6.1 Infancy and Childhood

Question 1

• do milk feeds stay the same from 4-6 months, 6-8 months, 9-12 months?

Answer 1

• 4-6 months: breast feeding can continue + remain same
• 6-8 months: milk feeds decreases from 15-mL/kg to 600-800 mL/day
• 9-12 months: 600-800 mL/day

Question 2

• what foods should be added around 6-8 months of age in BLW? (5 ish) vs 9-12 months? (5 ish)

Answer 2

FOODS TO ADD at 6-8 months:
- iron fortified cereals for infants, cooked strained porridge (can add at 4-6 months too)
- meats (GOOD SOURCE OF IRON! bc high bioavailability), beans, eggs –> well cooked, strained, pureed
- fruits (fresh or frozen, no added sugar or salt for natural flavor), add strained
- vegetables: COOK! (to avoid bacteria) + add strained, prepare hygienically with no added sugar, salt, fat and oil
- finger foods (biscuits, toasts)
FOODS TO ADD at 9-12 months:
- gradually eliminated strained food and introduce chopped/well cooked f&v, table meats
- add different textures of cereal with fruit pieces, cereal bits
- juice or formula by cup (after 1 year)
- increase small finger foods as pincer grasp develops
- well cooked mashed or chopped table foods

Question 3

why start adding juice after 1 year of age? is juice encouraged for infants?

Answer 3

• bc has an oversatiety effect! + can cause dental caries
• not encouraged bc don’t want infant to eat less nutrient dense foods

Question 4

drinking from a cup
- introduce cup at what age?
- by when can infants typically control cup and movement of tongue?

Answer 4

• 6 months of age
• by 10-12 months
  *continue bottle/breastfeeding while introducing new foods for at least 1 year

Question 5

when is the transition to solid foods complete for an infant?

Answer 5

when food and liquids the infant takes in daily are equal in calories to amount provided by bottle feeds or breastmilk

Question 6

• infants are more accepting of new foods between __-__ months vs when introduced after ___ months
• preferences are largely _______

Answer 6

• 4-7 months vs when introduced after 12 months
• largely learned!
  *should be sensitive to infant’s needs –> refusal to eat may be need for attention or complain against discomfort

Question 7

how can breastfed infants be more accepting of now foods?

Answer 7

flavor of breasmilk changes depending on what the mother eats = allows greater taste exposure to infant = can help accepting new foods! + more variety!
*ie eating lots of spicy food might make the breastmilk more spicy = infant will eat less

Question 8

infant feeding skills development
- 10 weeks:
- 3-6 months
- 4 months:
- 6-8 months:
- 9 months
- 1-3 years

Answer 8

• 10 weeks: no extrusion reflex (child no longer spits out food)
• 3-6 months: palmar grasp
• 4 months: can move head forward and turn away
• 6-8 months: critical period of development in relation to eating –> need stimulus of food to learn: rotary chewing: pairs of opposing teeth
  *delayed stimulus will give psychomotor dev issues (ie microcephaly)
• 9 months: hold onto bottle by themselves
• 1-3 years: child still developing orally and muscularly –> increases ability to eat
  *learning process from playing with food is good! not necessarily spoon feeding is needed

Question 9

what is needed for oral maturation?
- earlier exposure will lead to what?

Answer 9

• exposure to new textures and flavors!
• earlier exposure = less picky eating later

Question 10

what developmental landmarks indicate this change? + give examples of appropriate foods
- introduction of soft mashed table food (3)
- finger feeding (large pieces of food) (2)
- finger feeding (small pieces of food) (1)

Answer 10

INTRODUCTION OF SOFT MASHED TABLE FOOD:
- tongue laterally transfers food in mouth + sitting posture + beg. chewing movements (up and down with jaw)
- tuna fish, mashed potatoes, mashed veg, ground meats in gravy, soft diced fruits, yogurt
FINGER FEEDING (LARGE PIECES OF FOOD)
- reaches for and grasps objects with scissor grasp + brings hand to mouth
- oven dried toast, teething biscuits, cheese sticks
FINGER FEEDING (SMALL PIECES OF FOOD)
- voluntary release (refined digital grasp)
- bigs of cottage cheese, dry cereal, peas, small pieces of meat

Question 11

what developmental landmarks indicate this change? + give examples of appropriate foods

