Quiz 1 Flashcards

Question

Stooling: breastfed infants

Answer 1

BF: yellow, seedy, 1-8x/day or 2-4x/week (okay b/c no unbroken down food) Less than FF, lower percentage of hard stools

Answer 2

FF: brown/green/soft/formed 1-4x/day (no less than every other day) Higher percentage green stools Soy --> highest percentage of hard stools

Answer 3

Normal to strain, cry & grunt - no coordination of muscles | Hard stools abnormal/ Prunes do work!

Answer 4

pattern develops w/diet & activity. 1-2x/day or QOD Increased awareness: may go off alone to poop Need to learn words to associate w/going Animation/fear of toilet common Need to watch others poop (normalize) Negativism may impede toilet training (if saying "no" to everything - not the right time) Painful stools will impede toileting process

Answer 5

Usually 1 stool/day Diet & activity important to regularity (no scientific evidence) Witholding pattern can lead to painful stools (can cause megacolon/lack of signals to brain) Straining UNCOMMON & may indicate constipation

Answer 6

Decrease in child's normal frequency WITH difficult or incomplete passage of hard dry stools

Answer 7

Stool incontinence after 4yo | usually secondary to constipation (liquid poop around solid poop - so must treat constipation)

Answer 8

``` Infection Change in diet (excessive fluids/juices) Protein, lactose, carb intolerance Stress Tx: BRAT (bananas, rice, applesauce, toast) - no evidence it works ```

Answer 9

``` walks well able to sit & play, dress & undress self partially Wants to put toys "where they belong" Likes to imitate Not in period of negativism Takes pride in doing things BM formed at regular time each day Able to remain dry 2hrs at a time Has words for urine & stool ```

Answer 10

Typically takes 2-3 months

Answer 11

can begin soon after birth | caregiver recognizes signals that infant is ready & needs assistance to toilet

Answer 12

``` develops about 29 weeks gestation Rapid, irregular pulse & RR Body twitches active dream state Ends w/brief awakening but they don't know how to go back to sleep yet ```

Answer 13

``` Non-rapid eye movement begins 32-35 weeks gestation HR & RR are lower Restorative functions of sleep 4 Stages: Stage 1: drowsiness, light sleep Stage 2: deeper but easily aroused Stage 3: Deeper, body relaxed, shallow breathing. Develops at 3-4mths Stage 4: Deep sleep. If awakened, confused. ```

Answer 14

``` Poorer health (depression) in parents, esp mothers. Moderate to severe in 17% infants, 14% preschoolers ```

Answer 15

``` 50 - 60 min more REM: enter REM shortly after sleep onset Newborns: 50% REM Premature infants: 80% REM Preschoolers: 30% REM ```

Answer 16

90-100 min 20% REM First REM 90min after sleep

Answer 17

Awake -> Stage 1 NREM -> Stage 2 NREM -> Stage 3 NREM -> Stage 4 NREM -> REM

Answer 18

REM w/frequent arousal. 16-17 hours per 24h. No circadian rhythm.

Answer 19

NREM increases. 14-15 hrs sleep. Can fall asleep after REM. Circadian rhythm.

Answer 20

Need for feeding at night less acute. Can sleep 12h, 2 naps during day. Separation anxiety starts (change sleep environment before).

Answer 21

associated w/increased wakening (sometimes digested faster)

Answer 22

11-12h at night No morning nap, keep afternoon nap Separation anxiety Rituals important

Answer 23

11-12h at night Some stop afternoon nap Fear of monsters

Answer 24

10-11 h at night | sleep problems learned behavior or sign of stress

Answer 25

9 hours/night irregular sleep schedule Most don't sleep enough: ETOH (>0.08 --> less REM, >stage2, >awakening), caffeine

Answer 26

SIDS: cannot be explained SUID: explained or unexplained - any sudden death during infancy

Answer 27

suffocation asphyxia entrapment

Answer 28

AAP - only on back, not side or stomach to avoid SIDS | Up to 1 yo

Answer 29

``` Firm crib mattress covered by fitted sheet No soft materials Not on shared beds No bedrails Not in sitting devices ```

Answer 30

AVOID | room share w/o bedshare --> decrease SIDS by 50%

Answer 31

AVOID - no soft objects or loose bedding, no bumper pads

Answer 32

lower risk for SIDS

Answer 33

AVOID 2nd hand sharing bed w/smoker particularly risky

Answer 34

increased risk

Answer 35

Reduced risk of SIDS. Increases w/exclusivity of BFing.

Answer 36

Pacifiers are protective - even if falls out. Do not hang on neck. Attach nothing to it Delay pacifier introduction until BFing firmly established - 3-4weeks

Answer 37

Avoid overheating (no standard definition) Babies need only 1 more layer than adults Avoid covering face & head/overbundling No evidence for fan

Answer 38

No evidence for causative link between IZs and SIDS, more evidence that it's protective

Answer 39

Avoid 0- no evidence

Answer 40

No evidence they decrease SIDS

Answer 41

if supervised, it's recommended to facilitate development & minimize developmental plagiocephaly

Answer 42

African-American, American Indian

Answer 43

Night waking & night feeding | *put to bed awake, reinforce circadian rhythm with quiet dark room, comfort & change in bed, feed only when necessary

Answer 44

Sleep assist method Baby in crib awake but drowsy. Make sure dry, fed, well. Return at progressing intervals to comfort but not pick up - 3min, 5min, 12 min *for infants 6mths of age (can go whole night w/o feeds)

Answer 45

sit w/infant until falls asleep independently. Parent gradually removes presence from room. First sitting near bed, then door, then outside door.

Answer 46

during NREM Don't try to wake but keep safe and back to bed Can try to wake up at point before it usually happens - after few weeks may stop

Answer 47

Has health consequences, e.g., ADHD, asthma & allergies Physical exam: TMs (r/o OM), neuro, nasopharyngeal structures Possible referral to ENT

Answer 48

better term than "youth sex offenders"

Answer 49

