Feeding Healthy Infants, Children, and Adolescents Flashcards
How often should infants feed?
At least 8x/24 hrs
Breastfeeding is protective agains what acute disorders
Diarrhea, otitis media, UTI, NEC, septicemia, infant botulism
Breastfeeding is protective agains what chronic disorders
IDDM, celiac disease, Crohn’s disease, childhood cancer, recurrent OM, allergy
T/F Breastfeeding is protective against overweight and obesity
T
T/F Varicella zoster infection is a contraindication to breastfeeding
T
T/F Herpes simplex virus infection is a contraindication to breastfeeding
T, if with active herpetic lesions of the breast
T/F CMV infection is a contraindication to breastfeeding
T
T/F Breastfeeding should be delayed in infants of mothers with hepatitis B infection until workup has been completed
F, no delay required
Maternal alcohol intake should be limited to ___ while breastfeeding
0.5g/kg/day, ~2 cans of beers, ~2 glasses of wine, ~ 2 ounces of liquor
T/F Cigarette smoking is not a contraindication to breastfeeding
T, but is discouraged
T/F Breastfeeding is generally contraindicated in mothers undergoing chemotherapy
T
MC reasons for nipple pain while breastfeeding
Poor infant positioning and improper latch
Mx for mastitis
1) Oral abx and analgesics 2) Promote breastfeeding or emptying of the affected breast
Mx for breast abscess
Temporary cessation of breastfeeding
Mx for breastmilk jaundice
Infant formula for 24-48h and/or phototherapy without cessation of breastfeeding
Calories provided with formula feeding in general
20kcal//30mL
Usual intake to allow a weight gain of 25-30g/day in the first 3 months of life
140-200 mL/kg/day milk formula
Whole cow’s milk should not be introduced until
12 months of age
Predominant whey protein in bovine milk
β-globulin
Predominant whey protein in human milk
α-lactalbumin
Soy protein-based formulas are indicated among patients with (2)
1) Galactosemia 2) Hereditary lactase deficiency
T/F Soy protein-based formulas are lactose-free
T
T/F Atopic dermatitis may be delayed or prevented in early childhood by the use of extensively or partially hydrolyzed formulas compared to cow’s milk formula
T
Preferred formula for infants intolerant to cow’s milk or soy proteins
Extensively hydrolyzed formulas
T/F There is no significant harm associated with introduction of complementary foods at 4 months of age
T
There is no significant benefit from exclusive breastfeeding for 6 months in terms of (6)
1) Iron 2) Zinc 3) Growth 4) Nutriture 5) Allergy 6) Infections
T/F Important principles for weaning: Energy density should not exceed that of breastmilk
T
T/F Important principles for weaning: Iron-containing foods are required
T
T/F Important principles for weaning: Zinc intake should be encouraged
T
Important principles for weaning: Intake of ___ should be low to enhance mineral absorption
Phytate
Important principles for weaning: Give no more than ___ ounces per day of cow’s milk
24 (~3 standard bottles)
Important principles for weaning: No more than ___ ounces per day of fruit juices
4-6
Bedtime bottles should be discouraged because of the association with
Dental caries
T/F A newborn can already discriminate between sweet and sour
T
Toddlers need to eat ___x per day
5
Most commonly consumed vegetable among toddlers and pre-schoolers
French fries
Among school-aged children and adolescents, new foods can be offered repeatedly ___x to establish acceptance or rejection of that food
8-10
Associated with improved diet quality due to the increased opportunities for positive parenting
Regular family meals sitting at a table
Undernutrition is usually an outcome of 3 factors
1) Household level food security 2) Access to health and sanitation services 3) Child caring practices
Most important causes of undernutrition
1) Inadequate knowledge 2) Lack of time women have available for appropriate infant care practices and their own during pregnancy
Most important factor for undernutrition in times of famine and emergency
Food insecurity
Define food security
Access by all people at all times to sufficient foods in terms of quality, quantity, and diversity for an active and healthy lifestyle without risk of loss of such access
Greatest risk of undernutrition occurs during
1) Pregnancy 2) First 2 years of life
Effects of early damage due to undernutrition during pregnancy and first 2 years of life are potentially irreversible
T
2 main causes of LBW
1) Prematurity (developed countries) 2) IUGR (developing countries)
Measures skeletal growth which reflects the cumulative impact of events affecting nutritional status that result in stunting
