Paediatrics: Feeding and Development Flashcards

Question

Primitive reflexes: 4-6

Answer 1

1) Stepping – will attempt to walk when feet placed near the ground, gone by 6 weeks 2) Asymmetric tonic neck reflex – when head turned to one side, opposite arm bends and the same side straightens out, integrates by 6mo 3) Galant reflex – flexion of the spine when stroked in the prone position toward the stimulat-ed side; integrates by 6-9 months

Answer 2

Global delay is defined as significant delay in two or more domains (two or more standard deviations from ‘normal’). Causes are variable; applying a ‘sur-gical sieve’ can be useful to order these.

Answer 3

1) Genetic – Trisomy 21, Fragile X, Duchenne Muscular dystropy, inborn errors of metabolism, e.g. PKU, Rett’s, mucopolysaccharidoses 2) Antenatal infection – TORCH, CMV, VZV, malaria, HIV 3) Antenatal toxin exposure – smoking, alcohol, illicit drugs, radiation, maternal medication

Answer 4

1) Perinatal events – hypoxia/HIE, birth trauma, complications of prematurity inc. IVH/periventricular leukomalacia, hypoglycaemia, hypothyroidism, hyperbili-rubinaemia 2) Post-natal events – meningitis, encephalitis, CMV, hypothyroidism, hypogly-caemia, hypo/hypernatraemia, head injury, toxin exposure, abuse, iron/folate/vitamin D deficiency 3) Correctable causes include: neglect, under-nutrition, iron deficiency anaemia and hypothyroidism. Consider assessing hearing and vision if there are concerns.

Answer 5

‘Positive indicators’ of developmental delay which would warrant referral to a community paediatrician include: * Loss of skills at any age * Parental or professional concern about vision, fixing or following an object * Hearing loss * Persistently low muscle tone or ‘floppiness’ * No speech by 18 months * Asymmetrical movements * Persistent toe walking * Other complex disabilities * Head circumference >99.6th centile or <0.4th centile or a change in circumference of 2 centiles or more.

Answer 6

‘Negative indicators’ or ‘limit ages’ include inability to: * Sit unsupported by 12 months * Walk by 18 months (boys) or 2 years (girls) *Walk without tiptoes * Run by 2.5 years *Hold object placed in hand by 5 months * Reach for objects by 6 months * Point at 2 years

Answer 7

1) Investigations: if there are motor concerns, check a CK (e.g. muscular dystro-phy) 2) Bloods – FBC, U&Es, CK, TFTs, vitamin D, B12, iron studies; consider metabolic screen (not included in Guthrie spot) Imaging: MRI, EEG 3) Clinical: audiometry screening, visual assessment, community paediatrician evaluation

Answer 8

* 3 months= reaches for object, holds rattle briefly if given to hand, visually alert particularly to human faces, fixes and follows to 180 degrees * 6 months= holds in palmar grasp, pass object from one hand to another * 9 months= points with finger, early pincer * 12 months= good pincer grip, bangs toys together

Answer 9

* 3 months= little or no head lag, lying on abdomen, good head control * 6 months= pulls self to sitting, rolls front to back * 7-8 months= sits without support (refer at 12 months) * 9 months= pulls to standing, crawls * 12 months= cruises, walks with one hand held * 13-15 months= walks unsupported (refer at 18 months) * 18 months= squats to pick up toy * 2 years= runs * 3 years= walks upstairs not holding rail * 4 years= hops on one leg

Answer 10

* 6 weeks= Smiles (refer at 10 weeks) * 3 months= laughs, enjoys friendly handling * 6 months= not shy * 9 months= shy, takes everything to mouth * 12-15 months= helps getting undressed * 18 months= plays alone * 2 years= doesn’t spill from cup * 4 years= plays with other kids * 5 years= can use knife and fork

Answer 11

* 3 months= quietens to parents voice, turns towards sound * 6 months= double syllables ‘adah’ * 9 months= says ‘mama’ and ‘dada’, understands no * 12 months= knows and responds to own name * 12-15 months= knows 2-6 words (refer at 18 months), follows simple commands * 2 years= combine two words, points to body part * 3 years= talks in short sentences (3-5 words), count to 10, idientifies colours, asks ‘what’ and ‘who’ questions * 4 years= asks ‘why,’ ‘when’ and ‘how questions’

Answer 12

* First infant formula- this is what can be given to newborns and continued for the first year * 'Hungry baby milks' or second milks- these contain more of a protein called casein and is thought to make the baby feel more full, however there is no evidence that it makes babies settle for longer *Follow on formula- there is no need to switch to these milks as babies can have first formula until 1 year and they should never be given to babies less than 6 months * Other types of milk to avoid under 1 year of age: goat's milk, sheep's milk, soya milk (unless advised by the GP), rice/oats/almond 'milks', evaporated or condensed milk

Answer 13

Cows milk can be introduced as a main drink from 1 year of age and can be introduced from 6 months into cooking. The risk of giving babies over 12 months more than 500mls of cow milk a day is that they will get iron deficient anaemia.

