Exam #1: Pediatric Nutrition Flashcards
Why is growth closely monitored in children?
Growth is an important indicator of proper nutrition
Is BMI in children used the same as adults?
NO
When does the most growth occur in children?
Infancy
*****Note that instructor calls infancy 0-2 years
Where does most of the mass come from in the first 4 months of life?
Fat
How does weight fluctuate in the first few weeks of life?
- Initial decline in first few days
- Should regain in 7-10 days
Generally, when should an infant double & triple weight?
Double= 6 months Triple= 1 year
How big is an infants stomach at birth, day 3, and day 10?
Newborn= shooter marble
Day 3= ping pong ball
Day 10= egg
*****This is important to remind mothers of to prevent over-feeding.
How do the energy requires of an infant compare to an adult?
Much higher as an infant
**Almost twice as much as adult comparatively; make sure parents are paying attention to hunger cues
What are the protein requirements of infants?
V. high i.e. 2.2g/kg/d at birth, which declines with age
*****Note that these requirements increase with stress/ trauma/ illness
What is the main dietary energy source in infants?
Lipids
What vital functions do lipids play in the developing infant?
- Absorption of fat soluble vitamins
- CNS develoment
- Brain development
What proportion of calories should come from fat in an infant?
40-50% or higher in the first year
What proportion of calories should come from carbs?
30-60%
Where should carbs come from in infants?
Cereals
Fruits
Veggies
What vitamin must be supplemented in infants that are exclusively breastfed?
Vitamin D
What vitamin is injected at birth to prevent bleeding or hemorrhage?
Vitamin K
Does calcium need to be supplemented in infants?
No- human milk and formula have adequate sources of Ca++
How can lactose intolerant infants get Ca++?
Cooked greens i.e. collard, mustard, kale
What can iron deficiency lead to in infants?
Long term developmental & behavioral issues
Should iron be supplemented in infants?
Yes, at 4-6 months
*****Note that cow’s milk is a poor source of iron
What is the recommended feeding method for all infants?
Breastfeeding
What is the major benefit to breastfeeding vs. formula?
Immune factors that are not in formula
What are the four stages of human milk expression?
1) Colostrum
2) Transition milk
3) Mature milk
4) Extended lactation
What are the characteristics of colostrum?
- Low fat
- High protein
- Rich in immunologic substances
What are the characteristics of transition milk?
- Ig & protein decrease
- Fat, calories & lactose increase
What are the characteristics of mature milk?
Fat, calories, & lactose remain high
What happens to the composition of milk during extended lactation?
Vitamin and mineral content decrease
How is breastfeeding assessed (for adequacy)?
1) Weight/ growth
2) Voiding i.e. # of wet diapers
3) Stooling
4) Feed-on-demand
5) Duration (10-20 min/ side)
6) Activity level of infant
Is it normal for a breastfed infant to go several days without a bowel movement?
Yes, it can be…
What is a common cause of constipation in a breastfed infant?
Iron supplementation
What are the three major forms of formula?
- Ready to feed
- Concentrate*
- Powder*
*Need to be mixed with water
How does formula differ from breast milk?
Micronutrients in higher concentrations i.e. vitamins, minerals, and iron
When are soy formulas recommended?
- Galactosemia
- Lactase deficiency
- Family values
Why are Ca++, phosphorus, zinc & iron increased in soy formula?
Soy phytates & fiber interfere with absorption
Why would you recommend protein hydrolysate formula?
Allergy to intact protein
Why would you recommend an amino acid based formula?
Severe protein allergy after switch to protein hydrolyaste
Why is cow’s milk not recommended until age 1?
- Renal solute to high
- Can lead to renal failure, dehyration, and GI bleed
- Whey: Casein ratio off
- Inadequate vitamins & minerals
- Not enough fat
- Low EFAs
When can solids be started in an infant?
When infant is able to sit w/ head up or propped up
How do you correct growth for premature infant?
40 weeks - GA= # weeks premature
*****This is the correction factor that will be used until 2 years (24 months)
What will a preterm infant be deficient in?
Fat
How are premature infants initially fed?
Enteral (feeding tube) vs. parenteral (IV)
- PN= VLBW or ELBW
What is adiposity rebound?
Increase in body fat in preparation for pubertal growth spurt
How does protein need vary with childhood and adolescence?
- Decreased need as growth slows after infancy
- Increased at puberty
Are multivitamins recommended in children?
NO
What are the definitions of “overweight” and “obese” in childhood/ adolescence?
Overweight= 85th-94th percentile
Obese= >95th percentile
What are the defining features failure to thrive?
- Infants that fail to grow and develop at normal rate
- Small head circumference
- Muscular wasting
- Weight loss/ poor weight gain
What is the difference between primary & secondary FTT?
Primary= social/ environmental
Secondary= originates from disease state
What is necrotizing enterocolitis?
Acute inflammatory bowel disorder characterized by ischemic necrosis of GI
**Mostly seen in premature or LBW
What are the major nutritional complications of CF in infants?
- Malabsorption especially of fat soluble vitamins
- Essential fatty acid def.
****CF prevents release of pancreatic enzymes to small intestine
What is the difference between acute and chronic diarrhea?
Acute= 3+ loose stools per day Chronic= 3+ for greater than 2 weeks
What is the definition of constipation in infants?
Delay/ difficulty in passing stools present for 2+ weeks
When is reflex a problem in infants?
When it interferes with growth
*****Note that this is v. common & typically does NOT require intervention
