Page 1041 - TNFlipTest

Toronto Notes 2019 Primary Care
■ parent-child bonding
■ economical, convenient • maternalcontraindications
■ chemotherapy, radioactive compounds, or medications known to cross to breast milk
■ HIV/AIDS, active untreated TB, herpes in breast region
■ >0.5 g/kg/d of alcohol or illicit drugs
■ OCPs are not a contraindication to breastfeeding (estrogen may decrease lactation, but is not
dangerous to infant)
■ MotherRiskTM Program – valuable research and counselling on reproductive risk or safety of drugs
and chemicals
■ poor weight gain: consider dehydration or FTT
■ oral candidiasis (thrush): treat baby with antifungal such as nystatin; can occur in breast or bottle-
Pediatrics P7
fed infants
Table 6. Common Formulas Compared to Breast Milk
Medications that Cross into Breast Milk
• Antimetabolites
• Bromocriptine
• Chloramphenicol
• High dose diazepam • Ergots
• Gold
• Metronidazole
• Tetracycline
• Lithium
• Cyclophosphamide
Signs of Inadequate Intake
• <6 wet diapers/d after first wk
• <7 feeds/d
• Sleepy or lethargic, sleeping throughout the
night <6 wk
• Weight loss >10% of birth weight • Jaundice
• 1 wet diaper per/d of age for first wk
• 1-2 black or dark green stools/d on Day 1 & 2 • 3+ brown/green/yellow stools/d on Day 3 & 4 • 3+yellow,seedystools/donDay5+
Type of Nutrition
Cow’s Milk-Based
(Enfamil®, Similac®)
Fortified Formula Soy Protein
(Isomil®, Prosobee®)
Partially Hydrolyzed Proteins
(Good Start®)
Protein Hydrolysate
(Nutramigen®, Alimentum®, Pregestimil®, Portagen®)
Amino Acid
(Neocate®, PurAminoTM)
Metabolic
Indications
Prematurity
Transition into breastfeeding Contraindication to breastfeeding
Low birth weight Prematurity
Galactosemia
Desire for vegetarian/vegan diet*
Delayed gastric emptying
Risk of cow milk protein allergy
Malabsorption Food allergy
Food allergy Short gut
Inborn errors of metabolism
Content (as compared to breast milk)
Lower whey:casein ratio
Plant fats instead of dietary butterfat
Higher calories and vitamins A, C, D, K
May only be used in hospital due to risk of fat-soluble vitamin toxicity
Corn syrup solids or sucrose in place of lactose Protein is 100% whey with no casein
Protein is 100% casein with no whey
Corn syrup solids, sucrose, or tapioca starch instead of lactose
Expensive
Free amino acids (no protein)
Corn syrup solids instead of lactose Very expensive
Various different compositions for children with galactosemia, propionic acidemia, etc.
* 10-35% of children with cow’s milk protein allergy also have reactions to soy-based formula
Injury Prevention Counselling
• injuriesaretheleadingcauseofdeathinchildren>1yrofage
• maincauses:motorvehiclecrashes,burns,drowning,falls,choking,infanticide
Table 7. Injury Prevention Counselling
0-6 mo
Do not leave alone on bed, on changing table, or in tub
Keep crib rails up
Check water temperature before bathing
Do not hold hot liquid and infant at the same time
Check milk temperature before feeding
Appropriate car seats are required before leaving hospital
6-12 mo
Install stair barriers Discourage use of walkers
Avoid play areas with sharp- edged tables and corners
Cover electrical outlets
Unplug appliances when not in use
Keep small objects, plastic bags, cleaning products, and medications out of reach
Supervise during feeding Appropriate car seats
1-2 yr
Never leave unattended
Keep pot handles turned to back of stove
Caution with whole grapes, nuts, raw carrots, hotdogs, etc. due to choking hazard
No running while eating Appropriate car seats
2-5 yr
Bicycle helmet
Never leave unsupervised at home, driveway, or pool
Teach bike safety, stranger safety, and street safety
Swimming lessons (>4 yr), sunscreen (from 6 mo), fences around pools
Appropriate car seats
Note: This list is not exhaustive. For more details, see Rourke Baby Record (http://www.rourkebabyrecord.ca/pdf/RBR2011Ont_Eng.pdf)