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Pediatrics Exam 1 > Lecture 4 - Nutrition And GI > Flashcards

Lecture 4 - Nutrition And GI Flashcards

1
Q

What is optimal infant and young child feeding?

A

immediate - post partum skin to skin within 1 hour

6 months - of exclusive/full breastfeeding

continued breastfeeding with appropriate complementary foods and feeding for 1 year or longer as mutually desired by mother and baby

both AAP and WHO agree that there should be 6 months of exclusive/full breastfeeding

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2
Q

How long should mothers breastfeed for?

A

the first 6 months of exclusive breast feeding

average for 1 year of breastfeeding, up to 2 years (and beyond…)

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3
Q

Women who were encouraged to breastfeed were more than ____times more likely to initiate breastfeeding.

A

4

lower socioeconomic and minorities were impacted the most (more likely to breast feed)

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4
Q

What are the contraindications to breastfeeding (maternal)?

A

HIV, human T cell lymphotrophic virus 1 and 2
acute TB (until 14 days after treatment)
herpes lesions on nipple
active varicella
drugs of abuse and alcohol abuse
maternal medications (JUST LOOK IT UP)

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5
Q

Which drugs of abuse are often okay during breastfeeding?

A

methadone

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6
Q

What are contraindications of breastfeeding (infant)?

A

galactosemia
tyosinemia
PKU

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7
Q

What benefits does the infant get from breastfeeding?

A

complete nutrition
reduced incidence of: URI, otitis media, GI infections, NEC, IBD, asthma, obesity, type 1 DM, SIDS
higher IQ scores

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8
Q

What are the benefits of breastfeeding for the mother?

A 
decreased post-partum bleeding
possible decrease in post partum depression 
reduction in breast and ovarian cancer 
may decrease risk of HTN, CVD 
promotes infant mother bonding 
saves money
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9
Q

How do you educate the mother on appropriate technique for breast feeding?

A

ideally you want the nipple aimed at the top of the mouth and the baby has a large amount of breast in the mouth
the babies nose should be FREE from the breast and the chin should be on the breast
the bottom lip should be flipped outward but you probably won’t see it
the alveolar should be seen the most above the babies mouth
the mother should not feel any pinching
if the baby does not attach well this means the breast produces less milk over time

cheeks dimpling show a shallow attachment

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10
Q

What are the early cues that the infant is hungry?

A

hand to mouth
arousal
rooting

crying is a late sign of hunger

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11
Q

If the baby hasn’t showed any signs of hunger cues or has been sleeping, how often do you want to wake the baby to feed them?

A

every 4 hours

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12
Q

In the first 24 hours of life, how much breast milk does the baby typically drink?

A

2-15mL (this is like 3 teaspoons)

this number slowly grows over the first few days

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13
Q

What is the typical number of urine outputs you should expect in an infant?

A

number of urination = day of life
until they are about a week old

then it should be 6-8 urinations per day to assure adequate hydration

urine usually colorless by day 3-4

brick dust after day 3 is potentially worrisome

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14
Q

When do we expect the first stool to pass in infancy?

A

meconium

within 1st 48 hours

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15
Q

What supplement might be low in infant during breastfeeding?

A

iron (if clinically indicated within the first 6 moths —then everyone gets it after 6 months in foods)

vitamin D RIGHT AWAY

AAP also suggests you avoid cow’s milk before 12 months
and provide fluoride after 6 months

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16
Q

What is the most commonly used formula?

A

cow’s milk protein

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17
Q

If a parent is vegan, what can you suggest for infant formula?

A

soy based formula

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18
Q

Infant dx with galactosemia should be given what kind of formula?

