Poor feeding in infants and children — formative SAQs

SAQ 1 — Neonate with acute poor feeding (10 marks)

A 6-day-old term infant has reduced breastfeeding for 18 hours, fewer wet nappies and increasing sleepiness. Temperature is 36.2°C. [26] [25]

Questions

1. List your immediate bedside priorities and why each matters. (4 marks) [26] [25] [5]
2. Give a one-sentence problem representation and your top three differentials. (3 marks) [5] [26]
3. What would make you admit rather than attempt community observation? (3 marks) [26] [5]

Model answer

Immediate priorities (4). ABCDE first. Check capillary glucose early because low intake risks hypoglycaemia and altered consciousness. Assess perfusion, work of breathing and temperature. Treat on a neonatal sepsis pathway when infection is plausible — poor feeding is a classic non-specific early sign. Do not delay stabilisation for a long diet history or tongue-tie clinic. Support feeding only after safety is addressed. [26] [25] [5]

Problem representation and differentials (3). Example: “Day-6 term neonate with 18 hours of reduced feeds, oliguria and lethargy, cool temperature, threat-led differential of evolving sepsis, hypoglycaemia secondary to low intake, and less likely evolving cardiorespiratory disease.” Top three: neonatal sepsis; hypoglycaemia/inadequate intake with dehydration; congenital heart or other cardiorespiratory disease if examination supports it. [26] [25] [19]

Admission triggers (3). Ongoing lethargy, abnormal glucose, suspected sepsis, dehydration, unreliable follow-up, inability of caregivers to maintain safe intake and observation, or any cardiorespiratory compromise. Early weight check alone is not enough if current physiology is unsafe. [26] [5]

SAQ 2 — Chronic feeding difficulty with selectivity (10 marks)

A 3-year-old with autism eats three foods, gags on new textures and has crossed two weight centiles downward over 6 months. No body-image concerns. [1] [14]

Questions

1. Map the problem onto PFD domains and state how ARFID may overlap. (4 marks) [1] [14]
2. Outline a stepwise management plan including when a tube might be considered. (4 marks) [1] [35] [2]
3. List three discharge or review safety-nets for the family. (2 marks) [1]

Model answer

PFD and ARFID (4). Name active domains: medical (rule out organic dysphagia/pain), nutritional (energy/micronutrient deficit and growth faltering), feeding skill (texture progression, oral-motor/sensory limits), psychosocial (mealtime conflict, caregiver stress, autism-related sensory patterns). ARFID-pattern restriction can coexist without weight/shape goals; consensus work exists to reduce misclassification. Do not dismiss as ordinary picky eating when growth is falling. [1] [14]

Stepwise plan (4). Confirm safety of swallow and exclude urgent medical drivers. Dietetics for nutritional rehabilitation and fortification goals. Feeding therapy for graded texture exposure without force-feeding. Behavioural/mental-health support for fear or sensory aversion. Multidisciplinary clinic. Consider temporary tube support only if energy debt or safety cannot be met orally, with explicit goals, monitoring and exit/reassessment plan. [1] [2] [35]

Safety-nets (2). Concrete red flags (dehydration, lethargy, choking/cyanosis, rapid further weight loss), early booked weight/growth review, and clear contact path if intake collapses or chest symptoms escalate. [1]