Growth, Development + Nutrition Flashcards by Toni Whitaker

Why are infants more vulnerable to poor nutrition?

poor fat + protein stores
extra nutritional demands for growth
freq illnesses reducing intake and increasing nutritional requirement

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What diseases are associated with low birth-weight?

CHD
stroke
htn
non-insulin dependent DM

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What is colostrum?

produced for the first few days

higher protein and immunoglobulin content

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What do the WHO recommend re breastfeeding?

exclusive breastfeeding for first 6 months of life

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What are long term health benefits of breast feeding?

reduced incidence of:
DM
obesity
htn
breast cancer

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What are possible complications of breast feeding?

unknown intake vol
transmission of infection/drugs
breast milk jaundice
restrictive for mothers - unable to go back to work
establishing breast feeding difficult - req support + guidance, oft unavailable
vitamin K deficiency - supplementation required!

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What are general benefits of breastfeeding?

ideal nutrition
life-saving in developing countries
reduces risk of GI infection + NEC
enhances mother-child relationship
long term health benefits

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What are the anti-infective components of breast milk?

humoral: secretory IgA, bifidus factor, lysozyme, lactoferrin, interferon
cellular: macrophages, lymphocytes

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What are the nutritional properties of breastmilk?

protein: 6:40 whey-casein ratio
lipids: rich in oleic acid
calcium: phosphorus ratio 2:1
low renal solute load
bioavailable iron content
longchainpolyunsaturated fatty acids

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What is the risk of exclusive breast feeding beyond 6 months

nutrient deficiency -> poor weight gain + rickets

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Why is unmodified cows milk inappropriate for infants?

too much protein+ electrolytes

inadequate iron + vitamins

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When are infants weaned?

solid food may be introduced as early as 3 months

usually replaces milk as diet staple at 6 months

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What is the physiological process in breast feeding?

actil receptors -> hypothalamus -> ant + post pituitary
ant-pit: prolactin -> cuboidal cells in acini of breast -> secrete milk
post-pit: oxytocin -> myoepithelial cell contraction in alveoli -> milk forced into larger ducts: ‘let down’ reflex

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What is mild failure to thrive?

a fall across two centile lines

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What is severe failure to thrive?

a fall across 3 centile lines

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When to get worried re failure to thrive?

weight below 0.4 centile -> always req evaluation

most with failure to thrive are below the 2nd centile

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What are the causes of failure to thrive?

inadequate intake
inadequate retention
malabsorption
failure to utilise nutrients
increased requirements

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What are non-organic causes of inadequate intake?

inadequate availability of food
psychosocial deprivation
neglect/child abuse

What are organic causes of inadequate intake?

impaired suck/swallow

chronic illness -> anorexia

What might cause inadequate retention leading to FFT?

vomiting / severe GORD

What might cause malabsorption leading to FTT?

coeliac disease
CF
cow's milk protein intolerance
cholestatic liver disease,
short gut syndrome
post NEC

What might cause failure to utilise nutrients leading to FTT?

syndromes
metabolic disorders
congenital infection
prematurity/IUGR

What might cause increased requirements leading to FTT?

CF
malignancy
chronic infection e.g. HIV
chronic renal failure
congenital heart disease
thyrotoxicosis

What measurement might indicate if a child is wasted/severely malnourished?

a weight for height

What measurement might indicate if a child has stunted growth?

reduced height for age | can be an indication of chronic disease or chronic malnutrition

What is marasmus?

severe protein-energy malnutrition wasting reduced skin fold thickness + MUAC

What is kwashiorkor?

``` severe protein malnutrition late weaning from breast milk, high starch diet develops following acute infection generalised oedema severe wasting weight may not be reduced flaky-paint skin rash: hyperkeratosis + desquamation enlarged liver: fatty infiltration angular stomatitis sparse depigmented hair diarrhoea, hypothermia, bradycadia, hypotension low plasma albumin, K, glucose, Mg ```

How might Vit D deficiency present?

Rickets or Hypocalcaemic sx: seizures, tetany, apnoea, stridor if

``` Bloods: normal serum Ca low phosphorous low 25-hydroxy vit D high plasma alk phos high PTH CXR: cupping + fraying of metaphyses + widened epiphyseal plate ```

Rickets

What are the cases of rickets?

nutritional: dark skin reduced sunlight exposure maternal deficiency dietary: exclusive breast feeding, strict vegan diets, parenteral feed malabsorption: coeliac, CF cholestatic liver disease defective D2 production: chronic liver disease incr D3 met: chronic renal disease, Fanconi synd,

What are clinical features of rickets?

``` FTT/short stature frontal bossing craniotabes delayed ant fontanelle closure delayed dentition harrison sulcus metaphyses expansion bowing of weight baring bones hypotonia seizures ```

What are complications of vitamin A deficiency?

xeropthalmia: night blindness -> corneal ulceration + scarring incr susceptibility to infection esp. measles

What are the complications of childhood obesity?

``` ortho: slipped upper femoral epiphysis, tibia vara idiopathic intracranial htn: headaches + blurred optic disc PCOS T2DM HTN gall bladder disease ashtma hypoventilation syndrome psych sequelae ```

BMI parameters in children

overweight: BMI>91st centile obese: BMI>98th centile v severe obese: BMI >3.5SD above the mean extreme obese: BMI>4SD

What pharmacological therapy can be considered in treating childhood obesity?

>12yrs BMI>40 or >35 + complications after dietary, exercise + behavioural approaches begun orlistat: lipase inhibitor, reduces absorption of dietary fat metformin: biguanide increases insulin sensitivity, decreases gluconeogenesis, decreases GI glucose absorption

What non-pharmacological methods can be used to combat childhood obesity?

healthier eating: reduce sugar intake in drinks, reduce portion size, increase protein and non-carb veggies increase habitual physical activity: 60min/day reduce physical inactivity: i.e. small screen time to

How does water fluoridation prevent dental caries?

ionic substitution --> calcium fluorapatite instead of calcium hydroxyapatite in the enamel less soluble in organic acids excess fluoride prior to enamel formation can cause dental fluorosis

Risk factors for dental caries

socioeconomic deprivation | 'prop feeding': putting infants to bed with milk or juice

At what age are infants able to roll?

>6 months Front -> back 24 wks Back -> front 28 wks

What is the definition of obesity in children?

BMI > 95th centile

What is the definition of obesity in adolescents?

BMI > 30 kg/m^2

How would you manage an obese child?

Treat any medical cause Lifestyle changes: more exercise, portion control, healthy options - dietary advice Behavioural therapy

What are the causes of obesity in children

Majority = primary obesity | Positive energy balance stored as adipose tissue