IBCLC EXAM: Infant Pathology Study
Guide
Failure to thrive - -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 - 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 - 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 - likely in first 24 hours postpartum d/t lag in cessation of maternal
glucose supply and development of infant's capacity for glucose synthesis
-breastfed infants can tolerate a lower plasma glucose without significant clinical
manifestations
-if infant asymptomatic, no evidence that treatment is necessary
-if levels are between 36-45 may require intervention
-risk factors: preterm, gestational diabetes, small or large for gestational age, or those
with sx, separation, cold room, infant crying, delayed feedings, acute brain injury, inborn
errors of metabolism
-sx: irritability, tremors, jitteriness, exaggerated moro reflex, high pitched cry, seizures,
lethargy, coma, cyanosis, apnea, tachypnea, hypothermia, poor suck, instability
tx: prevent with skin to skin, frequent feeds. monitor glucose on those with risk factors or
sx. Monitor until consistent normal levels obtained. IV glucose if consistently or
dangerously low, despite interventions, still breastfeed!
Ankyloglossia (tongue tie) - short frenulum restricting the tongue, causing reduced milk
transfer, nipple pain, latch trouble, low supply
dx (we are not licensed to diagnose): take hx, observe feeding (usually unable to
maintain latch, compressing nipple tip, d/t shallow latch)
tx: frenulotomy, help with positioning: prone or extended head
High palate - normal palate appears short, wide, "U" shaped, and only slightly arched
-likely with tight frenulum
-difficult for tongue to compress breast tissue adequately
Guide
Failure to thrive - -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 - 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 - 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 - likely in first 24 hours postpartum d/t lag in cessation of maternal
glucose supply and development of infant's capacity for glucose synthesis
-breastfed infants can tolerate a lower plasma glucose without significant clinical
manifestations
-if infant asymptomatic, no evidence that treatment is necessary
-if levels are between 36-45 may require intervention
-risk factors: preterm, gestational diabetes, small or large for gestational age, or those
with sx, separation, cold room, infant crying, delayed feedings, acute brain injury, inborn
errors of metabolism
-sx: irritability, tremors, jitteriness, exaggerated moro reflex, high pitched cry, seizures,
lethargy, coma, cyanosis, apnea, tachypnea, hypothermia, poor suck, instability
tx: prevent with skin to skin, frequent feeds. monitor glucose on those with risk factors or
sx. Monitor until consistent normal levels obtained. IV glucose if consistently or
dangerously low, despite interventions, still breastfeed!
Ankyloglossia (tongue tie) - short frenulum restricting the tongue, causing reduced milk
transfer, nipple pain, latch trouble, low supply
dx (we are not licensed to diagnose): take hx, observe feeding (usually unable to
maintain latch, compressing nipple tip, d/t shallow latch)
tx: frenulotomy, help with positioning: prone or extended head
High palate - normal palate appears short, wide, "U" shaped, and only slightly arched
-likely with tight frenulum
-difficult for tongue to compress breast tissue adequately
