The irritable infant Flashcards

Question

Is goats milk allergic

Answer 1

Yes, as allergenic as cows milk

Answer 2

Ranitidine and omeprazole have not been shown to be effective in reducing crying In the absence of frequent vomiting, anti-reflux medication to manage persistent infant irritability is not recommended

Answer 3

Frothy watery diarrhea | Perianal excoriation

Answer 4

presence of faecal reducing substances ≥0.5%% and pH

Answer 5

in breastfed babies, may be functional lactose overload (high lactose content in breast milk in babies who frequently switch breastfeeding sides +/- feed frequently ie

Answer 6

Formula: lactose free/hydrolysed formula Breastfed: space feeds >3 hours, empty breast at each feed and alternate sides for feeding. Consider referral to lactation consultant for feeding advice

Answer 7

If crying is of acute onset, consider: ``` Urinary tract infection Otitis media Raised intracranial pressure Hair tourniquet of fingers / toes Corneal foreign body / abrasion Incarcerated inguinal hernia ```

Answer 8

Red flags: 1. Sudden onset of irritability and crying should not be diagnosed as colic; a specific cause is usually present 2. The maternal and family psychosocial state must be taken into account. Maternal post-natal depression may be a factor in presentation. Note that excessive crying is the most proximal risk factor for Shaken Baby Syndrome. 3. Suspect cow milk / soy protein allergy if - vomiting / blood or mucus in diarrhoea / poor weight gain / family history in first degree relative / signs of atopy (eczema / wheezing) / significant feeding problems (especially worsening with time) - gastro-oesophageal reflux is diagnosed - lactose malabsorption is diagnosed in formula-fed babies

Answer 9

History and examination: - Vomiting, diarrhea - Eczema - Failure to thrive - Feeding difficulties Yes: -Consider cows milk allergy, GORD-->consider trial of cow milk free formula/maternal diet No: - Medical cause unlikely-->baby tired? Hungry? Unable to self soothe? - Colic management: discuss normal sleep and crying, settling techniques, parental support, arrange regular follow up

Answer 10

Generally not required May consider stool examination for reducing substances and pH Urine MCS for acute crying and vomiting Fluroscein staining if history suggestive

Answer 11

1. Establish pattern to feeding / settling / sleep 2. Aim to settle the baby for daytime naps and night-time sleep in a predictable way (eg, quiet play, move to the bedroom, wrap the baby, give the baby a brief cuddle, then settle in the cot while still awake) 3. Avoid excessive stimulation - noise, light, handling. 4. Excessive quiet should also be avoided. Most babies find a low level of background noise soothing 5. Darken the bedroom for daytime sleeps 6. Carry baby in a papoose in front of the chest 7. Baby massage / rocking / patting 8. Gentle music 9. Respond before baby is too worked up 10. Give the mother permission to rest once a day without the need to carry out household chores. Have somebody else care for the baby for brief periods to give the parents a break.

Answer 12

1. Medication is rarely indicated. 2. Colic mixtures, gripe water etc are of no proven benefit. 3. Anticholinergic medications are not recommended due to the risk of serious adverse events (apnoeas, seizures). 4. Simethicone (Infacol Wind Drops / Degas Infant Drops) has no effect on infant crying when compared with placebo 5. Spinal manipulation= placebo 6. Formula changes are generally not helpful unless proven cow milk protein allergy

Answer 13

Cause unknown, appears unwell

Answer 14

``` Referral within days for ongoing support is vital Options: -Maternal/CH nurse -Local medical officer -GP -Unsettled baby clinic -Mother-baby day unit -Admission to hospital->if child considered at risk of non-accidental injury or parental exhaustion ```

Answer 15

See a doctor if: You need reassurance that there is no medical cause for the crying. Your baby is refusing feeds or is having less than half their normal feeds. Your baby does not seem to settle with any of the things you are trying. Your baby continues to cry for long periods. You feel you are not coping. You feel the crying is impacting on your relationship with your baby. You are finding it hard to enjoy your baby or to feel positive about them. You feel your mental health or your relationship with your partner is being affected. OR you are worried for any other reason.

Answer 16

1. Comfort 2. Hungry 3. Dirty nappy, rash 4. Burp 5. Uncomfortable 6. Suck 7. Overtired 8. Conditions right to settle 9. Sick, fever 10. Does parent need a break

Answer 17

``` Fever Lethargy Poor feeding Less responsive socially Poor weight gain ```

Answer 18

Always ask about feeding, temperature, change in behaviour or social responsiveness. Are there any other symptoms to suggest serious disease e.g. vomiting, lethargy, poor weight gain? Never forget to examine the groin for testicular torsion or incarcerated inguinal hernia. If irritability is associated with a temperature, manage as "Febrile Infant".

Answer 19

``` Feeding Weight changes Vomiting, diarrhea Fever Temporal relationship What he does during the episode How he is between crying Mothers reactions, supports, mood ```

Answer 20

Temperature Weight gain General observations->social interaction Abdominal exam->ALWAYS check for incarcerated hernia

Answer 21

This a well-recognised but poorly understood condition that spontaneously resolves by 3 months of age. No long term complications Mother may need help from friends/family Avoid overfeeding, wind regularly, rick/carrying can help No drugs have been shown to be safe, or help

Answer 22

Wrong age Sudden onset Colour change and vomiting->suggestive of serious acute disorder Intussusception Strangulated inguinal hernia Testicular torsion Malrotation

The irritable infant Flashcards

(48 cards)