Maternal, Infant, Child, and Adolescent Nutrition
What this domain tests
This domain tests nutrition through pregnancy, lactation, infancy, childhood, and adolescence, with emphasis on growth standards and preventive counseling.
Core rules
- Pregnancy energy needs rise by about 300 kcal/day in the second and third trimesters, not double. Folic acid 400 µg/day should start before conception. Iron needs rise to about 27 mg/day.
- Gestational diabetes screening usually occurs at 24–28 weeks. Medical nutrition therapy focuses on carbohydrate distribution, adequate energy, and glucose monitoring.
- Exclusive breastfeeding is recommended for about six months, with continued breastfeeding to two years or beyond. Complementary foods start at about six months.
- Avoid cow milk as a main drink before 12 months; avoid honey before 12 months because of botulism risk. Vitamin D 400 IU/day is recommended for infants.
- Use WHO growth standards for children under five and WHO growth references for older children. Track weight-for-age, length-for-age, and BMI-for-age.
- Adolescents need calcium and iron for peak bone mass and growth; obesity and eating disorders both require careful assessment.
Worked example
A woman at 28 weeks with BMI 31 has gestational diabetes. Estimate energy at about 25–30 kcal/kg of adjusted prepregnancy weight, distribute carbohydrate across three meals and two snacks, and monitor fasting and postprandial glucose. Do not prescribe severe restriction; ketosis and inadequate weight gain are harms. Review weight gain against Institute of Medicine ranges for obese pregnancy, about 5–9 kg.
Traps
Telling a pregnant woman she is eating for two; starting solids before four months; giving cow milk before 12 months; using honey for infant cough; recommending a low-calorie diet in pregnancy without supervision; interpreting a single growth point without the trend.