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MBBS IV - Junior Clerkship WCS > JC120 (Paediatrics) - Child early growth and nutrition > Flashcards

JC120 (Paediatrics) - Child early growth and nutrition Flashcards

1
Q

Key determinants of growth during infancy, young childhood and puberty

A

Fetal stage/ infancy – nutrition = single most important factor

Young childhood – growth hormones, thyroid hormones

Puberty – sex hormones

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2
Q

Physiological factors that limit infant digestion and nutrition

A

Neonatal GIT is underdeveloped:

  1. Uncoordinated sucking and swallowing
    - Poor esophageal motility
    - Poor LES tone and frequent reflux
  2. Delayed gastric emptying
  3. Disorganized intestinal motility: rapid emptying of ileum and colon limits water and electrolyte absorption, risk of dehydration
  4. Less GIT secretions for digestion (salivary, pancreatic, gastric, HBP…)
  5. Immature kidneys unable to expel undigested waste products
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3
Q

Describe how the fetal GIT develops for nutritional uptake

A

Fetal GI tract is exposed to constant passage of fluid that contains Growth factors, Hormones, Enzymes, Immunoglobulins
»> transitional changes to support growth of GI tract:
 Mucosal differentiation, GI development
 Development swallowing, intestinal motility

Gut hormones also causes GIT to mature

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4
Q

Describe how immature kidney function influences neonatal nutrition

A

Immature nephrons and pituitary gland in neonates = cannot concentrate urine and process high solute loads

> > Selection of food with Low potential renal solute load is better than high renal solute load

Human milk (= best, lowest burden) 
Whole cow milk (= highest solute load, do not give)
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5
Q

Factors that changes amount of gut hormones in neonates

A
  • Elevated in fetal distress for passage of meconium (meconium-stained liquor; MSL)
  • Enteric intake of food&raquo_space; induce epithelial hyperplasia, stimulate microvillous enzymes production
  • Early enteral feeding and breastfeeding increases GIT hormone expression
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6
Q

Role of gut hormone in neonatal GIT development

A

1) Gut motility - Motilin
2) Tropic to gut mucosa - Enteroglucagon

3) Intestinal mucosal and pancreatic growth
 Enteroglucagon
 Gastrin
 Pancreatic polypeptides

4) Stimulus to insulin release - Gastric inhibitory polypeptide (GIP)

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7
Q

Clinical assessment of nutritional deficiency in a baby

A

Signs: Cachexic appearance, marked wasting over buttocks, stunting, failure to thrive

Growth parameters:

  • Body proportion: weight/height, +/- head circumference
  • Growth record (compare with past)
  • Comparison with other babies (relative to peers: age- and sex-appropriate)
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8
Q

Key milestones of child growth

  • Birth weight
  • Weight trend
  • Height
  • Head circumference
A

Birth weight at term:
 3.2kg (F)
 3.4kg (M)

Weight:
 Double by 4 months (6-7kg)
 Triple by 10 months

Height:
 1⁄2 adult height by 3 years
 3⁄4 adult height by 9 years

Head circumference – 85% adult HC by 3 years

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9
Q

WHO criteria for child growth failure

- Underweight, stunting and wasting

A
  1. Underweight = Z-score cut-off point of
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10
Q

Failure to thrive

  • Clinical definition
A

Definition (= medical diagnosis):
 Failure of expected growth in children younger than 3 years
 Downward crossing of two percentile lines in weight over 6 months

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11
Q

Outline groups of causes of failure to thrive

A

Poor processing of nutrition:

  • Inadequate calorie intake
  • Abnormal digestion/ malabsorption
  • Inability to process calories - Syndromal genetic diseases/ Metabolic disorders
  • Excessive loss

Increased calorie requirement/ abnormally high calorie requirement

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12
Q

Causes of inadequate calorie intake in a neonate/ child

A 
Maternal Factors: 
 Failed breastfeeding
 Inappropriate feeding technique
 Wrong formula
 Poor preparation (misconception/ tradition)

Child factors:
 Congenital anomalies (e.g. cleft palate)
 CNS disorders (e.g. swallowing problem)
 Distress (due to cardiopulmonary conditions)
 GI – vomiting, GER (reflux)

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13
Q

Causes of malabsorption in a neonate/ child

A

Primary: Uncommon (e.g. cystic fibrosis)

Secondary:
 Post-gastroenteritis (common): secondary disaccharidase deficiency  meal intolerance
 Necrotising enterocolitis (NEC) – premature baby
 Short gut syndrome (due to surgical resection of ischemic bowel)
 Food allergy/ intolerance

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14
Q

Causes of defective calorie processing in a neonate/ child

A

Syndromal diseases - e.g. Down syndrome

Metabolic disorders:
 Inborn errors of CHO metabolism
 Aminoacidopathies
 Mitochondrial diseases

