Breast Is Best
Whenever baby seems hungry
How much formula should baby drink per feed in the first week of life?
1-2oz
A 3-week-old female infant presents to clinic for a wellness visit. After reviewing her growth chart, you note that she has not yet returned to birth weight. What is the most likely cause of her growth faltering?
Inadequate caloric intake
10%
8-12
How much formula should baby drink per feed by the end of 1st month?
3-4oz
A 15-year-old girl presents to clinic with her father. Her father is concerned that she has lost 40lbs in the past year. Her Z-score is -2.7, down from +1.9 last year. Dad is concerned that she seems "sad all of the time". You ask dad to step out of the room and perform this assessment.
HEADSS
How much weight do you expect newborn's to gain per day?
20-30g (1oz)
Approximately how many minutes should baby nurse (per side)
10-15 mins
Approximately how many ounces should you expect baby to drink in a day (hint: weight based)
32 oz or 2.5oz per pound of body weight
A 6 week old boy is brought to the clinic with vomiting over the past 2 weeks. The vomiting occurs with every feed, is non-bilious, and is projectile. Even though the mother has tried small, frequent feeding and holding the infant upright after feeds, the vomiting has persisted. On physical examination peristaltic woes are seen over the upper abdomen, and a olive shaped mass is palpated in the right upper quadrant. What is the likely diagnosis in this patient?
Pyloric stenosis
What is the potential implication of not correcting growth faltering in a timely manner?
Ways to know if baby is eating enough
weight gain, 6 wet diapers per day min, 3-4 BM's minimum, baby seems satisfied after feeds
What is the longest "stretch" a newborn should sleep at night without feeding?
A 3-month-old male presents to clinic for continued growth faltering. Parents have brought a feed journal which shows that he is getting an appropriate amount of calories. Parents deny that baby is spitting up significant amounts of feeds, however they do notice he becomes diaphoretic during feeds. What is the next step in work up for this patient?
Echo
What Z-score would indicate severe malnutrition?
-3 or less
Ways to improve insufficient supply
effective milk drainage, pump between nursing sessions, lactation consultation, ensure proper latch, Fenugreek
At what age/weight can you expect to drop the nighttime feed?
2-4 months or 12lbs
A 3 year old girl gets admitted to the hospital because of failure to thrive. Her parents explain that she often has large greasy stools. They have noticed these for the past 4 months. This child was born a term after an uncomplicated pregnancy, and weighed 7 lb at delivery. She did not pass meconium until the age of 3 days. She is below the 5th percentile for both height and weight. A physical examination shows a decreased amount of soft tissue mass. Her lungs are clear to auscultation. The abdominal exam is unremarkable. Later it is discovered that the patient has exocrine pancreatic insufficiency which is the cause of her growth faltering. What is a possible diagnosis that explains this clinical picture?
Cystic Fibrosis
A z-score decrease of ___ over time suggests moderate malnutrition
2