General information: Growth and Nutrition

Question 1

What is the caloric requirements for a 0-3 mo old?

Answer 1

115 Kcal/kg/day

Question 2

What is the caloric requirements for a 3-6 month old?

Answer 2

110 Kcal/kg/day

Question 3

What is the caloric requirements for a 6 month–> 3 year old?

Answer 3

100 Kcal/kg/day

Question 4

What is the caloric requirements for a 4-6 y.o.

Answer 4

90-100 Kcal/kg/day

Question 5

How do you measure head circumference and how long should you do so?

Answer 5

measure 3x and record the largest one

performed from birth –> 3 y.o.

Question 6

When do you measure length, when do you measure height?

Answer 6

Length = birth--> 2 y.o.
Height = >2yrs old

Question 7

Ho wdo you calculate BMI for a child >2 y.o.

Answer 7

(Wt(lbs)/Ht2(in)) x 703

Question 8

How should you measure the wt of a child <2 y.o.

Answer 8

unclothed, using a balance-beam table

Question 9

How should you measure the wt of a child >2 y.o.

Answer 9

minimal clothing using floor model beam

Question 10

what should you consider when assessing and interpreting growth measurements

Answer 10

• context of the family and grwoth hx

- plot over time to track growth

Question 11

If weight has increased or decreased but heigth and head circumference has stayed that same, what is the likely cause of the change in wt?

Answer 11

dietary

Question 12

pathological causes of increased wt

Answer 12

Endocrine

• hypothyroidism
• excessive cortisol (cushings)
• thalamic/pituitary d/o

Genetic

• down syndrome
• prader-willi syndrome
• laurence-moon syndrome

Question 13

pathological causes of decreased wt

Answer 13

• psychosocial deprivation
• hypothyroidism
• iron deficiency
• organ failure
• lead intoxication
• HIV infection
• immune deficiencies

Question 14

pathological causes of increased Ht

Answer 14

• excess HGH
• hyperthyroidism
• Klinefelter syndrome
• Marfan syndrome
• homocystinuria

Question 15

pathological causes of decreased wt

Answer 15

• HGH deficiency
• hypothyroidism
• chronic anemia
• chromosomal d/o (turner)
• organ failure
• skeletal dyspalsia
• psychosoical deprivation

Question 16

pathological causes of increased Head circumference

Answer 16

hydrocephalus

Megaencephaly

Question 17

pathological causes of decreased Head circumference

Answer 17

Craniosynostosis

Prenatal insult

• maternal drug/alcohol abuse, infection
• complications of pregnancy/birth

Chromosomal defects

Question 18

what are nutrition needs influenced by?

Answer 18

onset of puberty
increased growth rates
changes in body composition
physical level of activity

Question 19

what are unique nutritional concerns during infancy

Answer 19

poor wt gain
trouble sucking/swallowing
spitting up or vomiting a lot
frequent fussiness or upset during/after feeding

Question 20

what are unique nutritional concerns during early childhood?

Answer 20

Extended use of bottle feedings
Pica, Poor appetite, Refusal to eat
Force-feeding, Food tantrums
Food as reward or punishment
High-fat or sugary foods

Question 21

what are unique nutritional concerns during middle childhood

Answer 21

High-fat or sugary foods
Food as reward or punishment
Preoccupation with body image

Question 22

what are unique nutritional concerns during adolescence

Answer 22

Junk or fast foods, Skipped meals

Preoccupation with body image, Risk of eating disorders

Question 23

___% of children in the US ages 2-20 y/o are obese

Answer 23

17

Question 24

Maternal obesity during pregnancy ↑ risk by ___-___x

Answer 24

3-5x

Question 25

What are complications of obesity

Answer 25

• Psychosocial→ discrimination, teasing
• Growth: advanced bone age, ↑ height, early menarche
• CNS: pseudotumor cerebri
• Respiratory: OSA
• Orthopedic: Slipped capital femoral epiphysis
• Metabolic: Insulin resistance, type 2 DM, HLD, cholelithiasis

Question 26

what are some steps to early ID of obesity?

Answer 26

Anthropometric data: wt, ht, BMI at every well visit and discussed
Dietary and physical activity hx → 24 hr recall
Physical examination
Lab studies as indicated

Question 27

Pediatric under-nutrition is usually the result of

Answer 27

• Inadequate food supply, access or utilization
• Poor access to health and sanitation
• Inappropriate feeding or child care practices
• Greatest risk: in utero through 2 y/o

Question 28

___is a Spectrum of conditions caused by varied levels of protein/calorie deficiency

Answer 28

Protein-energy malnutrition (PEM)

Question 29

what are causes of Primary PEM

Answer 29

social/economic factors that result in lack of food

Question 30

what are causes of secondary PEM?

Answer 30

• ↑ caloric requirements: infection, trauma, CA
• ↑ caloric loss: malabsorption
• ↓ caloric intake: anorexia, CA

Question 31

___ is the result of severe Inadequate calories and nutrients

Answer 31

Marasmus

Question 32

what are s/s of Marasmus

Answer 32

Loss of muscle mass and subcutaneous fat stores
Skin is dry and thin, hair sparse
Apathetic, weak, irritable when touched

Question 33

____ is a severe Inadequate protein intake in presence of fair-good caloric intake

Answer 33

Kwashiorkor

Question 34

What are s/s of Kwashiorkor

Answer 34

Hypoalbuminemic state results in pitting edema
Body weight is near normal for age (edema)
PE→ normal SubQ adipose tissues, marked atrophy of muscle mass

Question 35

what are complications of malnutrition?

Answer 35

Susceptible to infxn

Bradycardia and poor cardiac output predispose child to HF

May have permanent growth stunting (depends on age at onset and duration of malnutrition)

Delayed development

Question 36

what is the tx for malnutrition?

Answer 36

Nutritional rehab should be initiated and advanced slowly→ start w/ rehydration and tx of concomitant infxns

Start calories at 20% ↑ than recent intake (or 50-75% of normal energy requirement) and then ↑ by 10-20% /day