CPS GI + nutrition Flashcards
Effect of endocrinopathy on growth
- affects height more than weight
vs. weight first in nutritional problems or systemic disease
Mid parental height
Males: (mother ht + father ht + 13) / 2
Females (mother ht + father height - 13) / 2
SD = +/- 8.5cm
FTT step 1 basic investigations
- CBC
- ESR or CRP
- lytes, venous blood gas, glucose
- BUN, Cr
- serum protein and albumin
- serum iron, TIBC, t sat, ferritin
- Ca, PO4, ALP
- liver enzymes
- serum immunoglobulins
- TTG with IgA
- TSH
Urinalysis
FTT step 2 investigations
- sweat chloride
- vitamin levels
- fecal elastase
- bone age
Benefits of dietary fibre
- decrease risk for constipation
- improved intestinal microbiome
- decreased body fat/metabolic syndrome (displacing high energy, low-nutrient foods)
- decreased post-prandial glucose and insulin
Topical fluoride 3 ways it prevents caries
- inhibits plaque
- inhibits demineralization
- enhances remineralization
Indications for fluoride supplementation
- > 6 months
- drinking water fluoride is <0.3ppm
- child does not brush (or have teeth brushed)2x/day
- child is susceptible to high caries (fam history, community or geographic trends)
Benefits of WHO vs. CDC growth charts
- WHO = more diverse, multiple countries
- only children with optimal growth
WHO: Underweight and severe underweight for age
0-10: wt for age <3rd percentile
10-19: BMI < 3rd percentile
severe underweight = < 0.1%ile
WHO: stunting and severe stunting for age
0-19: length/ht for age < 3rd percntile
severe stunting = <0.1%ile
WHO wasting and severe wasting for age
0-2: weight: length percentile < 3rd
2-19: BMI < 3rd percentile
severe = <0.1%
WHO: risk of overweight by age
0-2: wt for length > 85th %ile
2-5: BMI >85th %ile
5-19: NA
WHO overweight by age
0-2: wt for length> 97%ile
2-5: BMI > 97%
5-19: BMI > 85%ile
WHO obesity by age
0-2: wt for length > 99.9%ile
2-5: BMI > 99.9
5-19: BMI > 97%ile
Severe obesity 5-10 = BMI > 99.9
Infantile colic
> 3hrs / day
3days per week
1 week
No failure to thrive
Dietary changes for infantile colic
- for infantile colic: can consider 2 week trial of hypoallergenic diet
- use of soy formula should be avoided, no evidence for lactase, insufficient evidence for prebiotics or probiotics
Risk factors for iron deficiency anemia before age of 2 yrs
- Baby/delivery factors
- preterm
- birthweight < 2500g
- male sex
- early umbilical cord clamping
- chronic infection
RFs for iron deficiency before age 2
- Mother/environment factors and feeding factors
Mother/enviornment: mothers with anemia or obesity, low SES, lead exposure
Feeding: exclusive breastfeeding longer than 6 months, cow’s milk intake, prolonged bottle use, low dietary intake of iron-rich foods
Significance of non-anemia iron deficiency and iron deficiency anemia
- lower neurodevelopmental scores
- compromised immune response
- low cognitive and motor function
Iron supplementation for term SGA or preterms
BWt 2-2.5kg: 1-2mg/kg/day
BWt < 2kg: 2-3mg/kg/day
supplement for first 6 months
(if formula fed ensure iron-rich formula)
Risks of unpasteurized human donor milk
- Donor health: Hep B, Hep C, HIV, HTLV, syphilis
- donor substance use
- donor medications/herbs
- donor having inter-current illness
- safe handling and storage practices
Effect of pasteurization on human breast milk
- inactivates bacterial and viral contaminants
- 13% of protein content is denatured
- beneficial immune cells are inactivated/reduced
- some water-soluble vitamins may degrade
Unchanged: carbs, fats, salts, fat-soluble vitamins,
Breastfeeding benefits
- cognitive development
- protection against: GI infections, AOM, resp tract infections, SIDS
7 principles for feeding from birth to 6 months
- breastfeeding exclusive for first 6 months
2 active protection support and promotion of breastfeeding - vitamin D 400 IU
- iron-rich complementary foods to be introduced first
- routine growth monitoring
- feeding changes are unnecessary for most colic, GER etc.
- rare contraindications for breastfeeding
7 principles for feeding from 6-24 mo
- breastfeeding is impt (up to 2 yrs or beyond)
- supplemental vitamin D
- complementary feeding along with breastfeeding (lumps by 9 mo)
- responsive feeding
- iron-rich complementary foods
- safe food, prep and storage
- regular schedule of meals and snacks from 1 year and beyond
Long term AEDs associated with specific micronutrient deficiencies (2)
- folate
- vitamin B12
- impaired bone health
Measurements for children with neurologic impairment
- weight
- height if possible (not segmental measurements)
- body composition e.g. skin fold
When to use condition specific growth charts
- consider for CP
Infant’s microflora influenced by…
- type of delivery
- diet
- environment
- gestational age
- presence of abx
Consider recommending probiotics for these reasons:
- prevent abx- associated diarrhea
- shorten duration of acute infectious viral diarrhea
- prevent NEC in prem infants who are at risk
- decrease sx of colic (there may be a role but insufficient evidence)
- decrease sx of IBS (preliminary results favorable)
Role for sports drinks
- may have a role for young athletes for prolonged and vigorous activities but generally UNNECESSARY
- for average child, water should be first choice
Risks of caffeine in children
- tachycardia, hypertension, ECG changes, vomiting, diarrhea, impulsive behavior, agitation, delusions, CV collapse, death
- higher risk of caffeine dependence
(with alcohol, increase risk of substance abuse and high risk behaviours)
Ideal macronutrient component of diet
45-65% CHO
10-30% protein
25-35% fat
Who recommendation re: free sugars
free sugars < 10% of total energy
~50g daily
Overweight and obesity are significant risk factors for nutrition-related chronic diseases:
- HTN
- dyslipidemia
- T2DM
- Coronary heart disease
- Stroke
- some cancers
- NAFLD
- sleep apnea
- OA
Health consequences of excess sodium
- hypertension
-obesity
(sodium sensitivity more common in HTN, African American, women, metabolic syndrome)
Sodium intake recommendations
- 9-13 yrs
- 14+ yrs
9-13: 1200mg/day (reduce if above 1800)
14+: 1500mg/day (reduce if above 2300)
Potential impacts of school nutrition programs
- increasing access to nutritious foods
- improving dietary behaviours
- lowering BMI
- impacts on academic performance
Breastfeeding decreases infectious diseases:
- bacterial meningitis
- bacteremia
- diarrhea
- resp tract infections
- otitis media
- UTIs
Breastfeeding benefits (non-infectious)
- decreases SIDS
- enhanced neurocognitive testing
- decrease in breast and ovarian cancers for mothers
- economical
5 reasons to initiate G - tube discussion
- poor oral intake and inadequate weight gain despite calorie boosting
- recurrent aspiration or prolonged feeding times
- GERD if insufficient oral intake
- if long-term G-tube feeding (>3-6 months is anticipated)
- dysmotility despite medical tx
Risks of G-tube feeding
Short term: peritonitis, bleeding, infection, anesthesia-related problems, abdominal organ puncture, death
Long-term: blockage, dislodgement, breakage, issues with stoma - bleeding, infections, irritation, worsening of GERD
