6/22 - Nutrition in Special Population Pediatrics

Question 1

What 4 things determine nutrient needs from infancy to adolescence

Answer 1

Rate and stage of growth
 Basal energy expenditure
 Physical activity
 State of health

Question 2

Percent of total calories needed from protein

Answer 2

10 - 15%

Question 3

Discuss iron supplementation and storage for infants

Answer 3

 Adequate iron stores for 4-6 mo in term infants

 By 6 mo, introduction of fortified cereal or meats

Question 4

Discuss fluoride supplementation for infants

Answer 4

 After 6 mo of age

 Powdered and ready-to-feed infant formulas do
not contain fluoride

 Mix formula power with fluoridated water or

 Supplement with 0.25 mg fluoride per day

Question 5

Discuss when B12 will be low in infants

Answer 5

Breast-fed infants whose:
 Vegan mothers who do not take supplements

 Mothers who have had gastric by-pass surgery

Question 6

PBM

Answer 6

Peak Bone mass

 Maximum PBM at skeletal maturity is protective

 PBM is achieved during the late stage of pubertal
development (90% by age 18 yr)

 Low bone mineral density is associated with
fractures later in life

Question 7

Disadvantages of Growth Charts in a Physical Exam

Answer 7

Advantages:

Non-invasive

Repeat over time to obtain serial data

Disadvantages:

Relatively insensitive–cannot detect short term changes

Do not identify specific nutrient deficiencies

Question 8

When do we start using an upright scale for height and weight in the office?

Answer 8

2 years old

Question 9

Common health issues we see in overweight adolescents (4)

Answer 9

1. Growth

 Taller, advanced bone age, mature earlier
 Early maturation is associated with
 Increased fatness and truncal fat distribution in
adulthood

2. Hepatic Steatosis
3. Orthopedic Problems
4. Sleep Apnea
    Occurs in 17% of obese children and teens (Marcus 1996)
    Deficits in learning, memory, and vocabulary (Rhodes 1995)
    Obesity hypoventilation syndrome (rare, potentially fatal
   disorder)
5. Cardiovascular
6. Type 2 Diabetes

Question 10

US Preventive Services Task Force Screening Recommendations

2 of them

Answer 10

1. Screen children aged 6 yr and older for obesity
    Obtain height and weight
    Calculate BMI and plot percentile
2. Offer or refer for intensive counseling and
   behavioral interventions
    Moderate to high intensity
    Include dietary, physical activity, and behavioral
   counseling components