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15
Q

Causes of increased caloric requirement in an infant/ neonate

A

 Chronic/ recurrent infection – urinary tract infection, tuberculosis
 Chronic respiratory insufficiency – bronchopulmonary dysplasia (BPD), CF (Caucasians)
 Congenital/ acquired heart disease
 Chronic anemia
 Malignancy
 Toxins – lead
 Drugs excess – thyroxine
 Endocrine disorders – hyperthyroidism (high metabolic rate)

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16
Q

Physiology of milk expression during breastfeeding

A

Baby sucks nipple: stimulates nerves in breast via autonomic nervous system to hypothalamus:

  1. Inhibit release of dopamine (reduce tonic inhibitory effect)&raquo_space; lactotrophs in anterior pituitary free to express its
    inherent capacity&raquo_space; secrete prolactin at a very high rate (lacteal glands produce milk for next feed)
  2. Produce and transport oxytocin to posterior pituitary gland&raquo_space; act on myoepithelial cells (contract to eject
    milk for this feed)
17
Q

Nutrients contained in breast milk

A

Energy: 67 kcal/100ml

Nutrients:
 Carbohydrates – lactose, oligosaccharides
 Proteins – LF (lactoferrin), α-lactalbumin, b-casein, lysozyme; cytokines, antibodies…
 Fat – LC-PUFA (long-chain polyunsaturated fatty acid: DHA (docosahexaenoic acid), AA (arachidonic acid), EPA (eicosapentaenoic acid))
 Micro-nutrients (vitamins), trace metals (Fe, Ca)

18
Q

Benefits of breastfeeding to baby

A

 Nutritional value: best composition with high bioavailability

 Enzymes, hormones and immune factors

 Reduce obesity and overfeeding (breastmilk is tailor-made to need of baby at different stage)

 Less contamination, readily available

Offers unique immunologic protection:

  1. Matches with sequence of postnatal development of immune system
  2. Helps adaption of the gastrointestinal tract in the switch from fetal to postnatal life

Protects against infections & allergy – 3 overlapping groups of bioactive agents:

  1. Direct-acting antimicrobial agents
  2. Anti-inflammatory agents
  3. Immunomodulating agents
19
Q

Benefits of breastfeeding to mother

A 
 Involution of uterus
 Better physical shape
 Less neoplasm (breast cancer)
 Improves psychological well being
 Less postnatal depression
20
Q

Benefits of breastfeeding to family and society

A

Family:

  • Maternal- infant bonding (attachment)
  • Reduce withdrawal, behavioral problem and child abuse / neglect
  • Contraceptive effect (for birth control)
  • Most economic & effective way of feeding

Society:
 Less medical consultations
 Less hospitalizations
 Less medical expense related to infections

21
Q

Health risks associated with not breastfeeding to baby and mother

A

For baby:
 Diabetes: 40%
 Obesity: 25%
 Recurrent ear infection (otitis media): 60%
 Hospitalization for asthma/ pneumonia: 250%
 Death in first year: 27%

For mother:
 Maternal breast cancer: 39%
 Maternal type 2 diabetes: 14%/year

22
Q

Disadvantages/ Risks of breastfeeding to baby

A

 Infections – virus, e.g. HIV, CMV, HTLV (T-cell lymphoma)

 Transmission of undesirable drugs, e.g. chemo-, radiotherapy, psychiatric drugs

 Inborn error of metabolism – babies require special diet

23
Q

Disadvantage/ risks of breastfeeding to mother

A

 Physical exhaustion (frequent, on- demand feed)

 Emotional stress

 Impaired sleeping quality

24
Q

WHO recommendation for neonatal diet and breastfeeding period

A

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to 2 years of age or beyond

25
Q

Describe pancreatic function at birth and compensatory mechanisms for neonatal nutrition

A 
Pancreatic function: relatively deficient at birth
Pancreatic enzymes (mature levels not achieved until late infancy)

Protein digestion:
- Gastric acid, pepsin, trypsin, chymotrypsin, pancreatic proteases, intestinal mucosal peptidases: all low level/ activity at birth

Carbohydrate digestion:

  • Pancreatic amylase level is low until 4-6 months - Compensated by breastmilk amylase
  • Disaccharidase level is normal - compensated by fermentation/ absorption in large intestines
  • Lactase level is low until 3-5 years

Fat digestion:

  • Pancreatic lipase is low until 1-2 years - compensated by lingual absorption, gastric absorption of breast milk
  • Bile acid level is low until 6 months - compensated by bile-salt stimulated lipase

MBBS IV - Junior Clerkship WCS (131 decks)

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