A

soy based formula

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19
Q

Milk protein allergy

A

aka “food protein” allergy

present in first 1-2 months of life

causes food protein proctolitis

  • painless, gross blood in stool
  • presents in first 1-2 months of lie
  • resolve within days to 2 weeks after agent is stopped

resolves by 12 months of age

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20
Q

EPIES

A

food protein induced enterocolitis syndrome

non IgE mediated response to food

this can be medical emergency

clinical dx
presents between 2 and 7 months of age

severe repetitive vomiting and diarrhea within hours of trigger food intake

cow’s milk and soy most common

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21
Q

Lactose intolerance

A

intolerance to milk sugar

full-term infants are born with sufficient enzyme to breakdown lactose –pre-term babies might not have enough enzymes

non-inflammatory

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22
Q

Primary vs secondary lactose intolerance

A

primary is RARE

secondary lactose intolerance after gastroenteritis (transient) or celiac disease

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23
Q

When can solid foods be started?

A

4-6 months of age
head control and oral-motor coordination influence timing

one new food every 3-5 days (single ingredients)

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24
Q

When can infants have cows milk?

A

for formula fed infants —introduced at 1 year of age
ideally Whole milk 12-24 months (out of a sippy cup!)
low fat/skim milk >24 months

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25
Q

Why should infants drink cows milk out of a sippy cup vs bottle?

A

to help prevent carries

to decrease consumption

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26
Q

What supplement must you make sure the mother has if she has a vegan diet and is breastfed?

A

vitamin B12

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27
Q

What is the definition of anaphylaxis shock?

A

acute onset of illness (min to hours) with
skin and or mucosa:
-pruritis, flushing, hives, angioedema

and either:
respiratory compromise
or
hypotension/end or damage

skin sxs occur in >80% of anaphylaxis

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28
Q

What are the recommended doses for epi in children?

A
  1. 15mg <25kg

0. 3 >25kg

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29
Q

Where do you administer epi?

A

IM to the lateral aspect of thigh

even if you have IV access – still do IM

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30
Q

Who gets admitted to the hospital for anaphylaxis shock?

A 
if they had >1 dose epi 
IV fluids for hypotension 
laryngeal edema 
severe asthma 
ingestion as trigger (worry about later effects)
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31
Q

Sensitization

A

The detection of specific IgE toward an allergen through skin prick, intradermal, or serum specific IgE testing

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32
Q

IgE mediated hypersensitivity

A

characterist clinical sxs upon exposure to an allergen
AND
the detection of specific IgE toward that allergen

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33
Q

What foods account for >90% of all food allergies?

A

Cow’s milk, egg, soy, wheat, peanuts, tree nuts, fish, and shellfish

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34
Q

GER vs GERD

A

GER = gastroesophageal reflux
passive passage of gastric content into esophagus with or without regurg/vomiting
NORMAL physiologic process, usually after meals, cause few or no sxs
occurs several time a day in infants, children, adults

GERD = disease
troublesome sxs and/or complications when reflux of gastric contents occurs

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35
Q

Currant jelly stools

A

seen in the triad for intussuscpetion

other things that can mimic this:

  • omicef ABX
  • hot cheetos
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36
Q

What do you do if a mother of a newborn infant has active varicella?

A

isolate mother
give infant VZIG
express milk when no breast lesions
breastfeed when no longer contagious

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37
Q

How much fluid should a 2 day old infant be eating?

A

5-15ml

38
Q

On day 2-3, what is the amount of fluid an infant needs?

A

15-30ml

39
Q

On day 3-4, what is the amount of fluid an infant needs?

A

30-60ml

40
Q

On day 4-5, what is the amount of fluid an infant needs?

A

45-60ml (like 2 oz)

41
Q

Meconium passes in the first 48 hours, then what happens?

A

Transition by day 4, seedy and yellow by day 5 (4-6 stools per day by day 5)

stool with every feeding is normal

can be quite liquidly

42
Q

1 in ____ children in the US are obese

A

5

43
Q

Does absence of skin sxs exclude anaphylaxis?

A

no

44
Q

When do you see GI sxs in anaphylaxis?

A

if the pt is has KNOWN allergy and previous exposure

vomiting and abdominal pain

45
Q

When do you see hypotension in anaphylaxis?