• introduction of more texture food from family menu (1)
• introduction of cup + beginning self-feeding (2)
• more skilled at cup and spoon feeding (2)
• may seek and get food independantly (2)

Answer 11

INTRODUCTION OF MORE TEXTURE FOOD FROM FAMILY MENU
- rotary chewing pattern
- well cooked chopped meats, cooked veg, toast, pasta
INTRODUCTION OF CUP + BEGINNING SELF-FEEDING
- approximates lips to rim of cup + understand container vs contained
*messiness should be expected!
- applesauce, cooked cereal, mashed potatoes
MORE SKILLED AT CUP AND SPOON FEEDING
- rotary movement of the jaw + ulnar deviation of wrist develops!
- chopped fibrous meats (roast and steak) + raw veg and fruit (introduce gradually)
MAY SEEK AND GET FOOD INDEPENDENTLY:
- walks alone + names food, expresses preferences, prefers unmixed foods
- food of high nutrient value should be available + balanced food intake should be offered

Question 12

infant feeding issues:
- cow’s milk: start after ____ months –> why? (2)
- before 4-5 months: avoid (5) bc contain ________ –> methemoglobinemia
- allergies: wait __ days after introduction of new food –> 75% of allergies are (3)
- allergies usually happen at first encounter of food?

Answer 12

• cow’s milk: after 12 months: allergies + low Fe content (high risk of iron def)
• before 4-5 months, avoid spinach, collards, carrots, beets and turnip –> contain nitrites –> methemoglobinemia (different binding capacity to O2)
• allergies: wait 3 days –> cow’s milk, egg whites, peanuts
  *studies show that can introduce peanuts/PB in minute dosing to decrease peanut allergy
• no! usually 2nd time food is eaten bc body developed antibodies to it

Question 13

Why should we limit fruit juices to infants? (5)
- req?

Answer 13

• orange juice can cause allergies
• apples & pear juice have too much sorbitol (gets fermented –> gas from bacteria can cause pain) –> can cause diarrhea if too great quantity
• increases risk of early childhood tooth decay (especially grape juice) –> never in a bottle!
• risk of it replacing milk and nutritious foods if given in too great quantity
• can spoil child’s appetite (oversatiety) if served within an hour of mealtime
  REQ: > 1 year old, 125-175 mL/d –> pasteurized, no added sugar

Question 14

when can infants develop diarrhea if drinking too much fruit juice?

Answer 14

• infants = limited capacity to absorb sorbitol
• reduced alcohol derivative of glucose (in some fruit juices)
• proceeds unchanged to the colon –> osmotic effect –> fluid enters colon –> diarrhea
  *sorbitol malabsorption

Question 15

what is associated with CHO malabsorption from fruit juices containing sorbitol and high fructose:glucose ratio?

Answer 15

infant colic!
- malabsorbed CHO –> excess hydrogen gas (from fermentation) –> increase breath H2 excretion levels + pain

Question 16

define infant colic (3)
- cause?
- associated with what?
- common practices/treatments?

Answer 16

• rule of 3 –> crying more than 3h per day, more than 3 days per week, for more than 3 weeks when well fed and otherwise healthy
• no specific determinable cause
• associated with CHO malabsorption (sorbitol) from fuit juices –> distention of bowel and pain from fermentation of sorbitols
• use probiotic lactobacillus rhamnosus GG (help with pain), rocking, swaddling, bathing and burping

Question 17

infant feeding issues:
- avoid (4)
- limit consumption of (4)

Answer 17

AVOID:
- deli meats (nitrates) (can promote methemoglobinemia)
- smoked or raw fish (parasites)
- larger game fish (polluants like PCBs and mercury)
- soft tofu (increase water, low protein and Fe content)
LIMIT:
- salt
- all forms of sugar (sucrose, glucose, fructose…)
- sugar substitutes (aspartame, sucralose)
- fats and oils containing harmful fats (shortening, hydrogenated oils…)

Question 18

• what happens if infant drinks cow’s milk < 12 mo? (2)
• reqs for cow’s milk > 12 month age
• do not serve skimmed, 1% or 2% before what age?

