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Pediatrics > Lecture 10: Obesity > Flashcards

Lecture 10: Obesity Flashcards

1
Q

How long should a mother exclusively breastfeed?

AAP recommendation

A

First six months

then do BF + foods until 12
then however long mom wants

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2
Q

What are the benefits of BFeeding for baby?

A
  • Protective effect against illnesses
  • Reduce risk of SIDS
  • 15-30% Reduced risk of obesity
  • emotional connection
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3
Q

what illnessees does breast feeding protect against

A
  • respiratory
  • GI disease
  • ear infections
  • allergies (eczema, asthma, atopic dermatitis)
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4
Q

what are benefits of breastfeeding for mom?

A
  • reduced PP hemorrhage
  • longer amenorrhea
  • reduced risk of ovarian and premenopausal breast cancers
  • possible reduced risk of osteoporosis
  • emotional connection
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5
Q

What are the disadvantages of BFeeding?

A
  • Tired
  • Mother is on special meds
  • Baby needs special diet
  • Cannot Bfeed if alcoholic or on drugs
  • Need to supplement Vit D still
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6
Q

When do you feed a baby?

A

When its hungry

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7
Q

How do you know a baby is hungry?

A
  • Licking lips
  • Sticking tongue out
  • Rooting
  • Hand to mouth
  • Opening mouth
  • Fussy
  • Sucking on everything (altho sucking can also be for comfort)

Hunger cues

Crying is a LATE sign of hunger

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8
Q

How often does a newborn eat on average?

A

Every 2-3 hours or 8-12 times every 24 hrs

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9
Q

How do newborn feeding amts increase?

A
  1. First days of life: 0.5 oz/feed
  2. 1-2 weeks: 1-2 oz/feed
  3. 2 weeks: 2-3 oz/feed
  4. 2 Months: 2-4 oz/feed (feeding slows Q3-4h)
  5. 4 months: 4-6 oz/feed
  6. 6 months: 6-8 oz/feed (feeding slows Q4-5h)

Formula-wise: 1oz per month until they get to 7-8 oz/feed.

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10
Q

What kind of baby is most likely to overfeed?

A

Bottle fed

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11
Q

How do you know a baby is getting enough to eat?

A
  • Beginning days: 2-3 WET diapers daily.
  • By 1 week: 5-6 WET diapers daily.
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12
Q

How much Vit D does a baby need?

A

400 IU QD until they drink 1 qt of whole milk

Milk would not start until 1 year at minimum.

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13
Q

What kind of babies need Vit D supplementation?

A

Any baby being BFeed or not drinking at least 32oz of formula

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14
Q

What is the recommended iron supplementation for a newborn baby being BFed?

A

1mg/kg/d of liquid iron until 6 months

They usually start eating food with iron by 6mo.

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15
Q

What is the recommended iron supplementation for a newborn baby being Formula-Fed?

A

Just use iron-fortified formula for the first year. make sure it contains 4-12 mg of iron

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16
Q

How does a baby’s wt change in the first 2 weeks of life?

A

DROPS by 7%, should be gained back by 10-14 days of life

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17
Q

How much wt do we expect a baby to gain daily?

A

15g

100-120 kcal/kg/d needed for this.

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18
Q

When do you check a newborn’s wt?

A

3-5 days after its born.

You would expect a small DROP in wt.

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19
Q

How does formula affect growth of babies

A
  • High risk for obesity in childhood.
  • rapid growth especially at 3/4 mo
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20
Q

what are th possible compositions of formula

A
  • reconstitiuted skimmed cows milk
  • mix of skim cow milk and electrolye depleted cow milks whey/casein protein
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21
Q

What are the biggest benefits of formula?

A
  • Catering to special needs (MPA, galacto, etc)
  • No other supplementation is generally required.
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22
Q

When can you start single grain rice cereal at the earliest?

A

4 months via a spoon BID

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23
Q

how often should you introdduce a new food to a baby

A

at 6 mo of age introduce a new fruit/veggie every 3-4 days

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24
Q

When can you start meats in children?

A

9 months of age

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25
Q

What 4 things signal a child is ready for complementary feeding?

