Infants, Toddlers, Adolescents, Elderly Flashcards
1
Q
Preemie baby fat needs
A
Need lots of fat
If cannot digest it need predigested or MCT
Need essential fatty acids - linoleic, alpha-linolenic, EPA and DHA
DHA makes a huge difference in IQ
2
Q
Corrected gestational age
A
Recognizing that a preterm baby will not behave and grow like a term baby - give them a corrected age like -3 months when they are born 3 m premature. Used in hospitals
3
Q
Benefits of breastmilk to preemie babies
A
Do far better with intelligence
Less problems
Much less necrotizing enterocolitis
4
Q
Disorganized feeding
A
If it hurts babies to feed they won’t want to eat. Grow up believing eating is painful and have trouble maintaining their body weight
5
Q
Oral hypersensitivity
A
Type of disorganized feeding where the baby misses a critical feeding window (ie, learning how to chew) that they don’t want the good in their mouth.
6
Q
Inborn errors of metabolism
A
PKU Maple Syrup Urine Disease Galactosemia Down Syndrome Autism
7
Q
How many tests done in CO for inborn errors of metabolism
A
38
8
Q
Why might newborn screening tests have to be done twice?
A
Baby has to have drank milk for 24 hours in order for tests to work but tested and discharged too soon.
9
Q
Autosomal recessive trait
A
Both parents need to have the recessive gene, and there is a 25% chance of the baby getting the disease
10
Q
PKU caused by
A
Lack of phenylalanine hydroxylase, the enzyme that converts excess phenylalanine (an essential AA) into tyrosine so the phenylalanine doesn’t build up and cause brain damage
11
Q
PKU diet
A
Diet customized for patient that does not have excess phenylalanine in it. Need some Phe because it is an essential AA - balance to find the right amount
12
Q
Lofenalac
A
Formula for PKU patients where most of the Phe is taken out and it is fortified with Tyr.
13
Q
Phenyl Free
A
Formula for PKU patients. Tastes vile.
14
Q
How long do patients with PKU need to be on PKU diet?
A
Forever. Used to be able to go off diet when a teenager, but have found that you lose IQ points
15
Q
What happens when woman with PKU gets pregnant
A
Unlikely that baby gets PKU. But baby is en utero the baby has PKU and the mom has to go back on the formula/diet because the effects on development are severe.
16
Q
Food with high phenylalanine
A
Milk
Meat
Diet soda
17
Q
Preemie babies kcal and protein needs
A
120 kcal/kg or higher if infections
3 - 3.5 g protein/kg
18
Q
Branched chain AAs
A
Isoleucine
Leucine
Valine
Are in high concentration in muscles
19
Q
Maple syrup urine disease
A
- Cannot break down branched chain AAs.
- Baby will convulse and die if not treated
- baby esp urine smell like maple syrup
20
Q
Treatment for maple syrup urine disease
A
- Protein free diet and formula with no BCAA. Have to make sure they have enough of the AAs but not any extra.
- sometimes put on dialysis
- kids can be doing well until they get sick, and then their levels skyrocket
21
Q
Galactosemia
A
Lack the enzyme to break down galactose (component of lactose) which is in breastmilk and formula
22
Q
Treatment for galactosemia
A
Use soy formula or lactose free formula - read label.
No cheese even though 99% lactose free
No green beans, organ meat, legumes - have lactose
23
Q
Effects of galactosemia
A
Mental impairment and females have trouble reproducing
24
Q
Down syndrome - another name
A
Trisomy 21
25
cause of Down syndrome
Three copies of chromosome #21
26
Odds of Down syndrome by mom's age
20 yr old - 1:2000
| 49 yr old - 1:10
27
Physical Characteristics of Down syndrome kids
```
Short
Proportionally short limbs
Flat broad faces
Flat filtrum
Folds of skin in corner of eyes
Unusual crease across hand
```
28
Effects of Down syndrome
- lower IQ (50 vs 90-109) - mentally 8-9 yrs old
- 50% have heart defects
- some have GI defects
- hypothyroid
- hearing and vision problems
- obsessive/compulsive disorders
- hard time dealing with change
- nutritional issues - obese when older (hypotonia) and lack of weight gain when younger (disordered eating)
29
Autism (aka autism spectrum disorders)
Spectrum of disorders from autism to Asburger's syndrome with main characteristics of social impairment, communication impairment and repetitive behaviors
- nutrition problems from being stuck on one food and compulsions - often have neophobia and sensory issues with food
30
Feeding at 1 year
Wean child from bottle and replace with whole cow's milk
Should be eating the same foods as the family
At 2 yrs change to 1% milk
31
Definition toddler
1-3 yrs
32
Definition preschooler
3-5 yrs
33
How many times do you need to offer a toddler a new food before they eat it
8-12
34
Division of eating responsibilities
Adult: what is served, when and where to eat
Child: what and how much to eat from what is offered; whether to eat
- child can choose not to eat, but should not get anything until next meal
35
How many times per day to feed toddlers and small children
6 times - 3 meals and 3 snacks
36
Calcium - why kids need
Laying down bone mineralization, have 90% of your bone density by the time 18 yrs old - need enough Ca to be able to develop peak bone density
37
Kids' fluoride needs
6m - 3 yrs: 0.25 mg if less than 0.3 ppm in water
3 - 6 yrs: 0.5 mg if less than 0.3 ppm
0.25 mg if 0.3 - 0.6 ppm
38
Streptococcus mutans
Bacteria that causes tooth decay when it comes into contact with sugar
39
Kids - lead concerns
Is an issue if you have an old house and may have lead paint - kids like to peel it and suck on it because it tastes sweet
40
Nutrients that effect lead absorption
Adequate iron decreases lead absorption
Vitamin C increases lead excretion (but cannot cure lead poisoning)
Ca decreases lead absorption
41
Guidelines for obesity prevention
1) limit SSBs
2) eat fruit and veg in recommended amounts
3) limit TV and screens to
42
If child is obese, weight loss?