Answer 18

• especially if unheated –> intestinal bleeding –> completely unsuitable
  + risk of anemia if have cow’s milk instead of breast milk < 12 month
• pasteurized whole milk (3.25% milk fat) –> max 750 mL /day (bc can displace other nutrient rich foods) –> introduce gradually, with iron rich foods, fruits and veg every day + fresh and milk hard cheese, yogurt kefir (source of calcium)
• before age 2

Question 19

by what year of life are infants required to develop sense of taste and acceptance/enjoyment of food + attitudes and practices which form basis for lifelong health-promoting eating patterns?
- leads to less what?

Answer 19

by 2nd year of life!
- good food intake = good growth
- leads to less picky eaters

Question 20

• what happens to dietary intake between 2 and 5 years old (3)?
• nutrition is likely sufficient if what?
• 3 important aspects of this stage of development

Answer 20

1. decreased nutrition needs and appetite
2. slowed growth
3. high activity level and relatively small stomach capacity –> amplifies importance of foods with high nutrient density
   - if child is growing normally in absence of GI issues –> let the child self-select their food!
4. learning about, trying and accepting new foods
5. mastering motor skills needed to feed themsleves
6. establishing healthy food preferences and eating habits

Question 21

food jag vs food aversion vs neophobia
- if kid dislikes nutritious food, what do you do?

Answer 21

FOOD JAG: child consumes same food, prepared the same way, on a consistent basis
FOOD AVERSION: strong dislike resulting in refusal to eat certain foods –> widespread –> picky eaters
NEOPHOBIA: reluctance to eat or avoidance of new foods
*all 3 associated with lower nutritional status
- best to continue to offer new or disliked nutritious foods along with other accepted nutritious foods

Question 22

how to prevent constipation in infants? (3)

Answer 22

*constipation is one of main reasons for pediatric visits
1. ensure adequate fluid intake
2. provide foods high in fiber
3. avoid fatty foods and foods low in fiber

Question 23

• can young children self-regulate their food intake?
• what happens to appetite and satiety btw ages 3 and 5? (3)
• what can influence food intake?
• important for parents and caregivers to do what?

Answer 23

• yes! as long as no medical condition and grow properly
  1. less responsive to internal cues
  2. more responsive to external cues (ie caregivers)
  3. may eat in absence of hunger (and overeat)
• child’s personality can influence!
• to help children recognize their hunger and fullness

Question 24

infant dietary intake affected by _______ influence! explain
- food choices influenced by (5 ish)
- should parents restrict unhealthy foods and pressure healthy food?

Answer 24

• parental influence! parental feeding practices linked to eating and weight status of children. children likely to adopt eating habits of parents or caregivers –> modeling!
  1. beliefs, values, norms and knowledge
  2. cost, quality, availability of various foods
  3. time (to prep healthy foods)
  4. social connections (eating in family context)
  5. information sources (food fads…)
• NO! can have opposite effects! + serving large portions may result in increased intake

Question 25

how to divide responsibility of feeding/eating btw parent and children?

Answer 25

PARENTS:
- determine what food is offered, when and where
- provides regular meals and snacks
- makes mealtime an enjoyable experience
- avoids catering to child’s likes and dislikes
- prohibits eating btw meals and snacks
CHILD:
- determines how much to eat
*division of responsibility emphasizes decreasing parental pressure to eat –> children is able to self-select and determine how much to eat

Question 26

8 tips of what parent can do so that infant can have good relationship with food

Answer 26

• Offer balanced food choices; allow child to have food preferences
• Serve food in causal, relaxed manner
• Respect infant’s caution regarding eating. –> no super fancy meals
• Stop when infant indicates he or she is full (no coercion –> frustration, power struggle)
• Avoid distractions
• Serve small portions to keep your child from getting discouraged
• Wait until child has finished the main course before serving dessert to other family members
• Serve nutritious desserts

Question 27

who apart from parents can affect infant’s dietary intake?
- mostly at what age?
- however, not as strong as during what period of life?

Answer 27

• peer influence! can impact opinions about food
• age 3 to 7 –> more likely to eat novel food if they see a peer positively modeling consumption –> stronger acceptance if peer if older + repeat exposures
• not as strong as during adolescence –> social network still forming, peer acceptance not as strong a motivator

Question 28

food neophobia
- what
- common for who?
- can lead to what?

