Poor feeding in infants and children — formative SAQs

SAQ 1 — Neonate with acute poor feeding (10 marks)

A 6-day-old term infant has reduced breastfeeding for 18 hours, fewer wet nappies and increasing sleepiness. Temperature is 36.2°C. ^{[26] [25]}

Questions

1. List your immediate bedside priorities and why each matters. (4 marks) ^{[26] [25] [5]}
2. Give a one-sentence problem representation and your top three differentials. (3 marks) ^{[5] [26]}
3. What would make you admit rather than attempt community observation? (3 marks) ^{[26] [5]}

Model answer

Immediate priorities (4). ABCDE first. Check capillary glucose early because low intake risks hypoglycaemia and altered consciousness. Assess perfusion, work of breathing and temperature. Treat on a neonatal sepsis pathway when infection is plausible — poor feeding is a classic non-specific early sign. Do not delay stabilisation for a long diet history or tongue-tie clinic. Support feeding only after safety is addressed. ^{[26] [25] [5]}

Problem representation and differentials (3). Example: “Day-6 term neonate with 18 hours of reduced feeds, oliguria and lethargy, cool temperature, threat-led differential of evolving sepsis, hypoglycaemia secondary to low intake, and less likely evolving cardiorespiratory disease.” Top three: neonatal sepsis; hypoglycaemia/inadequate intake with dehydration; congenital heart or other cardiorespiratory disease if examination supports it. ^{[26] [25] [19]}

Admission triggers (3). Ongoing lethargy, abnormal glucose, suspected sepsis, dehydration, unreliable follow-up, inability of caregivers to maintain safe intake and observation, or any cardiorespiratory compromise. Early weight check alone is not enough if current physiology is unsafe. ^{[26] [5]}