No - want them to slow their weight gain and grow into their weight
43
Four stages for childhood obesity
Stage 1 - prevention plus
Stage 2 - planned, structured diets
Stage 3 - comprehensive multidisciplinary intervention
Stage 4 - tertiary care intervention
44
Stage 1 for childhood obesity treatment
Prevention Plus - do all the prevention stuff but really emphasize them, do a lot of follow up, support really makes a difference as long as it is not nagging
- goal is weight maintenance until
45
Stage 2 for childhood obesity treatment
Start planned, structured diets
| TV reduced to
46
Stage 3 for childhood obesity treatment
Comprehensive Multidisciplinary Intervention -
- Weekly visits with team for minimum of 8-12 weeks - team of exercise specialist, behavioral counselor, RD and primary care provider
- structured behavior modification from therapist
- food monitoring
- physical activity goal setting
- negative calorie diet - trying to lose weight - not more than 1 lb per month
- behavioral counseling for parents
47
Stage 4 of childhood obesity treatment
Tertiary care intervention - only for severely obese adolescents with comorbidities who have failed other treatments
- replacement meals, VLC diets, protein sparing fasts, bariatric surgery if those don't work (BMI > 35 with severe complications, BMI > 40 with moderate complications)
- done in specialty center under constant med supervision
48
Toddlers should grow
8 oz per month
| 0.4 inch per month
49
Preschoolers should grow
4. 4 lbs per year
| 2. 75 inches per year
50
Growth charts at age 2 - 20
CDC
Weight for age and height for age on front
BMI for age on back
51
Overweight and obese on growth chart for 2-20
On BMI for age chart, overweight is >85% and obese is >95%
52
Overweight on growth chart for
Weight for length > 95th percentile
53
Adiposity rebound
The point on BMI for age chart when the graph stops sloping down and starts sloping up. Occurs earlier in life (around 4 years) for kids > 95% and later in life (around 6 years) for kids
54
Protein requirements for kids
1-3 yrs: 1.1 g/kg
4-8 yrs: 0.95 g/kg
No problems with protein if eating needed kcals and growing well on charts
55
Three minerals you need to watch in kids
Iron
Calcium
Zinc
56
Who in US is most likely to be iron deficient
Kids between 9-18 months old
Pregnant women
57
Effects of iron deficiency
Anemia
Mental development - Lose IQ points
Behavioral disturbances
Growth issues
58
Tests usually used for iron deficiency and why they are not helpful
Hematocrit
Hemoglobin
Usually by the time they drop the effect on mental development has already happened
59
Test that should be done for iron deficiency and why it is not
Serum ferritin, not used because it costs around $400 vs 11 cent hemoglobin
60
Levels of normal hemoglobin for kids 5 and under
1-2 years: 11.0 g/dL
2-5 years: 11.1 g/dL
(Sea level)
61
CDC recommendations for hemoglobin testing
High risk (low income, vegetarian parents, bad diet)
Between 9-12 m
6 m later
Annually until 5 yrs old
Low risk: everyone screened at 1 yr (per AAP)
62
Maximum amount of milk kids should have at 12 m
24 oz (limited to prevent milk anemia)
63
Milk anemia
Switching from formula to cow's milk at 1 yr and have not introduced enough solid foods
Most common cause of anemia at 1 yr
64
Treatment for anemia
2 mg Fe per kg per day
Do it for 1 m
If you see an increase of 1 g/dL or > 3% increase in hematocrit, then you know the kid was iron deficient and should continue the drops
Test again at 6m
65
Foods to recommend that will increase iron
Meat
Fortified cereal
Legumes
Not spinach
Not peanut butter
66
Deficiencies other than iron that can cause anemia
Folate
B12
B6
67
What mineral to check when kids are not growing well
Zinc - give them zinc and growth takes off
68
What deficiency from taking zinc supplements too long
Copper
69
Cystic fibrosis
Autosomal recessive trait, most common lethal birth defect, causes defective chloride channels, results in sticky mucus to form in the lungs, pancreas and other organs.
