Consideration of Nutrition Support of the Pediatric Patient Flashcards
Which children are at the greatest risk for Iron deficiency anemia?
Infant switched from formula to whole milk
An obese 12 yo female is admitted to the hospital for an evaluation of sleep apnea. A diet history reveals that she drinks 3 cans of soda, 24 oz of juice and 8 oz of chocolate milk daily. What mineral my she be deficient?
Calcium
A child with cerebral palsy and G tube is admitted to the hospital for fundoplication. This procedure is used to manage
GER
Premature infants are at risk of MBD in what scenarios?
Cholestasis, chronic steroid use ,very low birth weight
When used in assessment of critically ill children, how do predictive equations compare to IDC?
No consistent comparison can be found
a 13 yo boy whose BMI is at the 97th percentile on the CDC and Prevention growth chart for age and sex would be classified as:
Obese
What is not associated with delayed bone age in children with short stature?
Precocious puberty
Which preterm growth chart allows for comparison for preterm infants from 22 weeks gestational age up to 10 weeks post term age?
Fenton
When does the AAP recommend universal screening for iron deficiency be performed in young children?
At 12 months of age
When reviewing a child’s growth chart data, the child’s weight-for-length curve is falling below the 3rd percentile. What Z-score indicates severely wasted?
Z-score below -3
What is the suggested daily amount of potassium required for maintenance in an infant receiving PN?
2-4 mEq/kg
What is the daily maintenance fluid requirement for a 5kg infant?
500 ml
On radiographic examination, a pediatric patient is found to have osteopenia and multiple fractures in various stages of healing. Serum laboratory results show: calcium: low. Phosphorus: low. Creatine: normal. Alk phos high. 25-OH vitamin D: low. 1,25(OH) vitamin D: low. PTH: high. What is the most likely diagnosis?
Vitamin D deficient rickets
What is the recommended daily enteral elemental iron dose for preterm infants, one month after birth?
2-4 mg/kg/d
What trace element should be supplemented in a child with chronic diarrhea?
zinc
What is recommended to prevent vitamin D deficiency in a 1 month old infant fed human milk?
supplement with 400 IU vitamin D per day
A seven month old infant fed reconstituted infant formula and other age appropriate complementary foods may be at risk of over supplementation with which mineral?
Fluoride
Non nutritive sucking should be used in the enterally fed neonate less than 32 weeks corrected gestational age to promote:
oral feeding when developmentally appropriate
What is not a contraindication to NGT feeds in a pediatric patient with CF?
Pancreatic insufficiency
What is the best indication for use of soy based infant formula?
Galactosemia
What concentration is considered to be an upper limit for the osmolality of infant formulas to avoid tolerance issues?
460 mOsm/kg
What distinguishes GER from GERD in infants?
Gerd is characterized by the presence of significant complications
What is false about infant regurgitation?
Regurgitation is rare in infants
What is true regarding aspiration in critically ill children?
The incidence of aspiration directly caused by EN is difficult due to a lack of good clinical research
What best describes the appropriate use of powdered infant formula in healthcare facilities?
Use only when alternative sterile liquid products are not available and when clinically necessary
In the hospital, what is the hang time for expressed human milk when used for continuous enteral feedings?
4 hours
A 4 month male has acute onset of diarrhea for 48 hours. His parents noticed that he hasn’t been wetting as many diapers and his mucous membranes are slightly dry. His anterior fontanel is soft and not sunken. He normally ingests milk based formula ad lib. What is the most appropriate nutrition intervention?
Oral rehydration therapy
What should be the maximum glucose infusion rate for a term infant receiving PN?
14-18 mg/kg/min
In an infant receiving PN what is the minimum amount of soybean based lipid ILE needed to prevent EFAD?
0.5-1.0 g/kg/day
What is the recommended daily intake of selenium for term infants receiving PN?
2 mcg/kg/day
For neonates, which amino acid should be added separately to PN solutions due to solubility concerns?
Cysteine
Standard neonatal parenteral amino acid solutions differ from standard adult parenteral amino acid solutions by having a higher content of:
taurine and tyrosine
Immediately following neonatal cardiac surgery, what is the best estimate of parenteral caloric requirements?
55-60 kcals/kg/day
What therapy would be considered most appropriate in nutritional management of an infant with chronic lung disease?
Use of a concentrated formula
Pancreatic enzymes supplemented at high doses in children with CF could result in:
Fibrosing colonopathy
The use of lactobacillus rhamnosus GG in pediatric practice has been found to be most effective in:
Treating infectious diarrhea
AN infant has a complete ileal resection with preservation of the ileocecal valve. The primary nutrition concern will be:
vitamin b12
Preterm infant formula or fortified human milk is used for premature infants. What is the rational for this?
After the first month, unfortified human milk may contain inadequate protein for the premature infant.
What does not describe the use of minimum enteral feeds in preterm neonates?
Increases risk of necrotizing entercolitis
Exclusive EN has been shown to be effective in inducing remission of Crohn’s disease in the pediatric population. What enteral formula is recommended as first line therapy?
Polymeric enteral formula
What are common symptom of celiac disease in childhood?
FTT, constipation, anemia
A 2 month old infant who has exclusively fed with cow’s milk develops a full body rash. Which of the following would be the most appropriate next step?
Switch to a protein hydrolysate based formula
The biochemical defect in PKU is a functional deficiency of the liver enzyme phenylalanine hydroxylase, which catalyzes the para-hydroxylation of phenylalanine to yield what amino acid?
Tyrosine
Biliary atresia in infancy is most frequently associated with which of the following?
Fat malabsorption
What is a characteristic of cachexia in a pediatric oncology patient?
Progressive wasting of lean tissue and body fat
What method of estimating energy requirements in critically ill children is least accurate when compared to REE by IDC?
RDA for energy
Nutrition therapy for pediatric patients with <20% total body surface area burn typically includes:
oral intake of high calorie and high protein diet
What is a metabolic alteration noted during the ebb response following burn injury to a pediatric patient?
Decreased REE
What is considered to be diagnostic criteria of infantile anorexia?
Refusal to eat adequate amounts of food for >1 month
What nutrition support therapy is essential to intestinal adaptation following significant bowel resection?
