Council on Medical Student Education in Pediatrics

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COMSEP Clinical Cases

NUTRITION

  1. Parents of a newborn infant want to know the advantages and disadvantages of breast-feeding compared to bottle-feeding. How would you counsel them?
  2. A mother is taking medications. Where would you find out the contraindications to breastfeeding?
  3. A mother who chooses not to breast-feed her child wants to know what types of formula are available and which would be appropriate for her child? What are the indications for using Soy protein formulas?
  4. A healthy four-month-old breast-fed child presents for a well-child examination. The parents want to know when he can begin solid foods and when he should be weaned from breast milk. When the mother decides to stop nursing, how would you advise her to stop?
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  5. A mother is concerned that her five-day-old infant is not breast-feeding well. What historical or physical examination findings would help you investigate her concerns? How does the mother know that she is producing milk? What additional resources may be available to help support this mother?
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  6. A healthy two-month-old infant, who is being breast-fed, is seen in your office for a routine visit. The mother asks about the need for vitamin and fluoride supplementation in her infant. Discuss which supplements should be considered and at what age. What if she is feeding formula?
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  7. A five-year-old boy is now at the 95th percentile for weight and 50th percentile for height whereas previously he had been at the 50th percentile for both height and weight. How would you counsel him and his family? Include the consequences of childhood obesity in your discussion.
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  8. A thirteen-year-old girl wants to "go on a diet". Her birthday was last week. Her current weight is 45 kg and height is 157 cm. What is her BMI? How would you evaluate and counsel her?
  9. The health conscious parents of a healthy, non-obese 15-month-old ask if they can switch her to nonfat milk, as they are concerned about obesity and heart disease. How would you counsel them?
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  10. A one month-old born at term weighing 3.3 kg presents for a well child visit. Today his weight is 4.0 kg, length 53 cm, and head circumference is 39 cm. He is taking four ounces of Enfamil with iron every 3-4 hours. Is this adequate weight gain? What are the caloric requirements for neonates and young infants?
  11. A 9-month-old is drinking formula. Her parents ask if they can change from formula to cow's milk as they could save a lot of money. How would you counsel them?
  12. An eighteen-month-old is drinking 48 ounces of whole milk a day. Is this appropriate? How would you discuss this with the parents? What complication might you see in this child?
  13. A fifteen-year-old wrestler comes in for an annual visit and wants to know your views on supplements and vitamins. How would you counsel him? What are the important questions to ask in your history and what should you check on your physical examination?
  14. In evaluating a four-year-old child, you discover that there is a strong family history of diabetes and the father had a heart attack at age 35. How would you counsel the patient and his family?
  15. The parents of a 14 year-old female who is a competitive runner are concerned that she has been tired, has stopped menstruating, and has been diagnosed with shin splints. How would you counsel them?

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