A
  1. Can hold head up unassisted
  2. Can sit unassisted
  3. Bring objects to mouth (interest)
  4. Ability to track spoon and open mouth
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26
Q

What is the danger of introducing peanut foods in the first year to an infant?

A

It is preferred that you DO introduce them to it to reduce their risk of developing an allergy to it.

Unless you have anaphylaxis to it i guess

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27
Q

When is juice recommended to children?

A

NEVER

Diabetes!!

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28
Q

How do milk recommendations change for a baby?

A
  • 16 oz of Whole milk starting at age 1.
  • Switch to skim/2% at age 2.
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29
Q

How many meals/snacks should a 2 year old eat daily?

A
  • 3 healthy meals
  • 2 snacks
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30
Q

When does a baby start getting picky?

A

Around age 1 there is a sharp drop in appetite with increased pickiness

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31
Q

When should you start flintstone vitamins for a kid?

A

18mo, start with 1/2

32
Q

What is the suggested macronutrient breakdown for a baby?

A
  • 55-60% carbs (1/2 should be WHOLE grains!) high fiber!
  • < 30% fats. (saturated and polyunsaturated should be <10% total calories each)
  • 10% Protein?
33
Q

When are chunks of food a choking hazard for kids?

A

Under 4

34
Q

What is the approximate ratio of calories to height for a kid?

A

40 cal/inch

32 inches = 1300 cal

35
Q

how should toddlers serving sizes compare to adult serving sizes

A

childrens serving size should be 1/4 of adults

36
Q

what is the approximate amount of calories that a child should consume based on age groups

A

2-3: 1000
4-8: 1400
9-13: 1600F, 1800M
14-18: 1800F, 2200M

37
Q

What did the Bogalusa study reveal about childhood obesity and adult obesity?

A

Obesity at 2-5 years old = 90% chance of obesity as an adult

38
Q

What is the risk for a child to become obese if 1 parent is? Both parents?

A
  • 1 parent: 3x risk
  • Both parents: 15x risk
39
Q

What are the not so obvious RFs for obesity?

A
  • Later bedtime
  • Ghrelin/leptin hormone dysfunction
  • Diabetic mothers
40
Q

Which hormone, as it rises, makes us LESS hungry?

A

Leptin

41
Q

where is leptin produced

A

adipose fat tissue. when body fat decreases leptin levels fall and appetite increases

42
Q

Which hormone, as it rises, makes us MORE HUNGRY?

A

Ghrelin

Ghrelin Gets Hangry

43
Q

where is ghrelin produced

A

the stomach wall.

44
Q

what hormone suppresses appetite after meals and counteracts ghrelin? where is this hormone produced

A
  • PYY
  • small intestine
45
Q

How does wt gain affect leptin?

A
  • More fat = more leptin
  • More leptin = body starts getting resistant to it
  • Your brain thinks you’re hungry
46
Q

What medications are associated with obesity?

A
  • Glucocorticoids
  • Megace (appetite stimulant)
  • Sulfonylureas (Glipizide, glyburide)
  • TCAs
  • MAOIs
  • OCPs
  • Insulin (excess)
  • TZDs
  • Risperidone
  • Clozapine
47
Q

What hormones among these are increased in obesity?

  • Leptin
  • Estrogens
  • Cortisol
  • GH
  • Insulin
  • Testosterone (male/female)
A
  • Leptin = INCREASED
  • Estrogens = INCREASED
  • Cortisol = INCREASED
  • GH = DECREASED
  • Insulin = resistance
  • Testosterone = DECREASED in men, increased in women
48
Q

what BMI percentages coordinate to underweight, healthy weight, overweight, obese, and severely obese?

A

underweight - <5
healthy weight - 5-84
overweight - 85-95
obese - >95 -99
severe obese - >99

49
Q

What two abdominal organs are we concerned most about in our ROS for an obese child?

A
  • Gallbladder
  • Fatty Liver
50
Q

What disease should we question in the ROS for an obese child?

A

Diabetes!!!!

polyuria, polydipsia, GU itches, blurry vision

51
Q

What is the ideal approach when discussing weight?

A
  • Use nicer terms like excess weight or elevated BMI
  • Show them a growth chart
  • Emphasize that lowering BMI even a little lowers CV risk!
52
Q

What is the general AAP recommendation regarding cholesterol screening in children?