A

RARE after exposure to known allergen

typically NOT seen in children

46
Q

What are the recommended doses for epi in anaphylaxis?

A
  1. 15mg <25 kg

0. 3 mg >25 kg

47
Q

How do you administer Epi?

A

even if they’re in the ER

you give IM to the lateral aspect of the thigh

48
Q

After anaphylaxis, how long does the pt need to be monitored in the ED?

A

4-8 hours

49
Q

When might a pt who had anaphylaxis be admitted to the hospital?

A

if you had to give them > 1 g dose of Epi
if they needed IV fluids for hypotension
laryngeal edema
severe asthma
ingestion as trigger —worry about later effects

50
Q

What are risk factors for development of food allergies?

A

eczema
asthma
environmental allergies
family hx of allergies

51
Q

LEAP study

A

learning about early introduction of peanuts

52
Q

If an infant has severe eczema or egg allergy, or both, when is the earliest that you can introduce them to peanuts?

A

4-6 months

53
Q

When is GER most common?

A

infants age 1-6 months
peak 3-4 months

in infants may occur 100x a day

most GER in infants resolves by 12 months of age

54
Q

What are the clinical features of GERD?

A

regurgitation/vomiting, weight loss or poor weight gain, irritability, heartburn/chest pain (older children), hematemesis, dysphagia, wheezing, stridor, cough, hoarseness

55
Q

At what age, if GER is still present, should you refer to a GI specialist?

A

> 18 months

56
Q

What can you do for parents who are worried about GER in their infant?

A

reassure them
consider adding rice cereal to food to thicken food
dont lay child down flat after they eat

57
Q

What can you do for older children who have heart burn?

A

PPI for 8 - 12 weeks

if no improvement after 2-4 weeks or if relapse after treatment d/c and consult GI

58
Q

Pyloric Stenosis

A

MC surgical disorder in neonates
more common in caucasian males

usually presents 3-6 months of age 
vomiting (non-bilious) 
projectile vomiting 
weight loss despite ravenous hunger 
hypertrophied pylorus "olive" might be palpable

hypochloremic, hypokalemic, metabolic alkalosis, dehyrdation

59
Q

What is the most common surgical disorder in neonates?

A

Pyloric Stenosis

60
Q

When/how do pts with pyloric stenosis present?

A

3-6 months of age with projectile vomiting and possible palpable olive - hypertrophic pylorus

61
Q

What is the treatment for pyloric stenosis?

A

correct dehydration and alkalosis

surgical correction with pyloromyotomy —complications rare

62
Q

Malrotation

A

abnormal intestinal rotation and fixation

60% will present with sxs in the first month of life
bilious emesis
abdominal distention
peritonitis (if untreated)

63
Q

When do you see bilious emesis?

A

with malrotation in children
typically in the first month of life or a bit later in infancy

must consider Volvulus in these pts

64
Q

Volvulus

A

life threatening condition associated with malrotation and twisting of the intestine on the mesenteric axis

needs to be considered in an infant/child with bilious emesis

65
Q

How do you dx volvulus?

A

clinical
upper GI series can demonstrate “corkscrew” appearance of the small bowel
negative imaging doesnt rule out volvulus

surgical consultation and operative intervention are essential

66
Q

Intussusception

A

telescoping of intestines

can involve any section of the bowel, however usually limited to the ileocolic distribution

can be life-threatening –> bowel ischemia can occur as intestine is completely obstructed

67
Q

When do you typically see intussusception?

A

can occur at any age
but incidence is highest in children under age of 2

cause is idiopathic in <2 
consider pathologic in >3 years 
-Meckel's diverticulum 
-polyp
-lymphoma
-vasculitis from HSP
68
Q

What is the classical triad seen with intussusception?

A

abdominal pain
vomiting
currant jelly stools

69
Q

What are other things that might present with currant jelly stools?

A

intussusception
hot cheetos
omnicef ABX

70
Q

Are infants with intussusception consolable when in distress?

A

no

71
Q

How is intussusception dx?