Answer 28

FOOD NEOPHOBIA: reluctance to try new foods or avoidance of certain foods and food groups
- common for preadolescent children to continue to demonstrate food neophobia
- can lead to developmental issues, increase infection risk, increase behavioral problems (shyness, difficulty learning…)

Question 29

picky eating
- define
- describe typical habits

Answer 29

PICKY EATING: no formal definition and not a diagnosis
- can continue to be a problem for many years, with 47% having duration longer than 2 years –> develops btw ages of 2 and 6 yo
typical habits ish:

• refuses specific foods or food groups, especially f&v
• unwilling to try new foods
• accepts limited types of food (usually less than 10)
• limits quantity of food eaten and/or eats only preferred foods
• prefers drinks over food
• mealtime exceeds 20 min
• eats food camouflaged in others/liquids
• use distractions to limit food intake

Question 30

food allergy vs food intolerance vs food sensitivity
- shared symptoms? (4)

Answer 30

FOOD ALLERGY:
- adverse reaction to a food or ingredient in food that involves body’s immune system
- shares some symptoms with food intolerances and sensitivities: nausea, stomach pain, diarrhea, vomiting
FOOD INTOLERANCE:
- abnormal physical response to food or additive
- ie lactose and gluten intolerances
FOOD SENSITIVITY:
- difficulty digesting a particular food
- onset of symptoms slower and may last longer

Question 31

gagging vs choking?

Answer 31

GAGGING:
- normal and to be expected! –> normal reflex to prevent choking
- help babies learn how to eat
CHOKING:
- rare and not to be expected
- first aid!

Question 32

when should a baby start solids?
+ 4 signs ish

Answer 32

• able to control head and neck
• sits up alone or with support
• brings objects to mouth
• try to grasp small objects like toys
• around 6 months old

Question 33

• common food allergies (8)
• how to diagnose? (3)
• nutrition management (2)

Answer 33

• cow’s milk, egg, peanut, tree nut, soy, wheat, fish, shellfish
  *cow’s milk allergy typically occurs in 1st year of life –> usually goes away with time
• skin prick test, radioallergosorbent test (RAST) blood test, oral food challenge with trial elimination diet
• remove offending food + provide detailed education material
  *depending on severity (if very severe anaphylactic shock) –> give minute doses of allergen to try to decrease risk of allergy

Question 34

how to avoid chocking at < 3 years of age?

Answer 34

• avoid whole nuts, popcorn, grapes, large berries, peanut butter, marshmallow, ice cubes, hot dogs in chunks –> foods that are hard, small round smooth and sticky solid foods
• supervision during feeding
• no running/playing while eating
• remove bones from meat and fish
• remove cores and pits from fruit
• cut grapes into quarters
• grate raw hard vegetables and fruits like carrots, turnips and apples

Question 35

why avoid honey for infants? Can cause (4)

Answer 35

bc honey or corn syrup can contain botulinum spores –> spores resistant to pasteurization, can germinate in GI tract –> produce toxin
- can cause weakness, respiratory distress and constipation, death

Question 36

describe baby led weaning
- size of pieces?
- when?
- who feeds the baby?
- key concepts (2)

Answer 36

• large pieces! (big enough for them to hold in their hands)
• around 6 months old
• parent provides, baby decides + TRUST the baby knows how much they should eat

Question 37

• most common single-nutrient deficiency among children in developing world? –> common cause for what?
• prevalence?

Answer 37

• iron deficiency! common cause for iron deficiency anemia
• prevalence: 6.6% to 15.2% in toddlers (1-3 years of age) in developed country –> depending on ethnicity and socioeconomic status
• increases to approx 40% in toddlers lacking dietary fortification or enrichment of iron in cereals, noodles and other foods + if difficulty chewing meats
  *found in lower income groups who don’t breastfeed and don’t have enough money to buy iron fortified formula

Question 38

symptoms of iron deficiency anemia? (12 ish)
- greatest risk in children < ___ yo
- associated with excessive what intake? + with excessive exposure to _______

Answer 38

• lack of energy, poor appetite, irritability, difficulty concentrating, slow weight gain, recurrent infections, pallor, dizziness, lightheadedness, headaches, cold hands/feet, rapid/irregular heartbeat
• < 5 years old
• excessive cow’s milk intake (max 2-3 cups/d –> displaces Fe rich foods) + excessive exposure to lead

Question 39

describe the many steps that lead to eating for a baby

Answer 39

• looking, playing, smelling, licking, spitting out, swallowing…

Question 40

Lead exposure:
- why are kids vulnerable (3)
- effects of exposure (5 ish)

Answer 40

• environmental sources (factory pollution, water, air, old paint, soil, dust, food cans… –> infants play on the ground a lot and put stuff in their mouth) + young children absorb 4-5 times as much ingested lead as adults + undernourished children are more susceptible
• impacts brain (cognitive performance) and nervous system + effects believed to be irreversible + distributes to organs and stored in teeth and bones + impaired psychomotor development + renal tubular function

Question 41

what is the relationship between lead exposure and iron?
- what 2 deficiencies increase absorption of which other 2 metals?
- what 2 thing increases risk of lead toxicity?

