A nurse in a clinic is teaching the mother of a 4-month-old infant who has been breastfed. The mother plans to switch her infant to an iron-fortified formula. Which of the following should be included in the teaching?

Choice A Reason:
Peanut butter should be eliminated from the diet of a pregnant client with PKU. It is a high-protein food that contains phenylalanine, an amino acid that individuals with PKU cannot metabolize properly¹. The accumulation of phenylalanine can lead to serious health issues for both the mother and the developing fetus, including the risk of intellectual disability in the child.

Choice B Reason:
Potatoes are generally safe for individuals with PKU to consume. They are not high in protein and thus do not contain large amounts of phenylalanine. However, portion sizes and overall dietary balance should be monitored by a healthcare professional to ensure proper nutrition.

Choice C Reason:
Apple juice is also safe for individuals with PKU. It does not contain protein and therefore is not a significant source of phenylalanine. It can be included in the diet as part of the fluid intake.

Choice D Reason:
Broccoli is a low-protein vegetable and is typically allowed in the diets of individuals with PKU. It contains some phenylalanine, but in much lower amounts compared to high-protein foods. As with all foods, it should be consumed in moderation according to dietary guidelines provided by a healthcare professional.

Choice A reason:
While burping can be a sign that a baby is feeding, it is not a reliable indicator of whether the baby is getting enough breast milk. Burping is a way to release air that babies swallow during feeding, which can help prevent discomfort and gas. However, it does not correlate directly with the amount of milk intake.

Choice B reason:
The number of wet diapers is a direct indicator of a baby's hydration status and, by extension, how much breast milk they are receiving. A newborn who is getting enough milk will typically have 6 to 8 wet diapers per day after the first few days of life. This shows that the baby is well-hydrated and is receiving sufficient milk.

Choice C reason:
Sleep patterns in newborns can vary widely, and sleeping for at least 6 hours between feedings is not typical for a 2-day-old baby. Newborns usually need to feed every 2 to 3 hours, and long stretches of sleep without feeding may indicate that the baby is not getting enough milk and does not have the energy to wake and feed.

Choice D reason:
A wake cycle of 30 to 60 minutes after feeding can be normal for some babies, but it is not a measure of whether they are getting enough milk. The wake cycle can be influenced by many factors, including the baby's overall health, comfort, and environment.