Pregnancy, breastfeeding & paediatrics

Question 1

What is a key strategy to manage fussy eating in children?

Answer 1

Avoid delaying lumpy foods, try offering foods 10 times, and model healthy eating habits.

Question 2

How long should meals last for fussy eaters?

Answer 2

20–30 minutes per meal.

Question 3

What is the purpose of plotting growth on charts for children

Answer 3

To compare growth against a healthy population of the same age and sex, ensuring proportional growth.

Question 4

Which charts are used for kids aged 0 - 2 years?

Answer 4

WHO growth charts, based on data from healthy, breastfed infants.

Question 5

What are the BMI cutoffs for children ages 2 - 18 years according to CDC guidelines?

Answer 5

<5th percentile: Underweight.
5–84th percentile: Healthy weight.
85–94th percentile: Overweight.
95th percentile: Obese.

Question 6

What is a Z-score, and why is it useful for growth assessment?

Answer 6

A Z-score shows how far a value is from the population median in standard deviations, ideal for assessing malnutrition and population studies.

Question 7

How much weight should a child gain in the first 3 months?

Answer 7

210 - 240g/week

Question 8

What is the expected length increase for infants by 1 year?

Answer 8

Length increases by 50% of birth length by 1 year.

Question 9

When should the growth of premature infants be plotted for corrected for age?

Answer 9

Until 2 years if born <37 weeks gestation.

Question 10

What are the 2 main growth spurts in children?

Answer 10

Infancy (birth–1–2 years)
Puberty (10–11 years for girls, 12–13 years for boys).

Question 11

What are the weight gain recommendations during pregnancy based on BMI?

Answer 11

Underweight: 12.5–18kg
Normal: 11.5–16kg
Overweight: 7–11.5kg
Obese: 5–9kg

Question 12

How much weight should a pregnant woman gain weekly during the 2nd and 3rd trimesters?

Answer 12

~400g/week in the 2nd trimester
~500g/week in the 3rd trimester

Question 13

What is the goal of baby-friendly hospital initiative?

Answer 13

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.

Question 14

What additional nutrient requirements exist during pregnancy?

Answer 14

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

Question 15

What are the stages of breast milk, and how do they differ?

Answer 15

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).

Question 16

What are the kcal & macro contents of breast milk?

Answer 16

~70 kcal/100 ml
~4.2 g fat (~3–5%)
~1.3 g protein (~1%)
~7 g carbohydrates (lactose) (~7%)

Question 17

Common signs of insufficient milk production

Answer 17

Lethargy or excessive sleepiness
Irritability during feeds
Poor weight gain
Persistent jaundice
Infrequent wet or dirty nappies

Question 18

When is BF contraindicated?

Answer 18

Very low birth weight (<1500 g)

HIV infection in the mother

Active tuberculosis (not on treatment)

Substance abuse or chemotherapy

Question 19

Key considerations for storing breast milk

Answer 19

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

Question 20

What are the energy requirements for children at different ages?

Answer 20

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

Question 21

What strategies can help manage fussy eating?

Answer 21

Offer new foods up to 10 times.

Take 20–30 minutes per meal.

Provide finger foods for independence.

Avoid separate meals or force-feeding.

Question 22

Recommended fluid intake for children based on age

Answer 22

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

Question 23

What foods should be avoided in infants under 12 months?

Answer 23

Honey (risk of botulism)

Cow’s milk as the main drink

Small hard foods (choking hazard)

Sugary drinks, soft drinks, tea, and coffee

Question 24

Signs of good feeding in a baby?

Answer 24

Audible swallowing

Satisfied baby post-feed

Breast softening

Steady weight gain

Wet nappies (6–8/day in early weeks)

Question 25

What are the stages of complementary feeding for infants?

Answer 25

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.

Question 26

Bottle feeding recommendations for infants:

Answer 26

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

Question 27

What are typical growth rates for infants and young children?

Answer 27

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

Question 28

What formula options are available for specific needs?

Answer 28

CMPA: Extensively hydrolysed or amino acid-based formulas.

Lactose intolerance: Lactose-free formulas.

Reflux: Anti-reflux formulas.

Vegan diet: Soy-based formulas.

