Infant health supervision birth to 3 months — formative SAQs

SAQ 1 — Day-5 weight and jaundice (10 marks)

A 5-day-old exclusively breastfed term infant presents for the first post-discharge check. Birth weight 3600 g; today 3180 g. Mild jaundice to the trunk. Four wet nappies in 24 hours. Mother reports painful latch. [1]

Questions

1. Interpret the weight change and list bedside features that decide outpatient versus higher-care disposition. (3)
2. Outline your immediate feeding and lactation plan, including reweigh timing. (3)
3. State how you would assess jaundice risk and the key principle of modern bilirubin decision-making for ≥35-week infants. (2)
4. List two red flags that would make you abandon the well-child pathway for a sepsis pathway. (2) [1]

Model answer (marking points)

1. Weight / disposition (3)

• ~11.7% loss from birth — significant early loss requiring structured plan, not generic reassurance.
• Integrate with wet nappies (only 4), alertness, suck quality, vital signs, capillary refill.
• Higher care if lethargy, poor perfusion, very low output, hypoglycaemia risk, or inability to feed safely. [1]

2. Feeding plan (3)

• Observe feed; correct position/latch; analgesia/support for maternal pain.
• Increase effective milk transfer (frequent feeds ± expressed milk); define temporary supplementation criteria if transfer remains poor.
• Early reweigh (often 24–48 h) with clear safety-net. [1]

3. Jaundice (2)

• Measure bilirubin (TcB ± confirmatory TSB as indicated); do not rely on visual estimate alone.
• Plot against age in hours and apply local implementation of AAP 2022-aligned thresholds for phototherapy/escalation. [1]

4. Sepsis red flags (2)

• Lethargy/hypothermia/fever/mottling/poor perfusion; or marked feed refusal with unwell appearance — ABCDE, glucose, sepsis pathway. [1]

SAQ 2 — Two-month visit package (10 marks)

You are running a 2-month health supervision visit for a thriving term infant. Parents bed-share on a soft mattress. Mother screens positive for depressive symptoms without suicidal ideation. Vaccines are due per the national schedule. [1]

Questions

1. List the core components of a complete 2-month health supervision visit. (3)
2. Give four concrete safe-sleep recommendations you will teach with teach-back. (3)
3. Describe your response to the positive maternal depression screen. (2)
4. State your approach to immunisation today if the infant has only mild nasal congestion without fever. (2) [1]

Model answer

1. Visit components (3)
Growth plotting; full undressed exam (including red reflex, hips, femorals); developmental surveillance; screening loop-closure; immunisation; anticipatory guidance (sleep, crying, car seat); maternal wellbeing; safety-net and next visit. [1]

2. Safe sleep (3)
Supine every sleep; firm flat surface; no soft bedding/pillows; room-share without bed-share; smoke-free (any four with clear wording). [1]

3. Maternal mood (2)
Acknowledge and validate; assess severity/safety; arrange warm handover to GP/perinatal mental health; plan follow-up — not leaflet-only. [1]

4. Vaccines (2)
Mild afebrile URTI symptoms are not usually a true contraindication; counsel and immunise on schedule unless a genuine contraindication exists; document consent and after-care. [1]