``` Childcare- more interaction Preschool age - inquisitive Exposure to nudity Family environment Access to porn Abuse Developmental disabilities ```

Answer 50

``` Transient, few, distractible touching/masturbating in public/private Viewing/touching others' genitals Showing genitals Standing/sitting too close Trying to view adult nudity ``` *assess situational factors

Answer 51

Transient, moderately responsive to distraction Rubbing body against others Trying to insert tongue while kissing touching peer/adult genitals crude mimicking of sexual acts sexual behaviors that are occasionally but persistently disruptive *assess situational factors

Answer 52

Persistent & Resistant to parental distraction Asking peer/adult to engage in specific sexual act Inserting objects into genitals Explicitly imitating intercourse Touching animal genitals Sexual behaviors that are frequently disruptive *assess situational factors

Answer 53

Involve children 4+ years apart Variety displayed on daily basis results in emotional distress or physical pain associated w/other physically aggressive behavior involve coercion child becomes angry if distracted *assess situational factors

Answer 54

Consent ("mature minor doctrine"), Confidentiality, Payment

Answer 55

Model I: Parent adolescent collaborative Model II: Patient Primary - Parent Secondary (purpose reviewed together, parent leaves and returns at end, confidentiality w/teen) Model III: Patient Alone - Parent Optional

Answer 56

Bright Futures: 11-14yo

Answer 57

All sexually active: GCCT If requesting HIV/AIDS - if treated for STI, unprotected w/multiple partners, high risk, IVDU, MSM, sex for $, etc

Answer 58

If ambivalent, more likely to get pregnant or STI (less likely to use condom)

Answer 59

16 years: in general 18 yo: if partner in position of power (NON school teacher, athletic coach) 13-15 yo: can consent to sexual relations w/anyone up to 3y older 12yo and younger: cannot legally consent NO age of consent if partner is school teacher, psychologist, or therapist

Answer 60

Weight doubles by 5-6 months, Triples by 12 months

Answer 61

small size of stomach | immaturity of digestive system

Answer 62

exclusive BFing for 6mths followed by continued BFing as complementary foods are introduced = best Breast milk as PRIMARY food for first year Vitamin & mineral supplementation: 400 U oral vit D drops for BF prior to discharge Iron supplementation may be needed Fluoride 6mths to 3 years if <0.3 ppm Solids: begin at 6mo depending on development and interest

Answer 63

First year of life and as long as mutually desired after that

Answer 64

decreased risk of OM, URI, LRI, asthma, RSV bronchiolitis, NEC, atopic dermatitis, gastroenteritis, IBD, obesity, DM, etc

Answer 65

50% of baby's genetic material Not static Virtually every component plays a nutritional role

Answer 66

Mammogenesis (dvpt of breast tissue): embryogenesis to puberty. estrogen & progesterone: Proliferation of ducts and glands. Lactogenesis I (initiation of milk production): mid pregnancy to day 2 PP. Progesterone: Lobular formation Prolactin: lobular, alveolar dev, colost. Placental lactogen: Increases prolactin Estrogen: Ductular sprouting. Lactogenesis II (onset of copious production of milk). Day 3-8. A switch from endocrine to autocrine (local) control. Progesterone down: Lactogenic trigger prolactin: supportive/permissive glucocorticoids: assists in milk production insulin, cortisol: supports milk production Galactopoeisis (aka lactogenesis III, maintenance of milk production): Day 9 to beginning of involution. Prolactin, cortisol, & insulin: Stimulates transcription of genes that encode milk proteins Oxytocin: Facilitates milk transfer- MER Thyroid, PTH and GHs (?): increase responsiveness of mammary cells to prolactin

Answer 67

can inhibit w/drawal of progesterone & subsequent release of prolactin

Answer 68

hypothyroidism, DI (vasopressin secretion is supressed, impedes prolactin release), PCOS, pituitary surgery On dopamine agonists: ergot alkaloids (carbergoline, ergotamine OCPs with estrogen

Answer 69

less protein: 1.1g More fat: 4.2g More carbs: 7g *per 100g fresh milk

Answer 70

Early: stirring, mouth opening, turning head & rooting Mid: stretching, increasing physical movement, hand to mouth Late: crying, agitated body movements, turning red

Answer 71

PCP, cocaine, connabis Methadone (unless adequately nourished and in maintenance program) ETOH: minimize intake < 0.5 g alcohol/kg body weight. Wait 2 hours. Does not increase milk production. Smoking: strongly discouraged.

Answer 72

increased calorie needs 450-500 kcal/day | Risk of mercury in fish - read recs

Answer 73

