Lecture 26 Nutrition in pediatrics Flashcards
What is considered normal growth when it comes to percentile within a growth chart for children?
between the 3rd and 97th percentile
What does infant nutrition look like, and some measures to assess their nutritional status?
they feed Q2-4H 8-12 x/day, formula fed usually feed less than breast
140-200 mL/kg/day around 90-135 kcal/kg/day
over time larger amounts consumed with less feeding
at 3 weeks, 6 weeks, and 3 months its normal for babies to feed more frequently for a few days to meet their growing needs
Measures of Status: number of wet diapers, ‘ins and outs’
infants who don’t readily arouse for food should be wakened to feed if more than 4 hours have elapsed since the start of last feeding
recommended to exclusive breastfeed for first 6 months of life if possible
What are things that breastfeeding helps protect against/reduce, and contributes to for the mother?
Protect/Reduce: asthma, gastroenteritis, RTIs, OM, late onset sepsis in pre-term infants, T1D and T2D, sudden infant death syndrome, lymphoma, leukemia, Hodgkin’s disease
Benefits for Mom: decreased postpartum bleeding, more rapid return to pre-pregnancy uterine size, reduce risk for T2D, reduced risk of postpartum depression, decreased risk of some cancers
What are true contraindications for breastfeeding?
infants with galactose 1-phosphate uridyltransferase deficiency (galactosemia)
mother is HIV antibody +
acute H1N1 flu
undergoing chemo with drug not compatible
active herpes outbreak on breast
taking drug not compatible
illicit drugs
What is galactosemia, S&S of it in infants, and how to treat/manage it?
means galactose in blood, caused by mutation in the GALE, GALK1, and GALT genes
hereditary as autosomal recessive disease
GALT enzyme missing or non-functional
babies with this aren’t able to metabolize galactose found primarily in breast milk, cow’s milk and dairy products
S&S: can build up in tissues and cause toxicity and can cause death
refusal to eat, spitting up or vomiting, jaundice, lethargy
later in life - learning disabilities (delayed speech), neurological (ataxia, tremors), ovarian failure
Tx: food avoidance (ex. cow’s milk, butter, yogurt, cheese, ice cream, whey, casein)
may need Ca2+ and Vit D supplementation
What are the types of infant formula, who should use it, and what are the components?
Types: Cow’s Milk infant formula for healthy term infants, specialized infant formulas, ‘organic formula’, etc,, Uses: can be used for infants who are not being exclusively breastfed
infants who are partially breastfed or not at all should receive iron fortified commercial infant formula until 9-12 months ⇒ 3.25% milk may also be introduced at 9-12 months
infants drinking soy formula should drink follow-up soy formula from 12-24 months
Components: commercial ones have 0.67 kcal/mL with 40-45% from carbs, 8-12% protein, and 45-50% fat
meant to mimic human milk
in infants at high risk of infection, pre-term or low birth weight, who are less than 2 months use liquid concentrate and ready-to-feed formula since powder isn’t sterile
What are vitamins and minerals that may be supplemented in infants?
Vit D: due to geography Albertans get less sun exposure ⇒ 250 mL of breastmilk = 10 IU, 250 mL of formula or cow’s milk = 100 IU
all fully and partially breastfed babies require a vitamin D supplement of 400 IU/day, not to exceed 1000 IU/day
Iron: by 6 months babies need iron from food regardless of it they are on formula or breastmilk
offer iron rich foods rich in vitamin C to aid absorption ⇒ iron fortified baby cereal, meat and meat alternatives
What are signs that an infant is ready to start eating solid foods and how should it be started, what foods and factors to consider?
most are ready around 6 months of age (continue to breast feed or formula while starting)
Signs: can hold head up, sits well in high chair, shows interest in food, makes chewing motions, can close mouth around a spoon
Start: parents choose the food but baby chooses how much to eat
start with 1-3 teaspoons, give baby 1 new food at a time, waiting 2 days to add next new food, start with pureed/smooth/mashed, change texture as baby grows, encourage self feeding as soon as baby is ready
don’t give honey until 1 years old (pasteurized honey after 1)
offer sips from open cup if thirsty,, for children above 2 years ⇒ skim, 1% or 2% milk recommended
What infants are at risk for allergies, what are common foods that can be introduced early to try and prevent allergies, and how should they be introduced?
At Risk: have hx of atopy, have first-degree relative with atopy F
oods: cow’s milk, egg, peanut and tree nuts, wheat, soy, shellfish, fish
Introducing: ensure texture, size, and shape is appropriate, introduce common allergenic foods one at a time, continue to offer these foods a few times a week to maintain tolerance
if rxn happens stop offering and consult physician