Answer 41

• lead is taken up by iron absorption machinery –> DMT1 = common Fe-Pb transporter in gut
• lead blocks Fe through competitive inhibition –> interferes with important Fe-dependant metabolism (ie heme biosynthesis)
• iron and calcium deficiency –> increases absorption of other elements like lead and cadmium
  1. iron deficiency = increase activity of DMT1
  2. lead exposure –> more lead absorbed bc of increased DMT1 activity = increase risk of lead toxicity

Question 42

what are the official guidelines for baby led weaning:
- health canada (2014)
- VS WHO (Oct 2023)

Answer 42

HEALTH CANADA:
- provide variety of soft textures and finger foods from 6 months of age
- safe finger foods include: pieces of soft-cooked vegetables/fruits, ripe fruit like banana, finely minced, ground or mashed cooked meat/deboned fish/poultry, grated cheese, bread crusts or toasts
WHO:
- infants should be introduced to complementary foods at 6 months, while continuing to breastfeed
- animal source foods, f & veg, and nuts, pulses and seeds should be key components of energy intake bc of overall higher nutrient density (high bioavailability of zinc and iron) compared to cereal grains

Question 43

true or false:
1) babies should start weaning at 4-6 months
2) babies don’t need teeth to start eating solid foods
3) foods need to be offered when baby is hungry
4) foods must be introduced 1 at a time, with 3 days in between
5) breastmilk intake should stay the same when baby starts solids
6) portion sizes depend on age of baby

Answer 43

1) FALSE: at 6 months
2) TRUE: use gums and tongue
3) FALSE
4) FALSE
5) TRUE! solids are not for energy intake, but to discover and explore solids
6) FALSE –> responsive feeding, trust baby to know how much to eat

Question 44

explain division of responsibility in baby led weaning

Answer 44

parents provide and baby decides!
PARENTS:
- provide food
- decide when (set meal and snack times)
- decide where (at kitchen table)
BABY:
- decides if (can be not interested, hungry, distracted…)
- decides how much!

Question 45

what foods should I introduce first? (4 characteristics)
+ examples

Answer 45

• soft that can be easily held –> not too small though (ie little peas) and not hard (choking hazard)
• nutrient dense
• high iron! (req is higher than for adult males –> baby should have a more animal based diet vs plant)
• variety!
  EXAMPLES
• cucumber, mango, strawberries, orange, watermelon, peach
• cottage cheese, fresh cheese
• high IRON: salmon, meatball, chicken drumstick (handheld!), slow cooker meat, red meat, fish, eggs
• waffles, pancakes, pasta
• hummus, mashed beans
• kale omelet

Question 46

what foods should parents avoid offering? (9)

Answer 46

• added sugars
• higher in sodium
• non pasteurized foods like soft cheeses
• honey (until age 1)
• fish high in mercury
• cow’s milk in replacement of breast milk
• juice
• caffeinated drinkgs
• choking hazards

Question 47

BLW:
- are allergies rare? stat
- what to do if an allergic reaction develops? (2)
- signs of allergic rxn usually develop within how long? upon ________ exposure
- allergy signs (8)

Answer 47

• quite rare! 90% of food allergies are caused by top 9 allergens
• contact doctor –> if baby has difficulty breathing, call 911
• 15 minutes after ingestion! upon repeated exposure (usually 2nd time)
• red dots around mouth, rash, upset stomach, diarrhea, vomiting, respiratory problems, swelling around lips/eyes/tongue/throat, asphyxia

Question 48

• does following BLW affect incidence of allergies and autoimmune conditions in children?
• when should you feed allergens to babies? even if at high risk?
• how to introduce allergens?

Answer 48

• no bc same foods are offered
• introduce allergens to all babies at around 6 months of age! and OFTEN! (a few times a week) even high risk babies with severe eczema that doesn’t respond to treatment, confirmed egg allergy or first-degree relative with food allergy or atopy)
• no particular order or method

Question 49

what are the 9 top allergens and how to introduce them?

