premature: 120–150 kcal/kg
Neonates: 100–120 kcal/kg
1–12 months: 90–100 kcal/kg
1–6 years: 75–100 kcal/kg
7–12 years: 60–75 kcal/kg
What strategies can help manage fussy eating?
Offer new foods up to 10 times.
Take 20–30 minutes per meal.
Provide finger foods for independence.
Avoid separate meals or force-feeding.
Recommended fluid intake for children based on age
3–10 kg (0 - 6 months): 100 ml/kg/day
10–20kg (6 - 12 months): 1000 ml + 50 ml/kg for each kg over 10 kg
20 kg: 1500 ml + 20 ml/kg for each kg over 20 kg
What foods should be avoided in infants under 12 months?
Honey (risk of botulism)
Cow’s milk as the main drink
Small hard foods (choking hazard)
Sugary drinks, soft drinks, tea, and coffee
Signs of good feeding in a baby?
Audible swallowing
Satisfied baby post-feed
Breast softening
Steady weight gain
Wet nappies (6–8/day in early weeks)
What are the stages of complementary feeding for infants?
Start at ~6 months with iron-rich pureed foods.
Gradually increase to 2–3 meals/day by 7–12 months.
Introduce textures to aid jaw development.
Bottle feeding recommendations for infants:
Days 1–4: 30–60 ml/kg/day
Day 5–3 months: 150 ml/kg/day
3–6 months: ~120 ml/kg/day
6–12 months: ~90–100 ml/kg/day
What are typical growth rates for infants and young children?
Birth–3 months: 150–200 g/week
3–6 months: 100–150 g/week
6–12 months: 70–90 g/week
1–2 years: ~2.5 kg/year
2–puberty: ~2 kg/year
What formula options are available for specific needs?
CMPA: Extensively hydrolysed or amino acid-based formulas.
Lactose intolerance: Lactose-free formulas.
Reflux: Anti-reflux formulas.
Vegan diet: Soy-based formulas.
What should parents focus on when introducing solids?
Start with iron-rich purees, like cereals and meats.
Introduce water early in a spouted cup.
Transition to family meals with suitable textures after 12 months.
Kcal, protein, fat & CHO (lactose) of 100ml breast milk:
Calories: 70 kcal
Protein: 1.3 g
Fat: 4.2 g
Lactose: 7.4 g/DL
How much breast milk does a baby consume daily on average?
~800 ml/day
Fed 8–12 times per day
What are the different stages of breast milk?
Colostrum: Produced in the first few days, thick, yellow, high in protein and antibodies, helps prevent jaundice.
Transitional Milk: Appears 2–5 days postpartum, lasts ~2 weeks, higher fat and lactose content, white in color.
Mature Milk: Starts ~2 weeks postpartum, bluish-white, includes foremilk (low fat) and hindmilk (high fat).
What are the nutrients of concern in exclusively breastfed infants after ~6 months?
Iron: Stores deplete by ~6 months; introduce iron-rich foods like fortified cereals and pureed meat.
Zinc: May become a concern if maternal levels are low.
What are the signs of insufficient milk production in an infant?
Lethargy or irritability
Persistent jaundice
Poor weight gain or weight loss
Infrequent stools or urination
What are the storage guidelines for expressed breast milk (EBM)?
Room temperature (<25°C): 6–8 hours
Refrigerated (<4°C): 72 hours (3 days)
Freezer (-18°C): 3 months
Deep freezer (-20°C): 6–12 months
Maternity ward rules:
Store for max 4 hours at room temp.
Refrigerate within 2 hours for max 48 hours.
What foods should breastfeeding mother’s avoid?
Alcohol: Limited to 1 drink/day; wait 2–3 hours before feeding.
Caffeine: Limit to 2–4 servings/day; avoid guarana-containing energy drinks.
High-mercury fish: Limit shark, marlin, orange roughy, etc.
Listeria-risk foods: Soft cheeses, deli meats, pre-cut fruits/veg, unpasteurised dairy/juice, and raw eggs.
When should solid foods be introduced, and what should be prioritised?
Start at 6 months with iron-rich foods (fortified cereals, pureed meat).
Gradually add vegetables, fruits, grains, and legumes.
Introduce lumpy foods between 6–9 months to avoid feeding difficulties.
What is the timeline for weaning & transitioning to a family diet?
6–12 months: Slowly increase complementary feeding frequency to 3x/day.
By 12 months: Transition to the same diet as the family with varied textures and balanced meals.
Contraindications for breastfeeding:
Very low birth weight (<1500 g)
Preterm (<32 weeks)
Mother with HIV, active herpes, substance abuse, or undergoing chemotherapy
Active tuberculosis (not on treatment)
What are the normal urine & stool outputs for infants?
Urine: ~6 wet nappies/day
Stool: Frequent, loose, mustard-yellow
Formula feeding requirements for infants:
Birth–4 days: 30–60 ml/kg/day
5 days–3 months: 150 ml/kg/day
3–6 months: ~120 ml/kg/day
Signs of a well-fed BF baby:
Effective swallowing and audible sucking
Satisfied post-feed
Regular weight gain
~6–8 wet nappies per day in early weeks
What are guidelines for introducing allergens to infants?
Introduce allergens before 12 months, leaving a 2–3 day gap between each new food.
Breastfeeding recommendations by WHO or Australia
WHO: Breastfeed up to 2 years.
Australia: Breastfeed for at least 1 year.
Dietary Recommendations During Pregnancy
Energy: +2000 kJ/day.
