growth, nutrition, anticipatory guidance Flashcards
bedwetting treatment
- can be primary or secondary (after 6mo continent)
- self esteem, limit fluids + caffeine before bed, empty bladder, pull-ups instead of diapers, involve in morning cleanup - no punishment
- alarms - for older kids
- desmopressin - ADH analogue, for short term (eg sleepover)
Normal sleep amounts
babies - 14-16hrs
toddlers/preschool - 10-13 hrs
night terrors
first 3rd of night, agitated if awakened, no recall
nightmares
last 3rd of night, mild arousal, agitate after, vivid recall, daytime sleepiness, common
colic definition + timing
paroxysms of crying without cause
lasts 3h/d, 3d/wk, for 3+ weeks
no FTT
peaks at 6wks, lasts until 3-4mo
worse in evening, afternoon
no treatment. Possibly CMPA diet if think causing.
exercise guidelines
toddlers - 180min active per day, 60 energetic by age 5
kids + teens: 60min per day, vigorous 3x/wk, strength 3x/wk
limit sedentary + screen time
normal growth rates
- lose 10% weight in first 4-6d
- regain BW by day 10-14
- double weight by 4-6m, triple by 1 yr
- HC < 32 at birth = microcephaly
- length/height - doubles by 4 years
- growth charts - use corrected up to age 2 years for premies
failure to thrive definition
weight <3%ile, falls across a major %ile, weight <80% of ideal body weight
FTT Ddx
- non-organic / psychosocial = most common
- congenital: turners, downs, FAS, TORCH, etc
- cardiac: CHF
- resp: CF, recurrent infection
- GI: GERD, vomiting, IBD, liver disease, malabsorption (CF, celiac)
- renal: chronic renal failure, obstructive uropathies
- endocrine: thyroid (high or low), hypopit, T1DM, DI
- CNS: swallowing, ID, CP diencephalic syndrome
- heme: chronic blood disorder, malignancy
- inflam: SLE, immunodef
Work-up for FTT
- based on Hx + PE
- look for etiology + sequelae (deficiencies)
could consider:
- CBC, lytes
- urea, Cr, UA
- TSH, T4
- celiac (TTG or EMA, IgA)
- vit A/D/E, ferritin, Ca?
- karyotype, microarray, bone age if short stature
Obesity definitions
age 0 - 2: use weight for length
age 2+ use BMI percentile
age 0-5:
- 85%ile = risk of overweight
- 97%ile = overweight
- 99.9% = obese
age 5-19:
- 85%ile = overweight
- 97%ile = obese
- 99.9% = severely obese
adults (BMI):
- > 25 = overweight
- > 30 = obese
Obesity Hx
- for comorbidities + etiologies
- headache + blurred vision (IC HTN)
- OSA sx
- joint pain
- menstrual hx, hirsuitism, acne (PCOS)
- polyuria, acanthosis
- stunted growth, striae
- hepatomegaly
- early puberty
- fam hx
- diet + exercise hx
- mental health (binge eating, mood, bullying, self-esteem)
- famHx: metabolic syndrome, CVD, etc
work-up for obesity
- lipids, glucose, A1C
- ALT q2y, if high consider liver US
- fasting lipids q2y
- if severe: PG, A1c q2y
- sleep study if symptoms
RF for FTT
child: LBW/premie, feeding/sleep/elimination issue, illness, dev delay
parent: hx abuse, unplanned preg, marital issue, drugs, young, stress, poor f/u, misconceptions re eating
both: colic, refusal to feed, behavioural issue, not respond/recognize needs
environment: low SES, social isolation, access to care
hx + PE for FTT
- detailed feeding hx
- behaviour
- vomiting, BMs, urine
- pregnancy/birth hx
- development
- fam hx (parent heights + puberty)
- med hx
- relationships, soc hx
- temperament, parent interactions
- Ht/Wt/HC on charts
- HR, RR, BP
- full PE
management of obesity
- structured behaviour programs (for treatment only, not prevention_
- permission to counsel, SMART goals, “root causes”, follow-up
- behaviour + health goals (not #s)
- include family in changes
- multi-D team
- meds not routine, surgery for select adolescents (not routine)
Contraindications to Breastfeeding
- galactosemia
- HIV, HTLV, herpes on breast, active TB in mom
- meds
Supplements for breastfed babies
- 400IU vit D per day
- prevents rickets, hypocalcemic seizures
Signs of successful breastfeeding
- <7% weightloss in first few days of life
- reach BW by 2 wks
- 20-30g / d weight gain in first 3mo
- milk “in” by day 4
- latches easily
- 3-6 stools per day, 4-6 voids/d (by 5-7d old)
- 8+ feeds per day
forumla types and uses
regular - for most babies
lactose free - cow based, for lactose intolerance (very rare)
for babies who spit up - can use for delayed gastric emptying/GERD
soy - for galactosemia (NOT for premies or CMPA - cross reacts)
partially hydrolized (nutramigen) - for CMPA (diarrhea, bloody stool, GERD, mayyybe constipation)
amino acid based - if fail extensively hydrolized
Calorie and fluid requirements
0-6mo:
about 100kcal/kg/day (a bit less >3mo)
TFI = 150-180
6m-3yrs:
80kcal/kg/day
TFI = 100-120ml/kg/d (ish)
Feeds per day
to 1wk: 8-10x, 2-3oz
1wk-1mo: 6-8x, 3-4oz
1-3mo: 5-6x, 4-6oz
can stop night feeds around 6mo if desired
Foods to be introduced at specific times
- start around 6mo when sitting, interested, opens mouth
- cont BFing up to 2 years
- cont formula until around one year
- start /w iron rich foods
- introduce lumpy before 9 mo
- avoid choking hazards
- introduce whole milk 9-12mo, no more than 500ml per day
- family milk at age 2
- no honey before age 1
- open cup at 6mo
