Week 8: Infant nutrition, colic, Headache in adults Flashcards
What supplement do you take to maximize pregnancy?
Take folic acid 2-3 months before conception
- Also take vitamin B12 and iron (27 mg)
What does nutrition look like for pregnant women?
What food safety should they take?
- minimize weight gain in 1st trimester; eat small amounts of food often
- during 2nd & 3rd trimester, eat 2-3 extra food servings (340-450 extra calories)
Food safety
- caffeine up to 300mg/day
- Avoid large fish due to mercury content
- Avoid unpasteurized milk, soft cheeses, and raw milk as it can cause miscarriages due to listeriosis
What type of nutrition does the mother need during breastfeeding
- Extra 500 calories/day (2500/day)
- min. 8 glasses of water per day; drink a glass each time you breastfeed
- Around 1000 mg/day of calcium
What is the recommendation for breast milk for babies?
- Recommended for the first 6 months (can go up until 2 years)
- should introduce other foods around 6 months
What are the benefits of breastfeeding for the baby and mother?
Baby
- reduced illness for baby (diarrhea, infections asthma)
Mother
- reduced postpartum bleeding
- weight loss
- reduced risk of breast and ovarian cancer
- Improved bone health
What is the first milk produced when the baby is born called?
What do they have?
When does it change?
Colostrum
- Thick, yellowish
- rich in proteins and antibodies
- Changes to breastmilk 72 hours after birth
Differentiate between foremilk vs. hindmilk
- Foremilk is released at the beginning of a feeding; watery at first satisfies thirst
- Hindmilk is released as feeding continues; rich, fatty, satisfies hunger, provides calories
When do you breast feed and how to determine if baby is getting enough
- Feed on demand. More frequent= more supply
- Usually every 2-3 hours (8-12 times a day)
Baby getting enough if:
- 6 or more wet diapers/day
- stools are soft, yellow, seedy
- weight gain
Explain Cow milk-based formulas
- Most common type
- Has lactose and vegetable oils and animal fats
- Avoid in CMA, galactosemia and congenital lactase deficiency
Explain Lactose-free cow milk-based formulas
- Lactose is replaced with maltodextrin and sucrose
- Used for congenital lactase deficiency (rare)
- Parents often purchase when they suspect child is gassy/fussy due to lactose intolerance
- May be useful after diarrhea
Explain soy protein isolate-based formulas
- Free of cow milk protein and lactose
- Iron fortified (high in minerals)
- Recommended for galactosemia or congenital lactose deficiency children
- Has potential cross-reactivity to cow milk
Explain amino acid based formulas
- Free amino acid proteins
- used in infants for severe milk protein hypersensitivity (severe CMA)
- can also be used for infants with malabsbsorption disease
Explain hydrolyzed protein based formula:
Partially hydrolyzed
Extensively hydrolyzed casein
Partially hydrolyzed (cow milk protein)
- less expensive more palatable (tasty)
- Marketed to relieve gas, fusiness
- Has lactose
- powdered
Extensively hydrolyzed (casein protein)
- used for infants with low tolerance to cow milk and soy protein
- used if they have malabsorptive disease
- Lactose free
- More expensive less tasty
- ready-to-use
What type of formula is used for treatment of vomiting?
Pre-thickened formulas
What supplementation do babies need while breast feeding?
First 6 months
- breastfeeding (has iron) (if using formula find iron-fortified formula)
- use vitaminD 400 IU/day (no need if using formula)
After 6 months
- introduce iron in food (single-grain iron-fortified infant cereal))
- Introduce new foods 3-5 days at a time
- Do not give sugary drinks or foods or honey
-Do not delay introduction of allergens (ex. peanuts, eggs)
What is colic and when does it happen
- recurrent & prolonged periods of infant crying without obvious cause and cannot be prevented
- Occurs in infants (2-16 weeks old)
What is the wessel rule of 3 for crying if they have colic?
3 hours a day for
3 days a week and for
3 weeks straight
What are sings & symptoms of colic
- Excessive crying
*Increased motor activity
*Increased muscle tone- Clenched fists, facial flushing
- Arching of back, drawing up of legs
- Abdominal distention
- Altered patterns of sleeping and eating
What are the 3 main causes of symptoms. Explain them
- Physiological
- difficulties with parent child interactions
- Maternal anxiety and stress - Organic
- Allergy to dairy food
- Immature autonomic nervous system - Behavioural
- improper feeding technique
- smoking close to child
Describe the differential diagnosis of colic
Colic is a diagnosis of exclusion and is considered when some of the following have been ruled out:
- infections
- Teething
- Pain
- Hunger
- Food sensitives
- Clothing discomfort
etc..