A

US or CT or air contrast enema

72
Q

What is the treatment for intussusception?

A

fluid resuscitation
ABX
surgical consultation
- options inclue air contrast enema or exploration

73
Q

Meckel’s Diverticulum

A

Rule of 2!
most common congenital anomaly of GI tract ~2% of the population
contains rests of ectopic tissues (2 types: gastric or pancreatic)
usually within 2 feet from ileocecal valve
most commonly 2 inches long
children <2 years have highest risk of sxs Meckel’s

74
Q

How can pts with Meckel’s Diverticulum present?

A

SBO
lower GI bleed
intussusception

75
Q

How is Meckel’s diverticulum dx?

A

Meckel’s scan

high specificity
low sensitivity

76
Q

What is the treatment for Meckel’s diverticulum?

A

stabilization - may need PRBCs
surgical consult
-operative management may be warranted even if Meckel’s scan is negative

77
Q

Hirschprung’s Disease

A

1 in 5000 births

absence of ganglion cells in the intestine –when you don’t have ganglion cells in the rectum, the rectum can not relax –this means straining with each stool

78
Q

How do neonates with Hirschprungs disease present?

A 
abdominal distention 
bilious emesis 
large bowel obstruction 
OR 
otherwise healthy infant with delayed passage of meconium
79
Q

Delayed passage of meconium

A

might be Hirschprung’s disease

80
Q

How does an infant/older child with Hirschpurng’s disease present?

A

constipation

child that require rectal stimulation to pass stool

81
Q

How is Hirschprung’s dz dx?

A

refer to Ped GI/ped surgery

supported by rectal exam:
-increased tone; explosive bowel movement after exam
KUB may demonstrate lower bowel obstruction

Gold standard: rectal biopsy –> histology demonstrates absence of ganglion cells

82
Q

What is the gold standard in dx Hirschsprung’s disease?

A

rectal biopsy

–> absence of ganglion cells

83
Q

What is the treatment for Hirschuprungs disease?

A

surgical resection of the aganglionic segment

colostomy followed by endorectal pull through at later date

complications:
- Hirschprungs associated enterocolitis
- constipation
- stricture
- fecal incontinence

84
Q

What is the DDx for constipation?

A 
infants: 
hirschsprungs 
allergic proctitis 
anorectal malformation 
hypothyroidism 
cystic fiborsis
spinal cord abnormalities 
older children: 
Hirschsprungs 
celiac disease 
hypothyroidism 
anatomical abnormalities
85
Q

What is the initial treatment for constipation?

A

assess for large volume of stool in rectum –disimpact vial oral or rectal “clean out” before starting treatment

Polyethylene Glycol PEG-3350 (Miralax)

  • can also consider lactulose, milk of magnesia, stimulant laxatives
  • infants - prune juice
86
Q

How long should infants/children with constipation be on treatment?

A

> 2 months

should not be stopped until the child is >1 months without sxs

87
Q

Encopresis

A

most commonly related to “overflow” and presence of constipation

stool withholding –> accumulation of large mass of stool in rectum

liquid stool seeps around the mass of stool; cannot be controlled

treatment aimed at underlying constipation (stool softeners)
timed sitting after meals and in afternoon in conjunction with oral laxative use

88
Q

What is the most common cause of bloody stools in peds pts?

A

Shigella infection

also consider:
Salmonella
Camphylobacter jeguni

89
Q

What should you be thinking if a child has acute watery diarrhea lasting several hours to days?

A

viral or toxin mediated

90
Q

What should you be thinking if a child has diarrhea lasting >7 days?

A

Giardia, cryptosporidium, C. diff

chronic disease - celiac, IBD

91
Q

What are some reasons a neonate might have acute abdominal pain?

A

NEC
hirschsprung
meconium ileus (think about CF)
perforation

92
Q

What are some reasons an infant might have acute abdominal pain?

A 
colic 
acute gastroenteritis 
intussusception 
incarcerated hernia 
volvulus (malrotation)

Pediatrics Exam 1 (6 decks)

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