Paeds Vivas · gastroenterology-hepatology-and-nutrition
Formula feeding and complementary feeding — branching viva
Branching viva from the principles of safe formula feeding and the timing of complementary feeding through the developmental readiness for solids at around six months, the early introduction of allergens, the never-before-twelve-months hazards, and the work-up of the infant with faltering growth.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a general clinic. The consultant asks you to talk through four families: a new parent choosing and preparing infant formula, a parent asking when to start solids and what first foods to offer, a parent worried about giving their infant egg and peanut, and a parent who has been giving whole cow's milk and honey since six months and whose infant is now pale.
Station opening — choosing and preparing infant formula
Examiner: "A new parent is choosing infant formula. How do you advise them, and how do you teach safe preparation?" [7]
Strong candidate (must-hit)
- Names a standard first infant formula (stage 1) based on modified cow's milk as nutritionally complete and appropriate from birth through to twelve months; states that specialised formulas (soy, partially or extensively hydrolysed, amino-acid, anti-regurgitation, lactose-free) are reserved for medical indications, not preference, and that follow-on and toddler milks are not nutritional requirements. [7]
- Teaches safe preparation: boil fresh water and cool to no less than 70 degrees Celsius, add the exact number of level unpacked scoops, use or refrigerate immediately; explains that over-concentration causes hypernatraemic dehydration and seizures while under-concentration causes faltering growth and hyponatraemia. [7]
Weak candidate
- "I would tell them to buy whichever formula they prefer and follow the tin, and to warm the bottle in the microwave." [7]
References5ShowHide
- [1]Fewtrell M; Bronsky J; Campoy C; Domellöf M; Embleton N; Fidler Mis N; et al Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr, 2017.PMID 28027215
- [2]Agostoni C; Decsi T; Fewtrell M; Goulet O; Kolacek S; Koletzko B; et al Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr, 2008.PMID 18162844
- [5]Du Toit G; Roberts G; Sayre PH; Bahnson HT; Radulovic S; Santos AF; et al Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med, 2015.PMID 25705822
- [7]Koletzko B; Baker S; Cleghorn G; Neto UF; Gopalan S; Hernell O; et al Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group. J Pediatr Gastroenterol Nutr, 2005.PMID 16254515
- [10]Tsai SF; Chen SJ; Yen HJ; Hung GY; Tsao PC; Jeng MJ; et al Iron deficiency anemia in predominantly breastfed young children. Pediatr Neonatol, 2014.PMID 24953965