70
Effects of cystic fibrosis
- Salty sweat
- Horrible cough from mucus in your lungs
- Pancreas plugged with mucus and cannot put out digestive vitamins
- Kids noticeably smaller (no digestive enzymes and expending more energy to breathe)
- infections
- steatorrhea
71
Treatment for cystic fibrosis
1) monitor growth with growth charts
2) monitor food intake - needs 2-4x more kcal and protein
3) fat-soluble vitamins - need water miscible ones
4) watch water soluble vitamins too - good supplement candidate
5) take enzymes with meals
6) small frequent meals
7) night feeding - PEG or NG tube - not TPN cuz infections
8) increase fiber and fluid due to constipation
9) eat more salt because don't regulate it well
72
% kids 8-18 that have a tv in bedroom
71%
73
Extra time kids watch tv if in bedroom
Extra 1 1/2 hours
74
% households that have TV on all the time
51%
75
Age group that watches the most tv
8-12 yr olds
76
Negative effects of TV
1) decreased play and activity
2) too stimulating with fast frames then kids need it
3) loss of social interaction
4) overheating while watching or due to cues
5) decreased sleep
6) behavioral issues - desensitized to violence
7) replaces reading
8) negative correlation with grades
9) more likely to drink, smoke, drugs, sex
10) stereotypes get ingrained
11) aggressive, violence, no empathy associated with humor
12) obesity, lack of exercise, poor food choices
13) parents spend less time with kids
77
Correlation between obesity and tv
- RMR slows to less than if you were doing nothing
- positive correlation with obesity, esp for > 2 hrs
- having TV in bedroom positive correlation w/ obesity
78
AAP recommendations for kids and tv
= 2 yrs - max screen time 1-2 hrs per day and should be quality tv
- no screens in bedroom
- screen-free zones in house
- TV watching should be purposeful, not background
- absolutely no tv during meals
79
Children's Television Act - 1990
Encourages broadcasters to have at least 3 hrs/ week educational programming for kids
- limits commercials on weekends and weekdays
- cannot use your program characters to advertise
80
Adolescence - definition
From 11-21 years of age when your body goes from immature to a fully functional adult
81
Puberty ages, girls vs boys
Girls: Starts between 8 and 12 years old, takes about 3 years.
Boys: starts between 9-14 years, takes about 4 years
82
Reasons why puberty may be occurring earlier
- better nutrition
- overweight
- chemical exposure
- phytochemicals and pharmaceuticals in foods
- stress
83
Females - weight gain/lean and fat body mass during puberty
- Can gain 18.3 lbs per year (peaking at 12.5 yrs, slowing at menarche)
- 44% increase in lean body mass
- 120% increase in fat mass
84
Needed body fat for menarche
17% to go through menarche, 25% for normal menstruation
85
Males weight gain and body fat in puberty
- Gain 20 lbs per year
| - body fat decreases to 12%
86
Things that increase or decrease bone density for adolescents
- calcium, vitamin D increases
- weight bearing exercise increases
- obesity is protective against osteoporosis
- salt decreases
- smoking decreases
- phosphorus increases
- protein, vit K - unclear
87
Tanner scale
Scale 1-5 to determine where you are in puberty based on secondary sexual characteristics
88
Fastest growing group by population in the US
85+
| Growing faster than any ethnic group
89
Centenarians
100+ years old
90
Supercentenarian
110+ years old
91
Life span
Maximum number of years someone might live. Human life span believed to be 110-120 yrs.
