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Breastfeeding/Nutrition

Objectives:

  1. Understand caloric/nutritional needs of infants and young children
  2. Be able to provide support to breastfeeding moms
  3. Know when and how to introduce solid foods
  4. Be aware of current practice for introducing highly allergenic foods
  5. Understand the components of a healthy diet throughout childhood and adolescence

Articles:

Additional Resources:

Self-Assessment:

1. You receive a call from the family of one of your patients. The family has a 3-week-old healthy infant who was delivered at term and has been exclusively breastfed since birth. The mother of your patient has been experiencing pain and lower extremity weakness since the delivery. Her physician has ordered magnetic resonance imaging with gadolinium-based contrast to evaluate for lumbosacral plexus nerve injury. When she scheduled the imaging procedure, she was advised by the radiology nurse to avoid breastfeeding for 48 hours after the contrast administration. The patient’s family is interested in your advice. Of the following, the MOST appropriate recommendation is that this mother:

  1. avoid breastfeeding for 24 hours after contrast administration
  2. avoid breastfeeding for 48 hours after contrast administration
  3. cease breastfeeding entirely after contrast administration
  4. continue to breastfeed or express her breast milk without interruption
  5. request that the imaging study be performed without contrast

2. You are seeing a 1-month-old male infant in your office for parental concerns about diarrhea. He was born at term after an uncomplicated pregnancy, passed his first meconium stool at 18 hours of age, and was discharged from the nursery at 36 hours of age. He is breastfed and has been growing adequately. The parents report diarrhea for 1 week, which they describe as 6 loose stools per day with some mucus and occasional small red specks that they think is blood. The infant has had no fever or vomiting, and is feeding and acting normally. No one else at home is sick and there has been no travel. His physical examination shows a vigorous infant with growth parameters at the 50th percentile. He has no skin rashes or anal fissures, and the remainder of his physical examination findings are normal. Although the stool is not grossly bloody, a stool test for blood is positive. Of the following, the MOST appropriate next step in the care of this patient is to:

  1. change his diet to an amino acid-based formula
  2. change his diet to a lactose-free formula
  3. eliminate cow milk from the mother’s diet
  4. obtain serum-specific immunoglobulin E for milk protein
  5. refer to gastroenterology for a colonoscopy

3. You are seeing a 4-month-old breastfed male infant for a health supervision visit with a resident. The infant’s mother reports frequent effortless regurgitation of food that follows most liquid meals. She reports no pain or fussiness with the episodes and no correlation with changes in maternal diet. 

The infant has a heart rate of 118 beats/min, respiratory rate of 26 breaths/min, and temperature of 37°C. He is alert and well nourished. His examination findings are unremarkable. The resident asks what education she should provide this mother about when regurgitation is likely to resolve. Of the following, it is MOST likely that these events will stop by:

  1. 6 months
  2. 8 months
  3. 9 months
  4. 10 months
  5. 12 months

4. You are seeing a 13-month-old boy who is new to your practice for a health supervision visit. The boy recently moved with his family to the rural area where you practice, where his parents have started a strawberry farm. They are currently living in and renovating a farmhouse that was built in 1915. Both their farm and home are supplied with well water. The entire family eats a variety of fresh fruits and vegetables that are grown on their farm.

The child’s parents report that he has been very healthy, with no significant medical history. He takes no medications and has no allergies. His immunizations are up to date. His growth and development have been progressing normally. He is breastfed and eats some solid foods, though his mother states that he is a “picky” eater. He does not attend daycare, and loves playing with his 7-year-old twin sisters and 13-year-old brother (who are all healthy and developing normally according to the parents).

In your office, the boy is well-appearing and active. His growth parameters are normal for his age, and findings of a complete physical examination are unremarkable.

His parents ask you to discuss the potential health consequences of exposure to environmental toxins in this boy and his older siblings and how they can reduce the risk of exposure to environmental toxins for their children. Of the following, the MOST accurate information that you can provide to address the parents’ concerns is that 

  1. all well water that this 13 month old and his siblings consume should be boiled to reduce their risk of exposure to both lead and nitrites
  2. the boy’s mother should discontinue breastfeeding to reduce his risk of exposure to pesticides
  3. the boy’s risk of developing asthma after exposure to air contaminants on the farm is the same as the risk of asthma development in his older siblings
  4. the boy’s risk of exposure to foodborne pesticide residues is lower than the risk of exposure faced by his older siblings because he consumes less food
  5. the boy’s risk of ingesting lead dust in his home environment is higher than the risk faced by his older siblings

Find the answers here.