Do I feel an olive?
What is the normal age range pyloric stenosis presents?
2 - 8 weeks old
(rare after 12 weeks)
Name 2 symptoms that should make you consider GERD instead of GER?
Growth faltering, recurrent vomiting, inconsolable crying, feeding refusal
In infants with cardiac disease, this symptom during feeding reflects increased energy expenditure and contributes to failure to thrive.
Sweating and tachypnea
A previously exclusively breastfed four month old had their first bottle of Similac today and 30 minutes later had vomiting, urticaria, and respiratory distress so family called 911. Diagnosis?
IgE mediated cow’s milk protein allergy, give Epinephrine - this is very rare!
What is the general rule of thumb for preparing formula (formula per oz)?
2 ounces of water to one scoop of formula
What are the classic lab findings you see with pyloric stenosis?
Hypochloremic, hypokalemic metabolic alkalosis
BONUS ** with paradoxical aciduria due to renal compensation
Name an option for conservative measures for infant GERD?
Thickening agents, feeding modifications (not overfeeding), Extensively hydrolyzed or amino acid formulas
A 4-week-old from South America presents to clinic with weight in the 2nd percentile, he has an open posterior fontanelle, umbilical hernia, large tongue. He spits up with feeds and required phototherapy at birth. Diagnosis?
Hypothyroidism
A 7 week old exclusively breastfed infant has had 3 mucousy, bloody stools. No growth faltering, but the child is fussy and irritable. What is the diagnosis and treatment?
Allergic Proctolitis or “Cow’s Milk Protein Allergy/Intolerance”, maternal elimination of cow’s milk from diet (can rechallenge one month later)
When should babies regain birth weight? Double birth weight? And Triple birth weight?
2 weeks, 4 months, and 12 months
Name three significant risk factors for pyloric stenosis?
First born, male, white, c-section, bottle feeding, maternal smoking, preterm birth, parental history, early erythromycin use (<2 wks)
Dad comes in with a 6 week old who cries all night and spits up “entire feeds”. He wants his baby to be put on famotidine like his older brother was because he think it will help his colic. Define colic.
Unexplained, inconsolable crying ≥3 hours/day and ≥ 3 days/week
A 3 month old is admitted to the hospital due to concerns for respiratory infection. His weight-for-length Z-score is -2.5. He has had chronic greasy stools. What is the best next step to help diagnose the underlying etiology?
Sweat chloride test
In clinic you are seeing an exclusively breastfed 4 month old with mild atopic dermatitis, on famotidine for spit up. Mom has cut dairy out for her diet after reading a blog about colic. Mom is asking about introduction of allergens, what are you recommendations?
Introduce allergens early! This baby is at risk for food allergy due to AD, famotidine, and limited maternal diet - early introduction should help prevent food allergy development
How many calories per day does a term neonate need (kcal/kg/day)?
100 kcal/kg/day
Holliday-Segar formula:
First 10 kg: 100 kcal/kg/day +
Next 10 kg: 50 kcal/kg/day +
Anything >20kg: 20 kcal/kg/day
What is the name of the surgery performed for PS and is it a surgical emergency?
Pyloromyotomy and no, the electrolyte derangements may be a medical emergency, but good rehydration should be established prior to the OR
Name a risk of PPI and H2 blockers in infants.
Increased respiratory and GI infections, obesity, food allergies, and fractures
A 6-month-old presents with poor weight gain, fevers, and several weeks of diarrhea. He is found to have oral thrush. Diagnosis?
HIV
A mom of a 4 month old formula fed infant put rice in his bottle last night because grandma said it would help him sleep longer. 3 hours following the bottle he had multiple episodes of vomiting, lethargy, and on exam signs of dehydration. Vomiting resolved in 24 hours. Diagnosis?
Food Protein Induced Enterocolitis (FPEIS)
An 9mo old in clinic has dropped a percentile curve since last visit. You think Mom may have switched to cow’s milk because it is cheaper. Why should cows milk be avoided in under 12 months besides risk of weight loss? Any labs to check today?
Iron in cow's milk has lower bioavailability in humans, leads to a nearly 4-fold increased risk of iron deficiency anemia compared to formula
How many mm thick does the pylorus muscle need to be to be considered pyloric stenosis?
≥ 4mm
Test of choice: abdominal ultrasound
Name an alarm symptom that would warrant further diagnostic workup when considering GERD.
Bilious or projectile vomiting, hematemesis, growth faltering, persistence beyond 12 months of age
At a 2-month check-up, a patient's mother notes that he has started to breathe fast and sweat during feeds. On exam, he has hepatomegaly and a continuous holosystolic murmur loudest at the left sternal border. He has fallen off the growth curve. Diagnosis?
Large VSD with left-to-right shunting
What is the pathophysiology of allergic proctocolitis?
We don't really know!
What percentage of birth weight can an infant lose in the first few days of life due to fluid loss?
10%, if losing more than 10% of BW then consider feeding difficulties