Development Flashcards
WHO recommendation for infant feeding
Recommend exclusive breastfeeding for first 6 months of life
- free
- contains antibodies which protect neonate against infection
- linked to better cognitive development, lower risk of certain conditions later in life, reduced risk of SIDS, less obesity in later life, reduce breast and ovarian cancer in mother but maybe due to socio-economic factors
Issues with breast feeding
Poor milk supply Difficulty latching Discomfort or pain for mother Inadequate nutrition for baby Overfeeding
Feeding volumes for baby
On formula
- 150 ml/kg/day
Preterm and underweight babies may require more
Split between feeds every 2-3 hrs initially, then 4 hours and longer between feeds until transition to feeding on demand
Acceptable initial weight loss in babies
10% for breast fed
5% for formula fed by day 5
Gain back by day 10
Features of weaning
Gradual transition from milk to normal food
Starts around 6 months of age
- pureed foods that are easy to palate and digest - pureed fruit and baby rice
Phases of growth in children
First 2 years = rapid growth driven by nutritional factors
From 2 years to puberty = steady slow growth
During puberty = rapid growth spurt driven by sex hormones
Definition of overweight in children
Overweight = BMI over 85th percentile Obese = BMI over 95th percentile
Complications of obesity
Bullying Impaired glucose tolerance Type 2 diabetes CVS disease Arthritis Certain types of cancer
Define faltering growth
Fall in weight across
- one or more centiles if birthweight below 9th centile
- two or more centiles if birthweight between 9th and 91st centile
- three or more centiles if birthweight above 91st centile
Ix for faltering growth
Urine dipstick - UTI
Coeliac screen - anti-TTG or anti-EMA antibodies
Specific tests if symptoms point to specific diagnosis
Mx of faltering growth
Regular reviews to monitor weight gain
When difficulty breastfeeding - midwives, health visitors, peer groups and lactation consultants
- feed with breastmilk prior to top up feeds
- express when not breastfeeding to encourage lactation to continue
Encourage regular structured melatiems and snockes
Reduce milk consumption to improve appetite for other foods
Review by dietician
Additional energy dense foods to boost calories
Nutritional supplement drinks
Causes of short stature
Familial short stature Constitutional delay in growth and development Malnutrition Chronic diseases - coeliac disease - IBD - congenital heart disease Endocrine - hypothyroidism Genetic - Down syndrome Skeletal dysplasias - achondroplasia
Define constitutional delay in growth and puberty (CDGP)
Variation on normal development Short stature in childhood Delayed puberty Growth spurt in puberty lasts longer - ultimately reach predicted height Delayed bone age
Define hypogonadism
Lack of sex hormones - oestrogen and testosterone
- normally rise prior to puberty
- lack of these hormones causes delay in puberty
Types of hypogonadism
Hypogonadotropic = deficiency of LH and FSH Hypergonadotrophic = lack of response to LH and FSH by gonads
Features of hypogonadotrophic hypogonadism
Deficiency of LH and FSH leads to deficiency of sex hormones
- no gonadotrophins stimulating the gonads
Result of abnormal functioning hypothalamus or pituitary gland
Causes of hypogonadotrophic hypogonadism
Previous damage to hypothalamus or pituitary - radiotherapy or surgery
Growth hormone deficiency
Hypothyroidism
Hyperprolactinaemia
Serious chronic conditions - cystic fibrosis or IBD
Excessive exercise or dieting
Constitutional delay in growth and puberty
Kallman syndrome
Features of hypergonadotropic hypogonadism
Gonads fail to respond to stimulation from the gonadotrophins (LH and FSH)
No negative feedback from sex hormones (oestrogen and testosterone)
Anterior pituitary produces increasing amounts of LH and FSH to try to stimulate the gonads
Causes of hypergonadotrophic hypogonadism
Result of abnormal functioning gonads
- testicular torsion, cancer or infections such as mumps
- congenital absence of testes or ovaries
- Kleinfelter’s syndrome - XXY
- Turner’s syndrome - XO
Define failure to thrive
Inadequate weight gain in infant or young child
- weight crosses > 2 centiles on growth chart
- persistently below 5th centile
Causes of failure to thrive
Increased energy requirements
- congenital heart disease, cystic fibrosis, renal failure
Inadequate absorption
- coelic, short gut syndrome, cystic fibrosis
Poor intake - physical
- reflux, neurological problem with impaired swallow, cleft palate
Poor intake - environmental
- inadequate food supply, maternal depression
Mx of failure to thrive
Mx in primary care by increasing calorie intake
Ix only if suspected organic cause as does not respond to increased calorie intake
Social services
Dietitian
SALT if feeding disorder