A

ALL children 9-11 should get screened.

53
Q

When is it indicated to screen a child earlier than 10y for cholesterol?

A
  • Parents/GP had ACS/CVA prior to 55 in men, 65 in women.
  • Parents/GP have total cholesterol > 240
  • Child has heart dz, DM, HTN, smoking, obese, or unknown.
54
Q

What does 5 2 1 0 mean?

A
  • 5 fruits/veggies a day
  • 2 hours of screen time max
  • 1 hour of play daily
  • 0 sugar-sweetened drinks
55
Q

What is the recommendation regarding diet drinks?

A

NO DIET DRINKS!

Makes you wanna snack even more

56
Q

Recommendation regarding low-fat diets in children?

A

NO! You want to just aim for healthier fats, not less.

Unsaturated fats are your friends: MUFAs and PUFAs

57
Q

What are the 4 golden rules of eating?

A
  1. Divide responsibilities
  2. Eat when you’re hungry, stop when you’re full
  3. Do not force your child to clean the plate!!!
  4. Eat together
58
Q

What does lack of sleep do to your hormones?

A
  • Increased ghrelin
  • Decreased leptin
  • Increased evening cortisol => insulin resistance

Sleep is #1

59
Q

What is the #1 cause for bullying at school?

A

Obesity

60
Q

What is the FDA approved tx for obesity?

Technically not for children

A

Qsymia (topiramate/phentermine combo) this is NOT FDA approved for children but is approved for obestiy.

61
Q

what other treatments are not FDA approved but have been used for weight loss in childhood obesity?

A
  • topiramate
  • phentermine (tachycardia, psychosis, panic, HF)
62
Q

Generally, what are the minimum requirements for a bariatric sx?

A
  • Older than 15
  • BMI >= 40 or beyond 100% of IBW
63
Q

what is the MC bariatric procedure

A

Gastric bypass (vertical banded gastroplasty)

64
Q

Safest/reversible bariatric procedure?

A

Laparoscopic Adjustable Gastric Banding (LAGB)

65
Q

Vit D deficiency is associated with what lab finding that can lead to obesity?

A

increased fasting inculin levels

66
Q

What is the guideline regarding Vit D levels of around 20-29?

Normal > 30

A
  • D3 OTC 1000U daily
  • Q3mo checks
67
Q

What is the guideline regarding Vit D levels of < 20?

Normal > 30

A
  • D2 (Rx) 50,000U/week
  • Q3mo
68
Q

What underlying female condition may lead to obesity?

A

PCOS

69
Q

what dx has increased free testosterone? what about decreased?

A

increased - PCOS
decreased - Klinefelter syndrome

70
Q

What genetic male condition may lead to obesity?

A

Klinefelter

Low T, and often are obese when adolescents.

71
Q

Metabolic syndrome criteria in children

A
  1. Waist circumference >= 90th percentile
  2. Hypertriglyceridemia >= 110
  3. Low HDL <= 40
  4. HTN >= 90th percentile
  5. Impaired glucose/FBG >= 110
72
Q

What is the MC syndrome form of obesity?

A

Prader Willi Syndrome

73
Q

Where is the Prader Willi Syndrome abnormality?

A

Chromosome 15q

Loss of paternally expressed genes

74
Q

How does Prader Willi Syndrome present?

A
  • Short w/ GH deficiency
  • Hyperphagia w/ obesity
  • Resistant to diet and exercise
75
Q

Why is dieting and exercise hard in Prader Willi Syndrome?

A
  • Hypotonia
  • Hyperphagia drive is insatiable :(
  • They have low metabolism due to their hormonal imbalances

They wanna eat no matter what :(

76
Q

What are the major criteria for PWS? (7)

1 pt ea

A
  • Hypotonia
  • Feeding issues
  • Excessive Wt gain
  • Hypogonadism
  • Facial anomalies
  • Developmental delay
  • Hyperphagia
77
Q

Overall, how do we approach monitoring pediatric obesity?

A
  • Q1-3 mo
  • If no change in 3-6 mo, call wt loss and dietician

Pediatrics (41 decks)

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