Infant Feeding

Chapter 98 Infant Feeding




Clinical Case Problem 1: A New Mother with Insecurities


A mother who just delivered her first baby 2   weeks ago comes to your office for her routine visit. She says that her milk just “isn’t enough” and she plans to start supplementing because her baby cries all the time and seems unsatisfied by her milk. The mother would have given up already, but her sister breast-fed and has been giving her encouragement. In addition, her husband has encouraged her to breast-feed because it is “best for the baby.” The mother appears tired, and during your interview, the child is on the breast the entire time. The child is at the 50th percentile for weight and the 50th percentile for length. More important, the child has gained an average of 50   g/day since discharge from the hospital. The child is feeding every 2 hours at this time.



Select the best answer to the following questions




1. What is the minimal appropriate weight gain (and a sign of both infant health and maternal-infant bonding with breast-feeding) after discharge from the hospital?


a. 15   g/day

b. 20   g/day

c. 30   g/day

d. 50   g/day

e. 75   g/day

2. What would be your suggestion to the mother in terms of feeding her infant?


a. reassure her that she does have enough milk, the infant’s weight gain is excellent, and the infant uses the breast for comfort as well as for nutrition

b. decrease the feeds of the infant to every 4 hours on a set schedule to prevent her fatigue

c. alternate every other feed breast and bottle

d. switch from breast-feeding to bottle-feeding

e. b and c

3. Regarding the feeding of infants when they cry, which of the following is the best advice to the mother?


a. feed the baby; no if’s, and’s, or but’s

b. let the infant cry for at least 30 minutes; if the infant is still crying, it is likely to be either a diaper problem or a food problem

c. supplement breast-feeding; crying may indicate inadequate milk supply

d. crying may or may not indicate hunger; assume that the baby needs to be fed until it is proved otherwise; if the baby refuses the breast, check for other causes of crying

e. crying is usually the first sign of hunger in a baby

4. Which of the following statements regarding milk production and maternal anxiety is (are) true?


a. there is little correlation between milk production and maternal anxiety

b. maternal anxiety may significantly increase milk let-down

c. maternal anxiety may significantly decrease milk let-down

d. the main determinant of a good milk supply is frequent, effective milk removal

e. c and d

5. Human colostrum is the precursor to human milk. What is (are) the major component(s) in colostrum offering a significant advantage to breast-fed infants?


a. macrophages that synthesize complement, lysozyme, and lactoferrin

b. bacterial antibodies that protect the infant against bacterial organisms entering through the gastrointestinal (GI) tract

c. antibodies that protect the infant against viral organisms entering through the GI tract

d. b and c

e. a, b, and c

6. Which of the following immunoglobulin (Ig) class antibodies is of particular importance and is found in abundance in human colostrum?


a. IgA

b. IgG

c. IgM

d. IgE

e. none of the above

The mother returns for the infant’s 2-month visit. Although he is doing well, she is afraid that she might need to start infant cereal or baby food to ensure that he is getting enough nutrition.



7. Your response is which of the following?


a. go ahead and feed him cereal at night to help him sleep better

b. introduce cereal at 4   months, and then add one food of the “first foods” every day

c. introduce cereal at approximately 6   months, and then add one new food every week or two

d. introduce cereal at any time he seems to be hungry after breast-feeding

e. none of the above

The mother calls your nurse after the 2-month checkup because she forgot to ask you about vitamins. Her sister’s baby, who was 6   weeks preterm, was given iron supplementation.



8. Your nurse tells her, on the basis of your answer, all except which of the following?


a. the American Academy of Pediatrics now recommends vitamin D supplementation of 400   IU daily to infants who are breast-fed and older than 2   months, although there is not strong evidence in favor of or against this recommendation

b. because fluoride concentration in the water of your community exceeds 1   ppm, no supplementation is required

c. because breast milk has less iron than formula does, all breast-fed babies need iron supplementation

d. preterm infants have lower iron stores than term infants do, so even though her sister’s infant needed iron, her infant does not

e. if she does not want to use vitamin D supplementation, she should make sure she is not deficient; deficient mothers have infants at higher risk for vitamin D deficiency



Clinical Case Problem 2: A 28-Year-Old Primigravida with Mastitis


A 28-year-old primigravida develops an erythematous skin discoloration in the upper outer quadrant of the left breast. She has achy, influenza-like symptoms and temperature of 101° F. You suspect bacterial mastitis.



9. At this time, what would you do?


a. stop breast-feeding and have the mother express her breast milk until the infection is cleared

b. continue breast-feeding and treat the mother with hot compresses and antibiotics

c. continue breast-feeding and treat both the mother and the infant with antibiotics

d. discontinue breast-feeding for now and provide antibiotics to the mother

e. discontinue any further breast-feeding and perform an incision and drainage immediately

The patient is discouraged when she returns 1   month later with another bout of mastitis. She has returned to work and is pumping with a breast pump during her breaks.



10. What is (are) the likely cause(s) of the recurrent mastitis you should explore?


a. check her latch-on and determine if the baby is positioned properly

b. encourage her to use different breast-feeding positions to massage different milk ducts

c. make sure she is getting adequate rest and hydration and is not waiting too long between feeds (or pumping)

d. check her nipples for cracks, fissures, or signs of fungal infection

e. all of the above

When you are visiting with the patient, she expresses her desire to breast-feed until her child is 12   months of age. You are impressed with her perseverance and ask her what makes her willing to endure the recurrent infections.



11. Which of the following is true concerning a woman’s decision to breast-feed?


a. most women decide to breast-feed during their third trimester

b. the opinion of the husband or boyfriend plays little or no role in the woman’s decision to breast-feed

c. hospital practices that do not follow the Baby-Friendly Hospital Initiative have little impact on a woman’s decision to breast-feed or to continue to breast-feed

d. putting the baby to breast soon after delivery, avoiding bottles and pacifiers, and encouraging rooming in with the mother are all important in helping a woman to breast-feed successfully

e. women who are younger with less education are more likely to breast-feed because of the cost of formula


Clinical Case Problem 3: A Mother with a Baby Who Spits Up Often


A mother comes to your office with her infant. Her baby is 6   weeks of age and has been “spitting up” all of her formula “since birth.” She is afraid the infant is malnourished. The baby weighs 11 pounds, 3 ounces. Her birth weight was 7 pounds, 6 ounces.



12. At this time, you should advise the mother to do which of the following?


a. return home and relax; the child will grow out of it

b. increase the time spent burping the infant and keep the infant semiupright after feedings

c. investigate the child for pyloric stenosis

d. suggest the use of a GI tract motility modifier such as metoclopramide

e. immediately refer the child to a pediatric gastroenterologist



Clinical Case Problem 4: A Mother with Breast-feeding Problems


A mother comes to your office with her 8-week-old infant girl. The mother is tearful and depressed. She has been trying to breast-feed, but she tells you, “I’m obviously inadequate. I’m not producing enough milk, and the baby is fussy all of the time.” On examination, the infant looks thin. Since her last checkup 3   weeks ago, she has gained only 90   g. The rest of the physical examination is normal.



13. At this time, what should you not do?


a. ask some very direct questions about the mother’s feeding technique

b. refer the mother to a lactation consultant

c. encourage the mother to start pumping and include the baby’s father or other family member in feeding her milk to the baby, adding formula if necessary until her milk supply is adequate for the baby’s catch-up growth

d. schedule a reassessment within 3   days after interventions have been undertaken

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Infant Feeding

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