What are some red flags for colic to refer immediately?
- persists for 3h+
- 16weeks+
- Accompanies a fever
- any signs of dehydration, excessive vomiting
- Caregiver is scared to hurt baby
- Caregiver has tried for 3+ days to soothe baby but nothing works
- Change in behaviour, decreased responsiveness
What is the first line treatment for colic
Nonpharmacologic measures
OTC can be used after
What dietary manipulations can be made if infant has colic?
Breastfeeding
- eliminate common aggravators from mothers diet
Formal feeding
- switch to hypoallergenic formula (hydrolyzed protein)
- switch to soy protein-based formulas
- switch to lactose-reduced formula
- IF CHANGES DO NOT IMPROVE IN 1 WEEK THEN GO BACK TO ORIGINAL FORMULA
What are some recommended pharmacologic treatments? (3)
- Probiotic agents
- evidence supports reduced crying time - Carbohydrates (sucrose)
- analgesic effects - Carminatives
- placebo effect?
- lowers gas
Differentiate between primary and secondary headaches
Primary
- 90% of headaches
- Not associated with an underlying condition
Secondary headache
- Associated with organic causes
- Symptoms of an underlying condition
- Ex. medication overuse headache, sinus headache
How to differentiate between
sinus
cluster
tension
migraine
Sinus
- pain behind cheekbones/browbones
- bilateral
Cluster
- Pain is around one eye
- unilateral
Tension
- Pain is like a band squeezing the head (forehead)
- bilateral
Migraine
- Pain, nausea, and visual changes are typical of classic form (half of whole head)
- unilateral
Explain characteristics of of Tension headaches
- symptoms: muscle pain possible radiating into neck along traps or scalp
- Gradual onset (30 min - 7 days)
Diagnosed by absence of other headache features - NOT aggravated by physical activity
- No N/V
Explain characteristics of of Migraine headaches
- Throbbing/pulsating pain
- sudden onset (4h-72h)
- aggravated by PA
- Can have N/V symptoms
Triggers: - stress, fatigue, oversleeping, fasting
Explain characteristics of of cluster headaches
- will have several attacks over a period of time
- penetrating/stabbing; MOST PAINFUL
- lasts around 15-180min
- Symptoms: lacrimation, nasal congestion, facial sweating, eyelid edema
- not aggravated by PA
Explain characteristics of of sinus headaches
- pressure behind eyes or face
- dull pain; worse in AM
- occurs w sinus; nasal congestion
How do you differentiate between types of headaches?
Rule out secondary causes of headaches
When should you refer to ER?
SSNOOPP
S: systemic, N/V, appear ill
S: severe (worst HA of my life)
N: neurologic s/s, changes in vision, mental status
O: onset is abrupt or new
O: other associated conditions (trauma)
P: prior HA history, increased frequency and severity
P: pain (unilateral eye)
When should you provide non-emergent referral to primary care provider?
- Any secondary cause of HA
- Chronic TTH or frequent migraines
- 1st HA ever
- Occurrence at night or on awakening in the morning
- Patient is 50+ with new undiagnosed HA
- 6+ pain in pain scale 1-10
When can you give self care for headache?
Migraine if 2+ of:
- nausea
- light sensitivity
- interference with activity
**Mild-mod & previously diagnosed –> self-care
TTH no nausea but 2+ of:
- bilateral headache
- nonpulsating pain
- mild-mod pain
- not worsened by activity
***Episodic (less than 15 times/month) –> self-care
Sinus headaches in diagnosed sinus infections
- Decongestants can drain sinuses
What are the doses of episodic treatments for:
Ibuprofen
Aspirin
Naproxen
Acetaminophen
Ibuprofen
- 400 mg
Aspirin
- 1000 mg
Naproxen
- 550 mg
Acetaminophen
- 1000 mg
What is the treatment for Chronic TTH & migranes?
Same as episodic TTH except
Naproxen
- 500 or 825mg
What is the limit for nonprescription analgesics? why?
Limit to 3 days/week or max 5 days
- may signal the presence of a condition that should be treated
What is medication-overuse headache and how to prevent it.
- Secondary headache; may occur in overuse of NSAID’s for 3months+
To prevent:
- use simple analgesics less than 15 days/month
- use combo analgesics or opioids less than 10 days/month
- do NOT ABRUPTLY stop medication but taper down
What is the 1st line treatment during pregnancy and lactation?
- nonpharm measures (avoid migraine triggers, food, environment, drugs)
- Migraines often improve during pregnancy
- Acetaminophen may be needed
