Breast Is Best
Formula 1
Cases
Miscellaneous
100
When should mom breastfeed baby?

Whenever baby seems hungry

100

How much formula should baby drink per feed in the first week of life?

1-2oz

100

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

100
A newborn's weight loss should not exceed __%

10%

200
Approximately how many times per day should baby nurse

8-12

200

How much formula should baby drink per feed by the end of 1st month?

3-4oz

200

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

200

How much weight do you expect newborn's to gain per day?

20-30g (1oz)

300

Approximately how many minutes should baby nurse (per side)

10-15 mins

300

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

300

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

300

What is the potential implication of not correcting growth faltering in a timely manner?

Decreased adult height and cognitive potential, secondary immune deficiencies, permanent damage to brain/CNS
400

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

400

What is the longest "stretch" a newborn should sleep at night without feeding?

4-5 hours
400

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

400

What Z-score would indicate severe malnutrition?

-3 or less

500

Ways to improve insufficient supply

effective milk drainage, pump between nursing sessions, lactation consultation, ensure proper latch, Fenugreek

500

At what age/weight can you expect to drop the nighttime feed?

2-4 months or 12lbs

500

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

500

A z-score decrease of ___ over time suggests moderate malnutrition

2