Answer 49

1. egg –> omelet, hard boiled, scrambled
2. peanut: thinly spread peanut butter on toast or fruit, ground peanuts or peanut powder mixed into oatmeal
3. cow’s milk: cottage cheese, yogurt, cream cheese spread onto toast, mozzarella cheese, grated cheese
4. soy: stir fried tofu sticks, mashed edamame beans
5. wheat: toast cut into quarters with butter, large pasta (tortellini, lasagna or rotini noodles)
6. fish: grilled salmon, filled trout, fish cakes
7. shellfish: crab cakes, crab, scallops or shrimp, cut up and cooked into a dish
8. tree nuts: thinly spread nut butter on toast or fruit, ground nuts or nut powder or nut flour mixed into a recipe
9. sesame: sesame spread (tahini), sesame oil

Question 50

what are the 4 important concepts that we should remember when BLW?

Answer 50

1. trusting baby
2. responsive feeding!
3. division of responsibility
4. cultural background of family

Question 51

what is the AMDR for:
- children 1-3 yo
- children 4-18 yo
- adults
*for fat, n6, n3, protein and CHO

Answer 51

CHILDREN 1-3:
- fat: 40-30% (smaller stomach capacity, need more energy dense foods)
- n6: 5-10%
- n3: 0.6-1.2%
- protein: 5-20% (lower bc of increased fat)
- CHO: 45-65%
CHILDREN 4-18 = same as adults
- fat: 20-35%
- n6: 5-10%
- n3: 0.6-1.2%
- protein: 10-35%
- CHO: 45-65%

Question 52

what percentage of fat as Energy will children 1-3 yo fail to grow properly?

Answer 52

20-25%! = growth stunting!
- need 30-40% for growth!

Question 53

DIETARY FAT AND CHILDREN
1. preschool and childhood years –> eliminated nutritious food choices bc of fat content?
2. early adolescence: emphasize energy intake adequate to sustain ______ with gradual increase/decrease of fat intake
3. once linear growth has stopped: fat rec?

Answer 53

1. nutritious food choices should NOT be eliminated or restricted bc of fat content
2. to sustain growth with gradual lowering of fat intake
3. fat intake as currently recommended is appropriate

Question 54

• what is 1 physiological aspects that makes children have a higher fat intake than adults? why?
• why do low-fat diets cause growth stunting? (3)

Answer 54

• children oxidize more fat than adults in relation to total energy expenditure (higher capacity to oxidize fat) –> supports dietary recommendation for higher total fat intake for children to support growth
  1. low fat = low cal
  2. low fat = excessive fiber intake = decrease animal intake = less protein
  3. less animal protein = less foods that are essential mineral bioavailable –> leads to micronutrient deficiencies: calcium, zinc, iron, vit A, riboflavin

Question 55

what is a good biomarker of zinc status?
- if is possible to have zinc deficiency if eating enough zinc in diet?

Answer 55

• tyrosine!
• yes! if zinc is not from bioavailable foods! ish

Question 56

dairy product intake during childhood
- associated with what?
- inversely related to risk of (3)
- explain the safety mechanism by milk fat consumption
- what does decrease in milk in past 3 decades lead to?

Answer 56

• associated with higher bone mass content
• risk of blood pressure, dental caries, overweight/obesity
• dairy product = release of satiety peptide hormones secreted by intestinal cells –> cholecystokinin and glucagon-like peptide 1 (induced by dairy product intake) –> reduces desire for other calorically dense foods
  *vs plant milk –> lower activation of peptide hormones –> less inhibition of satiety
• decrease milk = increase soft drinks and sugar sweetened bevs = increase risk of overweight and obesity in childhood

Question 57

• what is most common complain at pediatric offices? 1 big category + 4 examples
• may be induced by who? (2)

Answer 57

• feeding problems! diarrhea, constipation, colic and refusal to eat
• may be induced by parents: high anxiety, ill health of mother (ignorance of child), breast-feeding problems OR inherent in infant (autism, CF, biomedical problem, malabsorption, microcephaly, development errors

Question 58

feeding problems in infants:
- refusal to eat associated with (5)
- at 4 years old –> may experience what? but still have (2)
- lack of ________ –> associated with (2) + may indicate what?

