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Paeds: Gastro and Growth > Infant nutrition > Flashcards

Infant nutrition Flashcards

1
Q

Until what age does a baby only need milk?

A

6 months

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2
Q

What are 3 forms of milk that a baby can have before age 6 months?

A
  1. Breast feeding
  2. Breast milk in a bottle
  3. Formula milk
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3
Q

What is the best type of milk to give a baby under 6 months?

A

breast milk

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4
Q

Why might women need lots of support and encouragement to breast feed babies?

A

It’s actually very difficult

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5
Q

How many stages of formula milk are there?

A

Stages 1-4

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6
Q

What is stage 1 of formula milk?

A

0-6 months

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7
Q

What is stage 2 of formula milk?

A

for ages 6-12 months - can opt to go for this one or stay on stage 1

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8
Q

What milk can a baby have age 12months - 2 years?

A

Can have full fat milk (or stage 3 but expensive, don’t need to)

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9
Q

From age 2 what type of milk can infants have?

A

semi-skimmed milk (or stage 4 formula - expensive)

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10
Q

Why don’t you need to give milk beyond stage 1?

Also it is expensive

A

stage 1 milk can be used up to 12 months and beyond this age infants can have supermarket milk (full fat 1-2y, 2y+ semi-skimmed)

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11
Q

What is one advantage of giving all 4 stages of formula milk?

A

contains all multivitamins needed and all children up to 5y should be given multivitamins

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12
Q

For the first 4 days of life what are the formula milk requirements of a newborn?

A
  1. Day 1: 60ml/kg/day
  2. Day 2: 90ml/kg/day
  3. Day 3: 120ml/kg/day
  4. Day 4 onwards: 150-180ml/kg/day
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13
Q

What is the difference between vomiting and posseting?

A

Posseting is just bringing up a little bit of milk after feeds - this is normal

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14
Q

How can babies present if they are being fed too much milk a day?

A

Vomiting

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15
Q

Why might the requirements of formula milk and breast milk be very slightly different?

A

Breast milk broken down quicker - baby may need slightly more per kg

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16
Q

What questions should you ask for a child exlusively breast fed? 4 key things

A
  1. How often go onto mother’s breast
  2. How long staying on breast for
  3. Do they appear to be feeding
  4. How long going between feeds
  5. Are they content after a feed
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17
Q

Why is it important to ask if breast feeding baby is feeding at the breast?

A

Sometimes for first few days go to breast but not feeding as a) not a lot of milk there and b) very rich for baby in first few days of life, don’t need a huge amount

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18
Q

Why is it important that newborn babies go to the breast even if they aren’t feeding a lot there at first?

A

Regular contact needed to help stimulate milk production; most babies won’t becoe hypoglycaemic, they use their adipose tissues to give energy they need to start feeding

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19
Q

What is the normal amount of time that babies should have between feeds?

A

1-3 hours. no less than 1 hour, no more than 3

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20
Q

How does poo change?

A

Initially meconium, then green seedy, then brown and normal

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21
Q

What question can you ask the mum about breastfeeding? What does this indicate?

A

How do her breasts and nipples feel - is latch difficult, baby not attaching properly - nipples will be sore, will hinder feeding and how she feels about it

22
Q

When does a mother’s breast milk usually renew?

A

Day 3 or day 4 - mums know when their milk usually comes in, feel breasts getting fuller

23
Q

What can indicate to the mother (and doctor) that a baby isn’t breastfeeding properly?

A

Breasts getting full and sore

24
Q

What are 5 things that can indicate whether a baby is feeding enough?

A
  1. Black tarry meconium turns to green seedy faeces
  2. Bristol stool chart - ask if it hurts, difficult to squeeze out, sausage shape or rabbit dropping
  3. vomiting/posseting- posseting ok but if a lot, every feed, child unwell, bilious colour
  4. is child content after feeding - feed, sleep, wake with a dirty nappy = normal
  5. weight - before covid, weighed, born, weighed on day 3 (day 5 in covid) - most babies lose weight in this period (99%). if weight los >10%, need to be seen by paediatrician, referred to emergency department
25
Q

If baby referred to emergency department for >10% weight loss in first 3-5 days, what is likely to be done?

A

Feeding history, examine (check signs of sepsis), U+Es

Then put on feeding plan

26
Q

With what type of feeds are newborns more likely to lose weight in the first few days?

