23. Nutrition, growth Flashcards
how much weight do infants gain 0-3 mths?
150-200g/week
how much weight gained 3-6 mths?
100-150g/weeek
6-12mths weight gain?
70-90g/wk
how many mLs formula is normal in first 4-6mths?
120-160mL per kg per day
When should solids start?
4-6 mths
chewing relfex is about 7-9mths
What is FTT defined as?
Being <3% for weight or dropping two or more percentile tracks (dependent on parental genetics). It implies failure to gain weight, with height and head circumference being initially well preserved
What is going on if head circumference is normal but body is small
chronically starved - all nutrition to brain
Does birth weight percentile predict future weight?
No, in the first 6-12 months of life, deceleration of growth may be normal, til infants equilibrate to their ‘true’ growth channels
what else to take into account regarding FTT?
look at the child - muscle bulk, subcut fat, activity and dev
6 prenatal causes of FTT
- prematurity with complications
- maternal malnutrition
- toxic exposure in utero
- alcohol, smoking, meds, infections
- IUGR
- chromosomal
3 broad categories of FTT causes
- poor absorption
- inadequate intake
- increased metabolic demand
renal causes of FTT
- UTI
- renal tubular acidosis
- chronic renal insuff
Cardioresp causes of FTT
- chronic upper airway obstruction
- congen heart disease
- cardiomyop
- CF
GIT causes of FTT
cleft lip/palate, GO reflux, pyloric stenosis, coeliac disease, pancreatic insufficiency, IBD, Hirschsprung’s
Metabolic causes of FTT
galactosemia, PKU, amino and organic acidopathies, hypercalcemia
Non organic FTT causes?
poverty feeding disorders/anorexia dysfx family child neglect lack parental support
Case 1
- irritable, crying baby
- non dysmorphic
- dry skin, red in patches on face and body
- vitals HR 160, RR 60, afebrile
- normal CV, Resp, abdo, neuro
- Birth weight 3.3 kg
- current weight at 5wks 3.35 kg
Possible causes?
Invx?
inadequate intake
malabsorption
increased requirements
invx
- FBE
- UE
- LFT
- urine
- ESR
- stool
Management of cow’s milk protein allergy colitis?
- admit to hosp
- stop cow’s milk formula
- satrt amino acid formula (neocate)
- close follow up
- expect catch up growth
History of FTT
- intake - when solids added, what is consumed
- output: colour/amount vomit and stool
- ask when first stool/mec was passed (hirschsprung’s)
- birth - weight, gestation, complications
- past hx - chronic illness, recurrent infections
- fam hx - maternal depression, consanguinity
- development
Examination in FTT
- inspect interaction of parents and child
- wasted appearance - esp gluts and thighs
- hair sparsity
- abdo protuberance (coeliac, pyloric mass, other masses)
- painful walk (scurvy)
- ricketic features - bow legs, wide fontanelle, no of teeth
- inspect muscle bulk
- subcut fat deposits
- ankle/sacral oedema
- head and neck - anaemia, cyanosis, glossitis
- papilloedema
- chest : hyperinflation, cardiac signs
- anus - excoriated - IBD
BMI chart cut offs for overwieight and obese
85th%- overweight
95%- obese
early protein hypothesis (formula)
formula -more protein than breastmilk
> increased circulating amino acids
> increased insulin secretion and IGF1
> weight gain