Answer 14

Overfeeding is more commonly associated with bottle fed babies Amount to give= On formula feed, babies should receive around 150ml of milk per kg of body weight. Preterm and underweight babies may require larger volumes. This is split between feeds every 2-3 hours initially, then to 4 hours and longer between feeds. Eventually babies and infants transition to feeding on demand (when they are hungry).

Answer 15

Weaning usually starts around 6 months of age. It starts with pureed foods that are easy to palate, swallow and digest, for example pureed fruit and “baby rice”. Over 6 months this will progress towards a healthy diet resembling an older child, supplemented with milk and snacks to 1 year of age.

Answer 16

It is acceptable for breast fed babies to loose up to 10% and formula fed babies to loose up to 5% of their body weight by day 5 of life. They should be back at their birth weight by day 10. The most common cause of excessive weight loss is dehydration due to under feeding.

Answer 17

* IgE mediated- this is immediate onset and symptoms can include wheezing, urticaria, blood in stools and colicky abdominal pain * Non IgE mediated- this is delayed and symptoms can include atopic eczema, constipation, loose stool and GORD. There is a wide variety of symptoms. * Affects up to 5-7% of infants, most grow out of it by 5 years old

Answer 18

* Avoid the allergen - refer to paediatric dietitians for advice, especially around dairy-free weaning. * You could trial extensively hydrolysed formula such as nutramigen LGG, * To confirm the diagnosis, they should try reintroducing cow's milk again after a 2-4 week trial to see if symptoms return * If the symptoms persist then the next step would be an amino acid based formula such as neocate LCP * Ensure calcium and vitamin D supplements if still breast fed * Children with CMPA can have a 'challenge test' every 6- 12 months. 50% of children will no longer have the allergy at 1 year of age. Can be done in stages via the milk ladder

Answer 19

* Day 1: 20-60ml/kg/day * Week 1 – 3m/o: 150ml/kg/day * 3-6m/o: 120ml/kg/day * >6m/o: 100ml/kg/day * Feed every 2-3 hours (ie: 8-12x a day) * These figures apply to term babies only; pre-term babies often have higher nutritional requirement (sometimes up to 180 – 200 ml/kg/day)

Answer 20

* Painful, tiring- breastfed babies feed more frequently, no one else can feed the baby, leaking * Mastitis, milk supply, anxiety * HIV- not recommended * Baby- hungry baby, colic, constipation, reflux, thrush, tongue tie, prematurity * Will need vitamin D supplements

Answer 21

* Are from a minority ethnic group * Are in managerial and professional occupations * Live in England (compared to other parts of the UK) * Are aged over 30 * Are first-time mothers * Left full-time education when they were over 18 * More likely to stop within 2 weeks if they haven’t been breastfed themselves and none of their friends breast feed

Answer 22

* Still aiming for volumes as per breastfeeding * Infant formula is the only alternative to breast milk * Cow’s milk is not suitable until a baby is 1 year old * Need to sterilize bottles and make up formula

Answer 23

* Corrected age = Chronological/Actual Age – (Term– Gestational age) * Term is considered 40 weeks * Eg: An 8-week old (chronological/actual age) baby born at 35 weeks has a corrected age of 3 weeks

Answer 24

* Start brushing as soon as first tooth appears- last thing at night and another occasion * Parents should supervise until at least 7 years old * Don’t rinse out your mouth after brushing

Answer 25

* Bottle feeding should be discouraged from 12 months * Only breast/formula milk or cooled boiled water should be given in bottles * For babies only water or milk should be drunk between meals * All children should have a maximum of 150mls per juice a day and should be with meals to reduce tooth decay * Only give sweet food including dry fruit at mealtimes * All children over 3 years should have fluoride varnish applied * Dental treatment is free for children under 19