Answer 58

• behavioral problems, failure to thrive, impaired growth and recurrent infections at 2 yo + learning difficulties
• may experience catch up growth (to same or higher percentile) if nutritional intervention BUT may still have feeding difficulties and hyperactivity
• lack of breakfast –> associated with poorer attention span and decrease problem solving abilities + may indicate poorer nutritional intake in general (bc not getting enough nutrients from only 2 meals a day)

Question 59

how can we diagnose feeding disorder of infancy and early childhood according to DSM-IV-TR? (6)

Answer 59

1. no weight gain or weight loss for > 1 month –> not following normal weight gain curve
2. 6 years old or younger
3. no GI or medical condition causing the eating problem
4. not caused by a mental disorder or the unavailability of food
5. not eating an adequate amount of food
6. has lost weight in one month or more

Question 60

feeding disorder of infancy/early childhood leads to what?
- describe/explain

Answer 60

leads to failure to thrive!
- complex clinical syndrome that describes infants and children who require nutrition intervention bc of unexplained deficits in growth

Question 61

what is growth faltering?

Answer 61

occurs when weight crosses 3 percentiles on standard growth charts over 3 months of infancy and over 6 months in the 2nd & 3rd years of life

Question 62

2 types of malnutrition: difference btw the 2?

Answer 62

1. wasting:
   - child too thin for height due to acute malnutrition
   - could be bc of refusal to eat
   - wasted and underweight, not stunted
2. stunting:
   - failure to grow physically and cognitively due to chronic or recurrent malnutrition
   - child doesn’t meet genetic potential of psychomotor dev and IQ and cognitive performance
   - not necessarily wasted, just stunted and underweight

Question 63

• how to prevent malnutrition?
• who is a greater risk of nutrition deficiencies?
• what to identify in a nutrition focused physical exam? (3)

Answer 63

• screening to ensure early intervention
• children with chronic diseases
  1. loss of subcutaneous fat (thinness)
  2. muscle wasting –> decrease arm circumference
  3. presence of nutrition related edema –> if protein status is low –> low plasma albumin –> decrease water in blood –> increase water in tissues

Question 64

failure to thrive:
- downward ________ deviation from _____ and _____ norms –> 2 types ish
- causes: 3 ish
- consequences (3)
- associated with what?

Answer 64

• downward growth deviation from age and gender norms –> stunted and wasted (?)
• organic (ie cystic fibrosis) and nonorganic (environmental, family, trauma, emotional), or a mix of both
• delayed motor skills, language acquisition, social skills –> don’t reach developmental landmark
• associated with refusal to eat

Question 65

failure to thrive:
- responsible for 1-5% of what? –> 4 causes
- significant drop in percentile rank OR < __-___th percentile
- is it a disease? is it a disorder?
- what may be necessary?

Answer 65

• 1-5% of pediatric hospital admissions –> causes: medical, psychosocial, nutritional, devellopmental
• 3-5th percentile
• not a disease or a disorder –> sign of undernourishment
• hospitalization may be necessary
  *multi disciplinary team: social support for families, speech therapists to eat food, RD…

Question 66

3 general patterns/categories of failure to thrive
- physical landmark ish
- consequence

Answer 66

1. decrease head circumference (HC) + wt & height < 5th percentiles
   - all 3 landmarks are low –> problems in eating properly
   - ie maybe microcephaly
   - normally intellectually handicapped
2. normal HC and height, weight is impaired
   - constitutionally short stature, chronic disease such as malabsorption, encocrine disorders (cystic fibrosis)
3. normal HC, lower weight and greatly lowered height
   - normally nutrition related including poverty or infant behavioral problems
   - macrobiotics (fad diet to avoid whole categories of food) –> insufficient vit D, calories, protein, Fe, and riboflavin

Question 67

explain organic vs non-organic causes of failure to thrive
- organic: lots of examples –> affects (2)
- non-organic: affects what? 3 examples
- can there be both?