A

Breast milk

27
Q

What can parents reporting blood in the nappy of a newborn indicate?

A

most likely actually urate crystals as a bit dehydrated while beginning feeding, can usually reassure it’s normal. but need to be sure - ask someone

28
Q

Befoe COVID, when was a newborn weighed and what is expected to be seen?

A

At birth and 3 days. 99% show weight loss, but not worrying if <10%

29
Q

What is the maximum amount of weightloss immediately after birth that is accepted as normal?

A

max 10%

30
Q

What are 4 key instructions that parents should know for making up baby formula?

A
  1. all bottles msut be sterilised until 12 months of age
  2. if making up 3 oz bottle, put 3oz or 90ml of cooled boiled water into bottle
  3. for each ounce, put scoop of formula into the water
  4. some parents make up all water for day and put in fridge which is fine but as soon as have made up a bottle with formula, baby needs to drink within an hour. longer - can’t expose baby to bacteria that will grow
31
Q

What is the conversion between ounces and mililitres?

A

1 oz = 30ml

32
Q

What are 3 ways to carry out weaning of a baby?

A
  1. finger led weaning - put out sticks of cucumer, carrot, bread, banana
  2. or spoon-fed lip led weaning - actively feed some porridge, yoghurt etc.
  3. generally mixture of letting then learn how to feed selves and with a spoon at same time
33
Q

At what age does weaning occur?

A

6 months

34
Q

What is important to remember when a baby stops formula milk, once they’re 1year old?

A

should receive multivitamins (if continuing formula milk, vitamins supplemened in formula)

35
Q

When should babies who breast feed be given multivitamins?

A
  • once they’ve established breast feeding - can take 6-8 weeks or so (drops that you put on tongue)
  • mum needs to be taking multivitamins too
36
Q

What are 4 things to ask about feeding in older children/ babies?

A
  1. Compare to usual feeding and drinking patterns
  2. Solids: meals, snacks, dietary components
  3. Drinking: amount and frequency
  4. Growth
37
Q

What are 2 situations when it’s particularly important to ask what children are drinking?

A
  1. DKA - polydypsia?
  2. Gastroenteritis - gettinge enough fluid?
38
Q

How can growth be assessed in a presenting child?

A

Look in red book and if looks particularly big or small, record weight in the book; if don’t have red book, make sure to document it

39
Q

What are 2 examples of when you should consider giving maintenance fluids in children?

A
  1. Baby with bronchiolitis in a lot of respiratory distress - won’t be able to afford to feed
  2. Older child with gastroenteritis getting dehydrated
40
Q

What fluids are given for maintenance fluids in children?

A

0.9% sodium chloride with 5% glucose ± 10 mmol KCl

41
Q

How do you calculate how many bags of NaCl you need?

A

Bags are 500ml bags; so divide total amount for day by 500 to give bags by day. Round up

42
Q

How do you determine the rate at which to give maintenance fluids?

A

Total maintenance fluid requirement for day divided by 24, to give rate per hour

43
Q

Calculate maintenance fluid requirements for the following:

  1. 6kg baby
  2. 17kg girl
  3. 42kg boy
A
  1. 600ml/day
  2. 1350ml/day
  3. 1940ml/day

all 0.9% sodium chlorid with 5% glucose

44
Q

What is infant colic?

A

term used to describe common symptom complex that occurs during first few months of life; paroxysmal, inconsolable crying or screaming often accompanied by drawing up of knees and passage of excessive flatus, occurs several times a day

45
Q

What is suspected to be the cause of infant colic?

A

thought to be gastrointestinal but no firm evidence of this

46
Q

In what proportion of infants does colic occur?

A

up to 40% of babies

47
Q

At what age does colic occur?

A

First few weeks of life, resolves gradually from 3-12 months of age

48
Q

What are 2 risks of infant colic?

A
  1. Stress and anxiety for parents
  2. May precipitate non-accidental injury in infants already at risk
49
Q

What is the management of colic? 4 aspects

A
  1. Support and reassurance
  2. Gripe water (of unproven benefit)
  3. If severe and persistent: may be due to cow’s milk protein allergy, empirical 2-week trial of protein hydrolysate formula (cow’s milk protein free)
  4. If no improvement with protein hydrolysate formula, consider trial of GOR treatment
50
Q
A

Paeds: Gastro and Growth (14 decks)

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