23. Nutrition, growth

Question 1

how much weight do infants gain 0-3 mths?

Answer 1

150-200g/week

Question 2

how much weight gained 3-6 mths?

Answer 2

100-150g/weeek

Question 3

6-12mths weight gain?

Answer 3

70-90g/wk

Question 4

how many mLs formula is normal in first 4-6mths?

Answer 4

120-160mL per kg per day

Question 5

When should solids start?

Answer 5

4-6 mths

chewing relfex is about 7-9mths

Question 6

What is FTT defined as?

Answer 6

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

Question 7

What is going on if head circumference is normal but body is small

Answer 7

chronically starved - all nutrition to brain

Question 8

Does birth weight percentile predict future weight?

Answer 8

No, in the first 6-12 months of life, deceleration of growth may be normal, til infants equilibrate to their ‘true’ growth channels

Question 9

what else to take into account regarding FTT?

Answer 9

look at the child - muscle bulk, subcut fat, activity and dev

Question 10

6 prenatal causes of FTT

Answer 10

• prematurity with complications
• maternal malnutrition
• toxic exposure in utero
• alcohol, smoking, meds, infections
• IUGR
• chromosomal

Question 11

3 broad categories of FTT causes

Answer 11

• poor absorption
• inadequate intake
• increased metabolic demand

Question 12

renal causes of FTT

Answer 12

• UTI
• renal tubular acidosis
• chronic renal insuff

Question 13

Cardioresp causes of FTT

Answer 13

• chronic upper airway obstruction
• congen heart disease
• cardiomyop
• CF

Question 14

GIT causes of FTT

Answer 14

cleft lip/palate, GO reflux, pyloric stenosis, coeliac disease, pancreatic insufficiency, IBD, Hirschsprung’s

Question 15

Metabolic causes of FTT

Answer 15

galactosemia, PKU, amino and organic acidopathies, hypercalcemia

Question 16

Non organic FTT causes?

Answer 16

poverty
feeding disorders/anorexia
dysfx family
child neglect
lack parental support

Question 17

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?

Answer 17

inadequate intake
malabsorption
increased requirements

invx

• FBE
• UE
• LFT
• urine
• ESR
• stool

Question 18

Management of cow’s milk protein allergy colitis?

Answer 18

• admit to hosp
• stop cow’s milk formula
• satrt amino acid formula (neocate)
• close follow up
• expect catch up growth

Question 19

History of FTT

Answer 19

• 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

Question 20

Examination in FTT

Answer 20

• 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

Question 21

BMI chart cut offs for overwieight and obese

Answer 21

85th%- overweight

95%- obese

Question 22

early protein hypothesis (formula)

Answer 22

formula -more protein than breastmilk
> increased circulating amino acids
> increased insulin secretion and IGF1
> weight gain