92
Oldest woman
In France, died at 122 yrs in 1977
93
Oldest man
In Japan, died at 116 in 2013
94
Life expectancy
Average number of years you would live if you were born in that year
95
Life expectancy if born today
79.65 years
96
Life expectancies by country
US is 42nd out of 225
Japan is 1st for a large country (84.46)
Chad is last (49.44)
97
According to the study by the horrible racist Terman, factor that determines if you live long or die young
Conscientiousness:
```
Resilient
Prudent
Motivated
Hard-working
Really good social ties
```
98
Longevity
Length of your life measured in years
99
Compression of morbidity
You want the illness period that you go through before you die to be as short as possible
100
Nutrition requirements for elderly
Need at least as much of nutrients as when younger, but energy requirements decrease - need to eat nutrient-dense diet
101
Stats on elderly and social security
35% of the elderly say social security is 90% or more of their income
102
Theories of aging
1) limited cell replication - apoptosis
2) molecular clock - telomeres
3) wear and tear - mutations and toxins
4) free radical stress - but antioxidants don't work
5) rate of living theory - presidents
103
Calorie restriction theory
Short lived studies on animals shows they live longer with calorie restriction if they get all their nutrients
Two long term studies on chimps showed opposite results.
104
Sarcopena
Muscle wasting
105
Senescence
Old age
106
Changes in human body as you age
1) body composition
2) taste and smell
3) teeth
4) appetite and thirst
5) gastrointestinal system
6) cardiovascular system
7) endocrine changes
8) musculoskeletal changes
9) renal
107
Changes in body composition from 30 to 70 years
Loss of lean muscle mass and increase in body fat
Every decade lose 2-3% of your muscle mass but can still build some.
108
Changes in body composition after 70 yrs
Lose lean body mass and fat mass. Overweight is now protective of health.
109
Why do the elderly need to maintain lean muscle mass
Stabilize skeleton, less likely to fall, can support body through an illness, have better functional status (ADLs and IADLs)
110
IADL
Instrumental Activities of Daily Living - can you go out and do your normal things: buy groceries, pay bills. Refers to ability not resources.
111
ADL
Activities of Daily Living - washing self, feeding self, self-care
112
Polypharmacy
Taking multiple drugs
113
Why polypharmacy effects nutrition status
Some drugs interact with nutrients
Are expensive and will buy instead of food
Some drugs or volume of drugs make you not want to eat
Drugs interact and make you sick
114
CDC exercise recommendations for the elderly
1) aerobic exercise 2 hrs and 30 min per week - hard because VO2 max decreases and BP increases every decade
2) muscle strengthening 2-3x per week - maintain or gain LBM, bone density and insulin control
3) balancing exercises 2-3x/week - prevent falls
4) flexibility 2-3x/week
115
Changes in taste and smell for elderly
Both taste and smell decrease when older than 60. Both decrease desire to eat. Loss of smell is an issue with hygiene and food rancidity.
116
Changes with teeth in elderly statistics
25% of people over 65 yrs do not have their natural teeth
Low is 13% in CA and HI
High is 46% in KY
Huge impact on nutrition because you cannot eat
117
Edontulous
No natural teeth in your mouth
118
Appetite and thirst changes in elderly
Appetite decreases after 70 yrs
Thirst is not a good indicator of hydration status especially in elderly - they don't want to drink more because it causes them to have to go to the bathroom
119
Changes in gastrointestinal system for the elderly
HCl decreases
Digestive enzymes decrease
Mucus in stomach decreases
Muscle tone decreases
Constipation decreases
Diarrhea increases - less HCl to kill off bacteria
Nutrient absorption decreases - less intrinsic factor
Heartburn and gerd increase - bacterial overgrowth
Gas increases
120
IOM recommendation for B12 and elderly
Take supplement after age 51.
Make less intrinsic factor and need it to absorb B12. B12 is necessary to maintain myelin sheaths
121
Gallstones in elderly
Very painful and can cause pancreatitis
Being overweight and losing weight increases chances
122
Stats on colon cancer and elderly
If over 50 you double your risk every 5 years
123
Diverticulosis
Outpouches in intestine from straining at stool
2/3 of people 80 and older have it
124
Diverticulitis
When outpouchings become infected
125
Changes in cardiovascular system and elderly
BP increases
Heart cannot pump as much blood
Risk from lifetime of artherosclerosis
126
Endocrine changes and elderly
Sex hormones, growth hormone, glucose tolerance, thyroid hormone all decrease
Cortisol increases
Elderly make 4x less vitamin D, and need more for more fat mass
127
Musculoskeletal changes and elderly
Lean body mass decreases
Bones get weaker
128
Polyurea
Urinating often
129
Nocturia or nycturia
Having to urinate at night
130
Enuresis
Wetting bed
131
Renal changes and elderly
- GFR decreases and harder to remove toxins
- bladder capacity decreases
- ADH decreases - doesn't increase at night like younger people
- less sensation that bladder is full
- bladder doesn't fully empty
132
Prostate and elderly male
Benign prostatic hyperplasia - prostate grows larger beginning at 25 yrs and can constrict urethra and affect urine flow