Answer 67

ORGANIC:
- congenital heart defect, malabsorption syndromes (cystic fibrosis, chronic liver disease, and celiac disease), infections, anemia, heart and renal problems, endocrine problems, prematurity, intellectual developmental delay or conditions like autism
- affect metabolism and nutrient bioavailability –> deficiencies
INORGANIC:
- affects how infant can self-feed
- abnormal development and behavior or child
- distorted relationship btw care-giver and child
- may be associated with deprived background or high income parents with distorted health beliefs (solely non-organic)
*many times both! organic causes will lead to inorganic causes

Question 68

failure to thrive can result from a number of factors: 7 examples

Answer 68

1. child not presented with adequate nutrition (disease state OR low income OR parent not doing their jobs)
2. child unable to take in adequate nutrients
3. problems such as inadequate parenting, distorted perception of pediatric nutrition, neglect, abuse
4. subtle neuromotor problems (associated with low birth weight)
5. psychiatric disorders
6. aversion to eating due to allergic rxns, GI reflux, negative experiences with lavage or nasogastric tube feeding in infancy
7. behavioral, interactional and environmental issues btw child and caregivers

Question 69

failure to thrive:
- could be due in part to _______ ________ difficulties such as _______ response in infancy (can go beyond normal timing of when it stops)
- associated with poor utilization of (2) (examples) or food not well retained after feeding
- 50% of children: general _________ problems and problems specifically related to _________ –> examples

Answer 69

• mechanical feeding difficulties such as extrusion response in infancy
• poor utilization of calories and nutrients (cystic fibrosis, milk intolerance, allergy, parasites) (lead to problems in poor absorption) OR food not well retained after feeding
• general behavioral problems and problems specifically related to eating (ie food aversions, picky eating)

Question 70

failure to thrive
- how to treat (3 ish)
- most effective with __________ approach –> describe
- what happens in extreme FTT?

Answer 70

• target suspected cause(s) + address feeding difficulties + provide treatment/therapy
• interdisciplinary approach! pimary core doctor/pediatrician + RD + OT + speech therapist (swallow, chewing) + social worker (provision of adequate food) + psychologist and other mental health professionals + specialists (ie gastroenterologists)
• extreme: hospitalization, tube feedings –> 150% of normal cal requirements for catch up growth + individualized medical and social support

Question 71

failure to thrive: prognosis (nonorganic FTT):
- majority of children > 1 yr achieve stable weight > ___ percentile
- FTT before age 1 –> high risk of what?
- FTT before 6 mo –> what?

Answer 71

• majority of children > 1 yr achieve stable weight > 3rd percentile
• FTT before age 1 –> high risk cognitive delay + behavioral problems + psychomotor dev
• FTT before 6 mo –> highest risk!!

Question 72

• how to diagnose infant/child overweight vs obesity?
• prevalence of obesity ages 2-5 yo?
• strong causes? (3 ish)

Answer 72

• overweight: BMI btw 85th and 95th percentile
• obesity: BMI above 95th percentile
• 13.9% from 2015-2016 –> increasing since 1970s and 80s
• genetics + environment = more predisposed
  *ALSO behavioral factors: dietary patterns, level of physical activity, medication use, education and skills, environment, and food marketing and promotion

Question 73

children who are obese are at greater risk of (8)

Answer 73

1. high blood pressure and high cholesterol
2. impaired glucose tolerance, insulin resistance and type 2 diabetes
   *metabolic syndrom!
3. breathing problems
4. joint problems and musculoskeletal discomfort
5. fatty liver disease, gallstones and gastroesophageal reflux
6. psychological stress
7. low self-esteem and low self-reported quality of life
8. impaired social, physical and emotional functioning

Question 74

• why need early intervention of obese children?
• _________ environment plays a role –> explain
• prevention via what is key

Answer 74

• because obese children likely to be obese as adults –> can have significant health consequences
• obesogenic environment! children exposed to numerous factors that contribute to increased consumption of unhealthy food and discourage physical activity (ie social media, use of TV)
• via healthy lifestyle!

Question 75

• risk of inactive children (2)
• physical activity should be (3)
• recommendations for children? (2 ish)

Answer 75

• inactive children often become inactive adults + inactivity (regardless of weight and diet) also increases risk of many diseases (CV health, lung and skeletal muscle health)
• should be enjoyable, age appropriate and offer variety
  1. light, moderate, vigorous activity 15 minutes per hour
  2. 3 hours of daily activity of all intensities

Question 76

7 benefits for children who exercise on a regular basis

Answer 76

1. less stress
2. better self-esteem
3. readiness to learn in school
4. better scholastic performances + cognitive benefits
5. healthy weight
6. healthy bones, muscles and joints
7. better sleep!