General information: Growth and Nutrition Flashcards
What is the caloric requirements for a 0-3 mo old?
115 Kcal/kg/day
What is the caloric requirements for a 3-6 month old?
110 Kcal/kg/day
What is the caloric requirements for a 6 month–> 3 year old?
100 Kcal/kg/day
What is the caloric requirements for a 4-6 y.o.
90-100 Kcal/kg/day
How do you measure head circumference and how long should you do so?
measure 3x and record the largest one
performed from birth –> 3 y.o.
When do you measure length, when do you measure height?
Length = birth--> 2 y.o. Height = >2yrs old
Ho wdo you calculate BMI for a child >2 y.o.
(Wt(lbs)/Ht2(in)) x 703
How should you measure the wt of a child <2 y.o.
unclothed, using a balance-beam table
How should you measure the wt of a child >2 y.o.
minimal clothing using floor model beam
what should you consider when assessing and interpreting growth measurements
- context of the family and grwoth hx
- plot over time to track growth
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?
dietary
pathological causes of increased wt
Endocrine
- hypothyroidism
- excessive cortisol (cushings)
- thalamic/pituitary d/o
Genetic
- down syndrome
- prader-willi syndrome
- laurence-moon syndrome
pathological causes of decreased wt
- psychosocial deprivation
- hypothyroidism
- iron deficiency
- organ failure
- lead intoxication
- HIV infection
- immune deficiencies
pathological causes of increased Ht
- excess HGH
- hyperthyroidism
- Klinefelter syndrome
- Marfan syndrome
- homocystinuria
pathological causes of decreased wt
- HGH deficiency
- hypothyroidism
- chronic anemia
- chromosomal d/o (turner)
- organ failure
- skeletal dyspalsia
- psychosoical deprivation
pathological causes of increased Head circumference
hydrocephalus
Megaencephaly
pathological causes of decreased Head circumference
Craniosynostosis
Prenatal insult
- maternal drug/alcohol abuse, infection
- complications of pregnancy/birth
Chromosomal defects
what are nutrition needs influenced by?
onset of puberty
increased growth rates
changes in body composition
physical level of activity
what are unique nutritional concerns during infancy
poor wt gain
trouble sucking/swallowing
spitting up or vomiting a lot
frequent fussiness or upset during/after feeding
what are unique nutritional concerns during early childhood?
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
what are unique nutritional concerns during middle childhood
High-fat or sugary foods
Food as reward or punishment
Preoccupation with body image
what are unique nutritional concerns during adolescence
Junk or fast foods, Skipped meals
Preoccupation with body image, Risk of eating disorders
___% of children in the US ages 2-20 y/o are obese
17
Maternal obesity during pregnancy ↑ risk by ___-___x
3-5x
What are complications of obesity
- 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
what are some steps to early ID of obesity?
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
Pediatric under-nutrition is usually the result of
- 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
___is a Spectrum of conditions caused by varied levels of protein/calorie deficiency
Protein-energy malnutrition (PEM)
what are causes of Primary PEM
social/economic factors that result in lack of food
what are causes of secondary PEM?
- ↑ caloric requirements: infection, trauma, CA
- ↑ caloric loss: malabsorption
- ↓ caloric intake: anorexia, CA
___ is the result of severe Inadequate calories and nutrients
Marasmus
what are s/s of Marasmus
Loss of muscle mass and subcutaneous fat stores
Skin is dry and thin, hair sparse
Apathetic, weak, irritable when touched
____ is a severe Inadequate protein intake in presence of fair-good caloric intake
Kwashiorkor
What are s/s of Kwashiorkor
Hypoalbuminemic state results in pitting edema
Body weight is near normal for age (edema)
PE→ normal SubQ adipose tissues, marked atrophy of muscle mass
what are complications of malnutrition?
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
what is the tx for malnutrition?
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
