Infant Care and Nutrition

Question 1

What is Diaper dermatitis?

Answer 1

-diaper rash
-fussiness, agitation, and irritability

Question 2

What are the factors that contribute to skin breakdown when wearing diapers?

Answer 2

-Perineal region skin is thin
-occlusion, moisture, microbes, GI tract proteolytic
enzymes, urine, feces, and friction

Question 3

Signs of Diaper dermatitis

Answer 3

-ink to red to bright red rash
-Shiny, wet-looking patches or lesions
-Sensitivity of affected area
-Dry raised bumps (papules) possible
-Rapid onset

-Severe – maceration, oozing, ulceration,
pustules

Question 4

Contributing factors of Diaper dermatitis

Answer 4

-Diaper type
-Diet (breastfed babies with less dermatitis, due to softer poo -> better absorbed by the diaper)
-Allergic reactions (soap, clothes)
-Chemicals

Question 5

How to treat Diaper rash?

Answer 5

A: Air the region - let the baby run naked
B: Barrier - provide barrier coverage

C: Cleansing - use smooth, non-alcoholic wipes, rinse with warm water, air dry, and limit cleansing only when stool present

D: Diaper
E: Education

Question 6

When to cleanse the perianal area?

Answer 6

Only when stool is present, to avoid irritation

Question 7

Treatment to relieve symptoms and clear the rash

Answer 7

-Oral analgesics

-Skin protectants: Zinc oxide, petrolatum, lanolin, glycerin, talc/cornstarch

-the greasier the better

Question 8

What type of diaper is appropriate/not appropriate to use?

Answer 8

Best: absorptive
Avoid: diaper with dye

Question 9

Patient Education

Answer 9

-Apply skin protectants liberally
-Reapply often – with each diaper change
-Do not remove protectant from previous application – minimize irritation
-Rash improves drastically within 24 hours of applying or making changes

Question 10

When to refer

Answer 10

Bleeding, oozing, or pus
Hasn’t resolved in 7 days
Fever, diarrhea, vomiting
Rash or skin lesions beyond the diapering area

Question 11

What is a Preakly heat?

Answer 11

-Heat rash caused by Blocked/clogged sweat glands
­
-Sweat can’t leave gland -> dilation and rupture of the pore à stinging, burning, itching

-Very fine, pinpoint, red-raised rash
-rapid onset, clears away rapidly

Question 12

Treatment of Preakly heat?

Answer 12

depends on the symptoms
-itching -> antipruritic
-Burning/stinging? – soothers, moisturizers

Don’t use greasy, oily products, we don’t want to block the glands -> use water-based products
NO hydrocortisone for infants

Question 13

How is Colic defined?

Answer 13

-more than 3 hours a day, for more than 3 days a week, for at least 3 weeks

-peaks at e 2-6 weeks, declines by age 3-4 months

Question 14

Potential trigger for Colic

Answer 14

-Gas
-Lactose intolerance
-“Maternal tension”
-Oversensitivity or overstimulation (light, noise)
-Discomfort
-Boredom
-CNS dysregulation

Question 15

Signs of Colic

Answer 15

-Uncontrollable crying
-Postural changes
­ Pulling legs to the abdomen
­ Clenches fingers

Question 16

Nonpharmacologic treatment for Colic

Answer 16

-Change mother’s diet or formulation (but unlikely to be related to that)
-Smaller, more frequent meals (smaller amounts of air intake)
Upright positioning during/after feedings
Motion (walking, swinging, rocking, holding)
Pacifier
Swaddling
Bathing
Singing/background noise

Question 17

Pharmacologic treatment for Colic

Answer 17

Simethicone drops (Mylicon, Little Tummys)
-helps with gas, and bloating -> give after a meal or at bedtime
-shake well
-place in the infant’s mouth, towards the cheek
-do not exceed 12 days per day

-have not shown to be effective, but no risk with using

Question 18

Pharmacologic treatment #2 for Colic

Answer 18

Gripe water
-Contains proprietary mix of ginger, fennel, chamomile, caraway, peppermint

-no studies!

Question 19

Presentation of Teethening

Answer 19

6+ months of age (could be sooner)
Irritability
Drooling (watery mouth)
Red gums, swollen gums
Gum rubbing, chewing/gnawing
Low-grade fever -> Tylenol (Ibuprofen from 6m)
Eruption cysts

Question 20

NONPHARMACOLOGIC Treatment

Answer 20

-Gum massage/rubbing
-Teething rings or toys
-Wet or frozen cloth
-If old enough to chew food, something crunchy
-Mesh teether with frozen fruit

Question 21

Pharmacologic Treatment

Answer 21

-Systemic Analgesics
­ Acetaminophen, Ibuprofen drops

Natural products
­-Chamomile
­-Lemon peel
­-Clove oil
­-Sugar

Question 22

What are the recommendations for infant nutrients?

Answer 22

American Academy of Pediatrics – breast is best
Pediatricians/parents everywhere – fed is best

solid food from 5-6 mo -> just to get babies used to chewing
-main dietary for babies is milk for year 1

Question 23

How does the amount of food intake change for infants?

Answer 23

-As they age they amount of food intake and the frequency goes down
-the overall food intake stays quite the same

Question 24

When do babies need Vitamin D supplements?

Answer 24

-Exclusively breastfed babies
-when food intake is less than 32 oz
-4000IU of Vitamin D daily

Question 25

What are common breastfeeding issues for women?

Answer 25

-Sore nipples
-Breast engorgement (swollen)
-plugging milk ducts
-low breast milk supply
-overabundant milk supply

Question 26

How to treat sore nipples

Answer 26

-Protectants & Lubricants

Question 27

What does All-Purpose Nipple Ointment consist of?

Answer 27

3 OTC agents
-Polysporin ointment (antibiotic)
­-Hydrocortisone cream
­-Clotrimazole cream (antifungal)

Question 28

What may cause pain in the breast ducts?

Answer 28

-Engorgement: Milk build-up due to not emptying the ducts (no time: work) -> RICE-like therapy for breasts

-Clogged ducts -> Soy or Sunflower Lecithin: may prevent clogged ducts by decreasing the viscosity of breastmilk
3600-4800 mg lecitihin per day

Question 29

Patient counseling

Answer 29

-Breastfeeding pumping should NOT be painful - if it is look for a lactation specialist
-Engorgement happens if breastmilk comes in or the feeding pattern changes
-Clogged ducts can progress to mastitis (inflammation of breast tissue) - requires antibiotics

Question 30

Products that boost the milk supply

Answer 30

-Alfalfa: boosts milk supply, increases fat content
-Fennel: boosts milk production
-Fenugreek: galactagogue (promotes lactation)

-Boosts milk production:
-Goat’s Rue
-Milk thistle
-Moringa

Question 31

Counsel on Breast supply

Answer 31

Breastmilk supply is built early on
Demand controls supply - it regulates after 6-12 weeks
-there is a limit on how much you can boost the milk production

Question 32

Formulations of Infant nutrients

Answer 32

Powder: mix with water (concentration is adjustable) not sterile, but it is cheaper -> for older babies

Liquid concentrate: liquid mixed with water, sterile, more expensive

Ready-to-feed: no mixing required, sterile, most expensive: for little babies

Question 33

Where are most milk products for babies derived from?

Answer 33

Cows milk
the other ones are specialized formulations with more dissolved (smaller molecular size) amino acids (easier to digest)