``` Room temp 3-4 h (6-8 h if very clean) Refrigerator 72h (5-8 daysif very clean) Freezer 6mths (12 acceptable) ```

Answer 74

BF & partially BF: 400 IU/day beginning in first few days of life Continue supplementation unless infant is weaned to 1 L/day or 1 qt/day of bit D fortified formula or whole milk *if non-BF and receiving less than 1000mL day of vit D supplemented formula/milk, same guidelines.

Answer 75

High levels of lactose & bit C in breast milk facilitates iron absorption Reserves laid down in utero - not affected by mom's iron intake during BFing Iron supplementation before 6mths may be detrimental Longer BFing - less likely to be anemic Gradual introduction of iron rich foods around 6mths - cereals, meats, dark green veggies, oatmeal, grains

Answer 76

Preterm LBW Hematologic D/Os Born w/inadequate stores

Answer 77

from 6mo to 3 yo - decision based on fluoride concentration in water supply, food, fluid, and toothpaste sources Too much fluoride: brown and white spots under enamel. Hard to repair.

Answer 78

vegetarian mothers and those w/gastric bypass - if mom doesn't supplement (4mg/day), then infant should

Answer 79

Ready to feed Concentrate (1 can water, 1 can formula) Powder (1 scoop formula, 2 oz water) *discard unused after feeding! Refrigerate after mixing

Answer 80

20kcal/oz in regular calorie formulas Some specialized brands have 22-24kcal/oz Babies need minimum 100-115 kcal/kg/day to gain weight

Answer 81

"hypoallergenic formula" useful for babies w/milk or soy protein allergies Easier to digest less likely to cause allergic reactions

Answer 82

Medical indications: galactosemia & hereditary lactase deficiency (ONLY) May be used for milk allergy Vegetarian (not vegan) Gastroenteritis if secondary lactose intolerance NOT recommended for preterm

Answer 83

Safety in vivo & in vitro study raise possibility of estrogenic effects of isoflavones in SIF Isoflavone levels higher in infants fed SIF Animal studies show isoflavones decrease fertility No human studies w/adverse effects

Answer 84

similar weight gain | More BMs in GM

Answer 85

NOT before 1 yo: can cause anemia by irritating gut and leading to small but consistent blood loss from GI tract (micro bleeds) Interferes w/absorption of nutrients High solute load which kidneys have trouble excreting

Answer 86

insufficient protein for <2yo hypoalbuminemia & poor weight gain Increased arsenic levels

Answer 87

Insufficient protein source for <2yo | No difference ingrowth rate (increment, length, head circumference) as compared to soy or hydrosylate

Answer 88

Nothing to say for or against

Answer 89

docosahexaenoic acid & arachidonic acid omega-3 FAs found in breast milk and certain foods, such as fish and eggs Some studies suggest adding to formula may help infant eyesight and brain development. Some shows no benefit.

Answer 90

possible health hazard | pasteurization does not change nutritional value

Answer 91

4-6 mths of age (from spoon/bowl, not bottle) Developmentally, at 4-6mths, extrusion (tongue thrust) reflex diminishes and infant begins to sit well with support 6-12 mths solids are in addition to, not replacing essential nutrients from milk

Answer 92

Often rice cereal Provides iron when prenatal iron stores are decreasing Easily digested rarely causes allergic reaction 1-2 tablespoons of cereal once or twice daily before milk feeding

Answer 93

after 6mths age avoid hot dogs hard veggies, whole grapes, chunks PB Supervise eating Parents should be familiar w/techniques of airway obstruction removal Introduce meats early (6mths) Delay introduction of honey until after 1 year (infantile botulism before 1yo)

Answer 94

associated w/reduced odds of childhood overweight/obesity Assoc w/increased risk of allergic sensitization to food and inhalant allergens Findings support introduction from 4-6mo, no later than 6mo!

Answer 95

Between 8-9mths, offer baby a cup w/assistance (discourage non spill- just like sucking) By one year, bottles should be slowly withdrawn BFing can continue, but water/juice from cup Cup @snack/mealtime to accustom child to drinking when thirsty and not as comfort (will decrease dental caries & caloric intake)

Answer 96

Newborns have maternal stores iron in breastmilk has high bioavailability Iron stores decrease by 4-6mo = need more dietary iron ***6-12 mo 11 mg/day iron. Formula contains 10-12mg/L of iron***

Answer 97

Normal to lose up to 10% weight in first week. Start to gain again around day 4/5. Expect all back in 1-2 weeks (closer to 2 for breastfed).

Quiz 1 Flashcards

(121 cards)