A full term infant with a birth weight of 3.5 kg, length of 50 cm and head circumference of 35 cm (all at 50th percentile) comes for an office appointment at two weeks of age. The baby is being fed infant formula. He is gaining weight appropriately. Considering the appropriate nutritional management of infants, select the appropriate advice to be given to new mothers who are thinking about whether they will choose to feed their babies with breast milk or infant formula exclusively.
Correct Answer C:
To recognize abnormal growth, one needs to understand normal growth. The average birth weight for a term infant is 3.3 kg. Weight drops as much as 10% in the first few days of life, probably as a result of loss of excess fluid; however, birth weight is regained within 1 week to 2 weeks after birth in majority of children.
In breastfed infants and formula-fed infants, the frequency of feeds, number of wet diapers and stools each day, and a history of sequential weights allow the physician the ability to gauge if the child is receiving adequate amounts of fluid and calories and is gaining weight appropriately.
Breast milk lacks vitamin D (choice C) and cows milk lacks iron. Babies who don’t get enough vitamin D are at risk of getting rickets, a disease that affects the way bones grow and develop.
→ Avoid feeding newborn infants in the first 12 hours of life in order to prevent aspiration (choice A) is incorrect. The baby can start to feed shortly after birth and does not need to wait for 12 hours.
→ Breast milk is deficient in iron and iron supplementation is recommended for breast fed infants (choice B) is incorrect. Cow's milk is deficient in iron.
→ Institute solid food at three months of age (choice D) is incorrect. Solid food is typically introduced between 4-6 months of age.
→ Breast milk may causes diarrhea if used exclusively, so formula should be added (choice E) is incorrect. Breast milk has many benefits for infants and the American Academy of pediatrics recommends breast feeding for at least the first year of life. There has been no study that established breast milk causes diarrhea if used exclusively; in fact, it is believed that breast milk decreases the risks of diarrhea.
In assessing the nutritional status of an infant it is useful to know that birth weight is expected to be regained within:
Correct Answer B:
A helpful guideline for assessing normal growth in the very young infant is that birth weight should be regained by the 14th day.
Between 7 and 8 years of age, your patient has grown 4.5 cm. His height, however, remains below and parallel to the 50th percentile. Clinical examination is entirely normal. His mother is anxious for further investigations to be undertaken.
Which one of the following would you undertake?
Correct Answer E: The growth percentiles by themselves don't say much. What really matters is the velocity of growth. A normal velocity of growth means the child's growth points will closely parallel the percentile line above it on the chart. Physicians don't worry about insufficient (or excessive) growth until a child's growth velocity has crossed at least two percentile lines (e.g., from above the 90th to below the 50th percentile).
Additionally, if a child's weight, height, or head size is below the 50th percentile, they might also call them small for age. In that case, what's most important is to see if the growth points parallel the 50th percentile line (meaning growth velocity is normal) or if the child is falling further behind (which is more concerning).
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