IBCLC EXAM: INFANT PATHOLOGY
QUESTIONS & ANSWERS(RATED A+)
Failure to thrive - ANSWER -infant continues to lose weight after 10 days of life
-does not regain birth weight by 3 weeks of age
-below 10th percentile beyond 1 month of age
signs: lethargic, sleep excessively, hypertonic, irritable, difficult to soothe, <6 wet
diapers with concentrated urine, infrequent scant stools, <8 short duration feedings/day
late signs: content to starve, sleep a lot, whine quietly/weakly
can be caused by maternal milk production, maternal or infant illness, management of
breastfeeding, and/or psychosocial issues. Usually a combination of factors
to plan catch up growth, use infant's ideal or birth weight to calculate volume required
(wt in lbs x 2.5/ feedings in a 24 hour period)
plan: frequent feedings, supplements with or after feedings until infant gaining well,
assess latch and suck technique
Dehydration - ANSWER rare, sodium levels >150, few to no stooling, little urine output,
sleepy, high weight loss, lethargy, weak cry, dry mucus membranes, lack of tears, poor
skin turgor, sunken fontanels
-causes: jaundice, poor suck, cardiac condition, downs syndrome, c/s, bfeed difficulty,
diabetes in mother, obesity in mother, breast reduction
-treat: review hx, observe feed, check labs, IV hydration, monitor milk sodium levels,
maintain lactation, resume breastfeeding once milk sodium levels normal and IV fluids
tapered
Jaundice - ANSWER yellow skin and sclera d/t high levels of bile pigment bilirubin
-Pathologic/direct/conjugated: hepatocellular disorders: levels rise quickly, requires
recognition and treatment
-Physiologic/indirect/unconjugated: elevated bilirubin levels secondary to either
increased production or decreased excretion
physiologic: normal jaundice, first days of life, monitor to ensure effective feeding,
phototherapy possible
, breastfeeding associated: starvation jaundice, first days of life, increase caloric intake,
establish effective feeding, phototherapy possible
breastmilk: unknown cause, usually days 5-10 of life, monitor, may require brief
interruption of feedings
-higher risk in preterms, excessive bruising, ABO incompatibility, infection, diabetes,
asian descent, family hx, delayed meconium passage, male
-sx: lethargy, refused feedings, excessive weight loss, vomiting, inadequate output
-tx with effective feedings to help infant stool, phototherapy possible, may require
supplementation (if wt loss >10%). risk is that infant could eventually develop
kernicterus (brain damage)
Hypoglycemia - ANSWER likely in first 24 hours postpartum d/t lag in cessation of
maternal glucose supply and development of infant's capacity for glucose synthesis
Galactosemia - ANSWER inherited disease in which liver enzyme that changes
galactose to glucose is absent
-tx: total weaning, non-dairy formula
-without treatment infant will suffer from lethargy to cerebral impairment to mental
retardation
Phenylketonuria - ANSWER genetic disorder where lack enzyme that changes
phenylalanine to a form that the body can use
tx: immediate dietary restriction of phenylalanine, give breastmilk and supplement of
phenylalanine free milk, avoid: eggs/meat/cheese/cow's milk
-without treatment can cause skin rashes, convulsions, and mental impairment
-wean slowly with phenylalanine monitoring along the way
Micrognathia - ANSWER receeding chin, may find tight musculature in infant
-affects opening of mouth, suck, vacumn, try to compensate with upper jaw, positioning
of tongue could be off, breast slides out of mouth
-tx: chin close to breast, extend head, prone
Neurological impairment - ANSWER affects suck and swallow, makes breastfeeding
challenging and time consuming, severity of condition will determine degree of
breastfeeding
Hypotonia - ANSWER low body tone, difficult to stay latched d/t weak suck, increased
risk of aspiration
QUESTIONS & ANSWERS(RATED A+)
Failure to thrive - ANSWER -infant continues to lose weight after 10 days of life
-does not regain birth weight by 3 weeks of age
-below 10th percentile beyond 1 month of age
signs: lethargic, sleep excessively, hypertonic, irritable, difficult to soothe, <6 wet
diapers with concentrated urine, infrequent scant stools, <8 short duration feedings/day
late signs: content to starve, sleep a lot, whine quietly/weakly
can be caused by maternal milk production, maternal or infant illness, management of
breastfeeding, and/or psychosocial issues. Usually a combination of factors
to plan catch up growth, use infant's ideal or birth weight to calculate volume required
(wt in lbs x 2.5/ feedings in a 24 hour period)
plan: frequent feedings, supplements with or after feedings until infant gaining well,
assess latch and suck technique
Dehydration - ANSWER rare, sodium levels >150, few to no stooling, little urine output,
sleepy, high weight loss, lethargy, weak cry, dry mucus membranes, lack of tears, poor
skin turgor, sunken fontanels
-causes: jaundice, poor suck, cardiac condition, downs syndrome, c/s, bfeed difficulty,
diabetes in mother, obesity in mother, breast reduction
-treat: review hx, observe feed, check labs, IV hydration, monitor milk sodium levels,
maintain lactation, resume breastfeeding once milk sodium levels normal and IV fluids
tapered
Jaundice - ANSWER yellow skin and sclera d/t high levels of bile pigment bilirubin
-Pathologic/direct/conjugated: hepatocellular disorders: levels rise quickly, requires
recognition and treatment
-Physiologic/indirect/unconjugated: elevated bilirubin levels secondary to either
increased production or decreased excretion
physiologic: normal jaundice, first days of life, monitor to ensure effective feeding,
phototherapy possible
, breastfeeding associated: starvation jaundice, first days of life, increase caloric intake,
establish effective feeding, phototherapy possible
breastmilk: unknown cause, usually days 5-10 of life, monitor, may require brief
interruption of feedings
-higher risk in preterms, excessive bruising, ABO incompatibility, infection, diabetes,
asian descent, family hx, delayed meconium passage, male
-sx: lethargy, refused feedings, excessive weight loss, vomiting, inadequate output
-tx with effective feedings to help infant stool, phototherapy possible, may require
supplementation (if wt loss >10%). risk is that infant could eventually develop
kernicterus (brain damage)
Hypoglycemia - ANSWER likely in first 24 hours postpartum d/t lag in cessation of
maternal glucose supply and development of infant's capacity for glucose synthesis
Galactosemia - ANSWER inherited disease in which liver enzyme that changes
galactose to glucose is absent
-tx: total weaning, non-dairy formula
-without treatment infant will suffer from lethargy to cerebral impairment to mental
retardation
Phenylketonuria - ANSWER genetic disorder where lack enzyme that changes
phenylalanine to a form that the body can use
tx: immediate dietary restriction of phenylalanine, give breastmilk and supplement of
phenylalanine free milk, avoid: eggs/meat/cheese/cow's milk
-without treatment can cause skin rashes, convulsions, and mental impairment
-wean slowly with phenylalanine monitoring along the way
Micrognathia - ANSWER receeding chin, may find tight musculature in infant
-affects opening of mouth, suck, vacumn, try to compensate with upper jaw, positioning
of tongue could be off, breast slides out of mouth
-tx: chin close to breast, extend head, prone
Neurological impairment - ANSWER affects suck and swallow, makes breastfeeding
challenging and time consuming, severity of condition will determine degree of
breastfeeding
Hypotonia - ANSWER low body tone, difficult to stay latched d/t weak suck, increased
risk of aspiration