Folate: 500 mcg/day (400 mcg supplemented).
Iron: 11 mg/day.
Iodine: 220 mcg/day (150 mcg supplemented).
Vitamin C: 85 mg/day.
Calcium: 1000 mg/day.
Fibre: 25 g/day.
Micronutrient Considerations in Breastfeeding
Dependent on Maternal Intake: Iodine, zinc, fatty acids, vitamin B12, vitamin D.
Independent of Maternal Intake: Iron, calcium, fat-soluble vitamins.
Nutrients of Concern if Exclusively Breastfed Beyond 6 Months
Iron: Stores deplete around 5–6 months; introduce iron-rich foods.
Vitamin D: Main source is sunlight; consider supplementation for high-risk groups.
Zinc: Concern if maternal levels are low.
Foods to Avoid During Breastfeeding
Caffeine: Limit high-caffeine drinks (e.g., energy drinks, tea).
Alcohol: Limit to 1 drink/day, wait 2–3 hours before feeding.
High-Mercury Fish: Avoid shark, marlin; limit other high-mercury fish.
Listeria-Risk Foods: Avoid deli meats, soft cheeses, raw eggs, and unpasteurised products.
Complimentary feeding guidelines
Start Solids: ~6 months, beginning with iron-rich foods (e.g., cereals, pureed meats).
Progression: Gradually increase to lumpy and finger foods by 7–12 months.
Liquids: Introduce water, continue breastfeeding alongside solids.
Infant growth & energy requirements
Weight Gain:
0–3 months: ~150–200 g/week.
3–6 months: ~100–150 g/week.
6–12 months: ~70–90 g/week.
Energy Needs:
Premature: 120–150 kcal/kg.
Neonates: 100–120 kcal/kg.
1–12 months: 90–100 kcal/kg.
1–6 years: 75–100 kcal/kg.
Fussy eating & mealtime strategies
Encourage Variety: Offer foods up to 10–12 times before acceptance.
Mealtime Environment: Minimise distractions, encourage family meals, set structured timeframes (20–30 minutes).
Food Selection: Age-appropriate portions, finger foods, and avoid sugary drinks.
Infant feeding milestones
From 6 Months: Introduce single iron-rich pureed foods.
From 7–12 Months: Add lumpy textures, encourage self-feeding, and family meals.
From 12 Months: Transition to cow’s milk (500 ml/day max) and regular family meals.
Supplementation recommendations for breastfed infants
Vitamin D: Start by 12 weeks.
Iron: Start by 6 months.
Vitamin K: Shortly after birth.
Normal weight gain for a baby
First Few Days: Expected weight loss, regain birth weight within 4-6 days.
Birth - 3 Months: 150-200g/week.
3-6 Months: 100-150g/week, slowing down.
6-12 Months: 70-90g/week, further reduction.
1-2 Years: ~2.5kg/year for those at the 50th percentile.
2 Years - Puberty: ~2kg/year.
Energy requirements in paediatrics
Premature: 120-150 kcal/kg/day.
Neonates: 100-120 kcal/kg/day.
1-12 Months: 90-100 kcal/kg/day.
1-6 Years: 75-100 kcal/kg/day.
7-12 Years: 60-75 kcal/kg/day.
12-18 Years: 30-60 kcal/kg/day.
Bottle fed infants (up to 6 months)
Days 1-4: 30-60ml/kg/day, gradually increase with appetite.
Day 5 - 3 Months: 150ml/kg/day (Prems: 180-200ml/kg/day).
3-6 Months: 120ml/kg/day.
6-12 Months: 90-100ml/kg/day, transitioning to solids.
Specialised paeds formula choices
Lactose Intolerance: Lactose-free formula.
CMPA: Extensively hydrolysed formula (<6 months) or rice protein-based (0-12 months). Soy formula (>6 months).
Severe Allergies/Eosinophilic Oesophagitis: Amino acid-based (e.g., Neocate).
Galactosaemia/Vegan Diet: Soy-based formula.
PKU: Amino acid formula (no phenylalanine). Partial BF possible.
HIV-Infected Mothers: Starter (stage 1) formula.
Reflux Issues: Anti-reflux formulas.
Stages of infant formula feeds
Stage 1: Newborn formula (0-6 months), 65-70 kcal/ml.
Stage 2: For 6-12 months.
Toddler Milk: Not recommended unless dietary needs exist. Use fortified cow’s/soy/full-fat rice/oat milk, 1.5 serves/day (>1 year).
Fussy eating & faltering growth recommendations
Introducing Foods: Don’t delay lumpy foods; try 10x.
Mealtime Routine: Grazing is okay; meals should last 20-30 mins.
Portion Sizes: Age-appropriate; offer balanced meals/snacks from all food groups.
Finger Foods: Promote independence; water between meals to maintain appetite.
Limit Dairy: 2 servings/day to avoid reducing appetite; avoid sugary drinks.
Infant mealtime environments important for development & food relationships
Family Meals: Encourage eating together.
Proper Seating: At the table, establish routine.
Independence: Children decide how much to eat.
Minimise Distractions: Maintain structured mealtimes.
Positive Atmosphere: Reinforce positive behaviours at meals.
Encourage exploration of foods by…
Visual Appeal: Colourful meals encourage interest.
Repetition: Offer new foods up to 10x.
Involvement: Let kids help with meal prep and cooking.
Confronting refusal of foods whilst weaning
Assess Reasons: Illness, tiredness, distractions, or snacking.
No Substitutions: Reinforces refusal. Offer refused foods at the next meal.
