Growth, Development + Nutrition

Question 1

Why are infants more vulnerable to poor nutrition?

Answer 1

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

Question 2

What diseases are associated with low birth-weight?

Answer 2

CHD
stroke
htn
non-insulin dependent DM

Question 3

What is colostrum?

Answer 3

produced for the first few days

higher protein and immunoglobulin content

Question 4

What do the WHO recommend re breastfeeding?

Answer 4

exclusive breastfeeding for first 6 months of life

Question 5

What are long term health benefits of breast feeding?

Answer 5

reduced incidence of:
DM
obesity
htn
breast cancer

Question 6

What are possible complications of breast feeding?

Answer 6

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!

Question 7

What are general benefits of breastfeeding?

Answer 7

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

Question 8

What are the anti-infective components of breast milk?

Answer 8

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

Question 9

What are the nutritional properties of breastmilk?

Answer 9

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

Question 10

What is the risk of exclusive breast feeding beyond 6 months

Answer 10

nutrient deficiency -> poor weight gain + rickets

Question 11

Why is unmodified cows milk inappropriate for infants?

Answer 11

too much protein+ electrolytes

inadequate iron + vitamins

Question 12

When are infants weaned?

Answer 12

solid food may be introduced as early as 3 months

usually replaces milk as diet staple at 6 months

Question 13

What is the physiological process in breast feeding?

Answer 13

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

Question 14

What is mild failure to thrive?

Answer 14

a fall across two centile lines

Question 15

What is severe failure to thrive?

Answer 15

a fall across 3 centile lines

Question 16

When to get worried re failure to thrive?

Answer 16

weight below 0.4 centile -> always req evaluation

most with failure to thrive are below the 2nd centile

Question 17

What are the causes of failure to thrive?

Answer 17

inadequate intake
inadequate retention
malabsorption
failure to utilise nutrients
increased requirements

Question 18

What are non-organic causes of inadequate intake?

Answer 18

inadequate availability of food
psychosocial deprivation
neglect/child abuse

Question 19

What are organic causes of inadequate intake?

Answer 19

impaired suck/swallow

chronic illness -> anorexia

Question 20

What might cause inadequate retention leading to FFT?

Answer 20

vomiting / severe GORD

Question 21

What might cause malabsorption leading to FTT?

Answer 21

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

Question 22

What might cause failure to utilise nutrients leading to FTT?

Answer 22

syndromes
metabolic disorders
congenital infection
prematurity/IUGR

Question 23

What might cause increased requirements leading to FTT?

Answer 23

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

Question 24

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

Answer 24

a weight for height

Question 25

What measurement might indicate if a child has stunted growth?

Answer 25

reduced height for age

can be an indication of chronic disease or chronic malnutrition

Question 26

What is marasmus?

Answer 26

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

Question 27

What is kwashiorkor?

Answer 27

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

Question 28

How might Vit D deficiency present?

Answer 28

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

Question 29

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

Answer 29

Rickets

Question 30

What are the cases of rickets?

Answer 30

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,

Question 31

What are clinical features of rickets?

Answer 31

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

Question 32

What are complications of vitamin A deficiency?

Answer 32

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

Question 33

What are the complications of childhood obesity?

Answer 33

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

Question 34

BMI parameters in children

Answer 34

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

Question 35

What pharmacological therapy can be considered in treating childhood obesity?

Answer 35

> 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

Question 36

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

Answer 36

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

Question 37

How does water fluoridation prevent dental caries?

Answer 37

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

Question 38

Risk factors for dental caries

Answer 38

socioeconomic deprivation

‘prop feeding’: putting infants to bed with milk or juice

Question 39

At what age are infants able to roll?

Answer 39

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

Question 40

What is the definition of obesity in children?

Answer 40

BMI > 95th centile

Question 41

What is the definition of obesity in adolescents?

Answer 41

BMI > 30 kg/m^2

Question 42

How would you manage an obese child?

Answer 42

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

Question 43

What are the causes of obesity in children

Answer 43

Majority = primary obesity

Positive energy balance stored as adipose tissue