Infant health supervision 6–12 months — formative SAQs

SAQ 1 — Structure the 9-month visit (10 marks)

A first-time caregiver brings a 9-month-old for routine review. The infant appears well in the waiting room. [1]

Questions

1. List the essential domains you will cover in this health-supervision visit. (4 marks) [1]
2. Give four high-yield anticipatory guidance points specific to emerging mobility and feeding at this age. (4 marks) [2] [3] [5]
3. Name two situations in which you would abandon the preventive checklist and convert to acute care. (2 marks) [1]

Model answer

Domains (4). Growth (weight, length, OFC plotted); developmental surveillance with observation; nutrition/complementary feeding and iron risk; safe sleep; injury/passenger safety; oral health; immunisation status; family psychosocial/perinatal mood and social determinants. Award marks for coherent domain coverage rather than exact wording. [1] [6]

Anticipatory guidance (4). Examples: advance iron-rich complementary foods and textures while continuing breastmilk/formula; avoid unmodified cow’s milk as main drink before 12 months; safe sleep (back, firm flat surface, no soft bedding); injury prevention (small objects, stairs, water, hot drinks); rear-facing car seat within limits; no honey under 12 months. [2] [3] [5]

Conversion triggers (2). Any two: lethargy/mottling/respiratory distress; suspected sepsis; severe dehydration; active seizure; major injury/safeguarding emergency; infant too unwell for vaccines. [1]

SAQ 2 — Iron-risk feeding and quiet infant (10 marks)

An 11-month-old drinks large volumes of cow’s milk from a bottle, takes few solids, and is described as “very quiet”. Growth has crossed from the 50th to the 15th weight centile over three months. The caregiver is not worried. [3] [4]

Questions

1. What is your problem representation in one sentence? (2 marks) [3] [4]
2. Outline your immediate assessment and investigation priorities. (4 marks) [3] [4] [1]
3. Give a stepwise management and safety-net plan. (4 marks) [3] [2] [4]

Model answer

Problem representation (2). Eleven-month-old with faltering weight trajectory, iron-poor feeding pattern (cow’s milk predominant, low solids), and possible developmental/interaction concern requiring structured assessment — not simple reassurance. [3] [4]

Assessment and investigations (4). Full feeding history and observed interaction; plot growth including length/OFC; examine for pallor, cardiac/respiratory work, tone, dysmorphism, bruises; developmental surveillance; psychosocial/food security screen; iron studies/Hb per local pathway; audiology if communication/response concern; avoid non-targeted shotgun panels without hypothesis. [3] [4] [1]

Management and safety-net (4). Stop cow’s milk as main drink if under local age threshold / transition appropriately at or after 12 months with dietetic advice; iron-rich solids and feeding support; treat confirmed iron deficiency per local protocol; early developmental follow-up or referral; safety-net for lethargy/poor intake/breathing difficulty; fixed early review; document shared plan and supports. [3] [2] [4]