Question 29

What should parents focus on when introducing solids?

Answer 29

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.

Question 30

Kcal, protein, fat & CHO (lactose) of 100ml breast milk:

Answer 30

Calories: 70 kcal
Protein: 1.3 g
Fat: 4.2 g
Lactose: 7.4 g/DL

Question 31

How much breast milk does a baby consume daily on average?

Answer 31

~800 ml/day
Fed 8–12 times per day

Question 32

What are the different stages of breast milk?

Answer 32

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).

Question 33

What are the nutrients of concern in exclusively breastfed infants after ~6 months?

Answer 33

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.

Question 34

What are the signs of insufficient milk production in an infant?

Answer 34

Lethargy or irritability
Persistent jaundice
Poor weight gain or weight loss
Infrequent stools or urination

Question 35

What are the storage guidelines for expressed breast milk (EBM)?

Answer 35

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.

Question 35

What foods should breastfeeding mother’s avoid?

Answer 35

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.

Question 36

When should solid foods be introduced, and what should be prioritised?

Answer 36

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.

Question 37

What is the timeline for weaning & transitioning to a family diet?

Answer 37

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.

Question 38

Contraindications for breastfeeding:

Answer 38

Very low birth weight (<1500 g)
Preterm (<32 weeks)
Mother with HIV, active herpes, substance abuse, or undergoing chemotherapy
Active tuberculosis (not on treatment)

Question 39

What are the normal urine & stool outputs for infants?

Answer 39

Urine: ~6 wet nappies/day
Stool: Frequent, loose, mustard-yellow

Question 40

Formula feeding requirements for infants:

Answer 40

Birth–4 days: 30–60 ml/kg/day
5 days–3 months: 150 ml/kg/day
3–6 months: ~120 ml/kg/day

Question 41

Signs of a well-fed BF baby:

Answer 41

Effective swallowing and audible sucking
Satisfied post-feed
Regular weight gain
~6–8 wet nappies per day in early weeks

Question 42

What are guidelines for introducing allergens to infants?

Answer 42

Introduce allergens before 12 months, leaving a 2–3 day gap between each new food.

Question 43

Breastfeeding recommendations by WHO or Australia

Answer 43

WHO: Breastfeed up to 2 years.
Australia: Breastfeed for at least 1 year.

Question 44

Dietary Recommendations During Pregnancy

Answer 44

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.

Question 45

Micronutrient Considerations in Breastfeeding

Answer 45

Dependent on Maternal Intake: Iodine, zinc, fatty acids, vitamin B12, vitamin D.

Independent of Maternal Intake: Iron, calcium, fat-soluble vitamins.

Question 46

Nutrients of Concern if Exclusively Breastfed Beyond 6 Months

Answer 46

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.

Question 47

Foods to Avoid During Breastfeeding

Answer 47

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.

Question 48

Complimentary feeding guidelines

Answer 48

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.

Question 49

Infant growth & energy requirements

Answer 49

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.

Question 50

Fussy eating & mealtime strategies

Answer 50

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.

Question 51

Infant feeding milestones

Answer 51

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.

Question 52

Supplementation recommendations for breastfed infants

Answer 52

Vitamin D: Start by 12 weeks.
Iron: Start by 6 months.
Vitamin K: Shortly after birth.

Question 53

Normal weight gain for a baby

Answer 53

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.

Question 54

Energy requirements in paediatrics

Answer 54

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.

Question 55

Bottle fed infants (up to 6 months)

Answer 55

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.

Question 56

Specialised paeds formula choices

Answer 56

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.

Question 57

Stages of infant formula feeds

Answer 57

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).

Question 58

Fussy eating & faltering growth recommendations

Answer 58

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.

Question 59

Infant mealtime environments important for development & food relationships

Answer 59

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.

Question 60

Encourage exploration of foods by…

Answer 60

Visual Appeal: Colourful meals encourage interest.

Repetition: Offer new foods up to 10x.

Involvement: Let kids help with meal prep and cooking.

Question 61

Confronting refusal of foods whilst weaning

Answer 61

Assess Reasons: Illness, tiredness, distractions, or snacking.

No Substitutions: Reinforces refusal. Offer refused foods at the next meal.