Height for age
Reflects chronic malnutrition
Height for age
Most immediate consequence of undernutrition
Premature death
Key interventions proven to be cost effective in reducing infant and child mortality, improving underweight rates, and reversing micronutrient deficiencies
1) EBF 2) Proper complementary feeding 3) Key hygiene behavior 4) Micronutrient interventions 5) Presumptive treatment for malaria for pregnant women in endemic malarial regions and promoting long-lasting insecticide treated bednets 6) Deworming and oral hydration 7) Fortifying
Most severe forms of malnutrition
1) Maramus 2) Kwashiorkor
Marasmus vs Kwashiorkor: Nonedematous
Marasmus
Marasmus vs Kwashiorkor: Results primarily from inadequate ENERGY or BOTH energy and protein intake
Marasmus
Marasmus vs Kwashiorkor: Edematous
Kwashiorkor
Marasmus vs Kwashiorkor: Results primarily from inadequate PROTEIN intake
Kwashiorkor
Marasmus vs Kwashiorkor: Failure to gain weight and irritability, followed by wt loss and listlessness until emaciation
Marasmus
T/F In Kwashiorkor, edema occurs EARLY
T, can mask failure to gain weight
Marasmus vs Kwashiorkor: Skin loses turgor and becomes wrinkled and loose
Marasmus
Marasmus vs Kwashiorkor: Liver enlargement can occur
Kwashiorkor
Marasmus vs Kwashiorkor: Dermatitis common
Kwashiorkor
T/F In Marasmus, loss of fat from sucking pads of cheeks occurs early
F, late
Marasmus vs Kwashiorkor: Muscle atrophy with resultant hypotonia
Marasmus
Marasmus vs Kwashiorkor: Hair is sparse and thin
Kwashiorkor
Chronic necrotizing ulceration of the gingiva and cheek caused by polymicrobial infection with F. necrophorum and P. intermedia
Noma
Tx for Noma
Penicillin and Metronidazole
3 phases of SAM treatment
1) Initial phase (1-7 days) 2) Rehabilitation phase (weeks 2-6) 3) Follow-up phase (weeks 7-26)
3 phase of SAM treatment: Stabilization phase
Initial phase
3 phase of SAM treatment: Correction of dehy and initiation of antibiotic
Initial phase
3 phase of SAM treatment: F100 diet
Rehab phase
3 phase of SAM treatment: RUTF diet
Rehab phase
3 phase of SAM treatment: Feeding to cover catch-up growth
Follow up phase
3 phase of SAM treatment: Oral feedings started with specialized high-calorie formula like F75
Initial phase
Initial caloric intake in the initial phase of SAM tx
80-100 kcal/kg/day
Caloric content of F75
75kcal or 315kJ/100mL
Protein content of F75
0.8g
Caloric content of F100
100kcal or 420kJ/100mL
Protein content of F100
2.9g
Caloric goal in the rehab phase of SAM tx
100kcal/kg/day
3 phase of SAM treatment: Iron therapy started
Rehab phase
T/F Feeding during the follow up phase of SAM tx should be as libitum
T
Hallmark of refeeding syndrome
Severe hypophosphatemis during the 1st week of starting to refeed
3 phase of SAM treatment: Treat or prevent hypogly, hypothermia, dehy
First 1-2 days of intial phase
3 phase of SAM treatment: Correct electrolyte imbalance
Initial to rehab phase
3 phase of SAM treatment: Treat infection
Initial phase
3 phase of SAM treatment: Correct micronutrient deficiencies without iron
Initial phase
3 phase of SAM treatment: Correct micronutrient deficiencies with iron
Rehab phase
3 phase of SAM treatment: Correction of micronutrient deficiencies
Initial to rehab phase
3 phase of SAM treatment: Increase feeding to recover lost weight
Rehab to ff up phase
3 phase of SAM treatment: Prepare for discharge
Rehab phase
Marasmus vs Kwashiorkor: Irritable
Marasmus
Marasmus vs Kwashiorkor: Extremely emaciated
Marasmus
Marasmus vs Kwashiorkor: Apathetic
Kwashiorkor
Marasmus vs Kwashiorkor: Old man’s appearance
Marasmus
Marasmus vs Kwashiorkor: Skin atrophic and cracked, prone to infection
Kwashiorkor
Marasmus vs Kwashiorkor: Normal hair
Marasmus
Marasmus vs Kwashiorkor: Frequent infections with minimal external signs (usually no fever)
Marasmus
Marasmus vs Kwashiorkor: Hair yellow to reddish
Kwashiorkor
Marasmus vs Kwashiorkor: Generally not dehydrated by can be hypovolemic
Kwashiorkor
Marasmus vs Kwashiorkor: Frequently dehydrated and usually dehydration is overestimated
Marasmus
Bilateral pitting edema of Kwashiorkor begins where
Lower legs and feet
T/F Exclusion of peanut and nut products from maternal diet while breastfeeding promotes allergy prevention
T
T/F Delay in introduction of major allergenic foods when complementary feeding promotes allergy prevention
T
When to introduce cow’s milk to prevent allergy development
1 yr
When to introduce egg to prevent allergy development
18-24 months
When to introduce peanut and tree nuts to prevent allergy development
3 yrs
When to introduce seafood to prevent allergy development
3 yrs
