newborns should gain 1oz/day
nursing on demand is recommended
introduce at 4-6 months; breast milk still primary nutrition
teach parents about tongue thrust
iron-rich foods, esp if premie
can blend breast milk into foods (!)
supplements during introduction
foods at 9 months
let them have a variety, teach their immune sys
*new belief: give kids everything they might eat in their lives within first year
20-25g protein daily
gauge kids on weekly intake (can vary a lot day to day)
most are cow-milk based, organic have rice syrup instead of corn
breast milk has more whey, less casein than cow
excessive, inconsolable crying in infants younger than 3 months
-due to gas, milk protein allergy, immature nervous sys?
Homeopathy: chamomilla, pulsatilla, colocynthis, dioscorea, nux vomica
craniosacral, gripe water
physiologic- just milk, babies growing well
esophageal- milk and acid, irritates the esophagus, poor weight gain
management: upright positioning after eating, small feedings, drugs, antacids, herbs, food allergies
Malrotation of bowel
Dx: barium esophagram
hypertrophy of pylorus–> obstruction of gastric outlet
onset 2-8 weeks; PROJECTILE vomiting
Dx: US and barium study
Grunting baby syndrome
not constipation, self limiting
80% present with failure to pass mec at 48 hours
Nausea and Vomiting
- viral gastroenteritis, watery diarrhea following vomiting
- bacterial gastro, pain, fever, anorexia, bloody diarrhea
- intussusception, periodic cramping, tx by barium enema
Acute Diarrhea causes
viral/ bacterial gastroenteritis
UTIs, OM, irritable bowel,
painless recurrent passage of 3 or more unformed stools daily for more than 4 weeks i
-ong-term mucosal injury secondary to viral gastroenteritis, carbohydrate malabsorption, mucosal damage (celiac), fat malabsorption, low fiber diet
TX: avoid dairy, decrease fruit juice/sugar, increase fat in diet, increase fiber in diet. probiotics, digestive enzymes, slippery elm, l-glutamine.
in breastfed babies, up to 1 week WNL
intentional/unintentional holding around potty training
usually invagination of the ileum through the ileocecal valve into the colon
3-24 months of age.
Sudden crampy abdominal pain, vomiting, and most notably, lethargy and paradoxical irritability
Diagnosis and treatment is usually barium enema study. or surgery
N/V and an acute abdomen, anorexia, fever, constipation, pain at McBurney’s point.
do not want to move, are irritable.
Rare before age 3.
Chronic abdominal pain
? Food allergies, celiac, anatomic issues (especially musculoskeletal), parasitic infections, h. pylori, UTIs, colitis or Crohn’s, maldigestion, drug reactions (NSAIDS, steroids, erythromycin), lead poisoning.
abdominal exam and (UA, CBC, O&P, stool culture, stool guaiac, celiac testing)