Lecture 9 - Nutrition Assessment of Infants, Children, and Adolescents Flashcards
When we are looking at the history information, what info are we looking for?
Past/Present diagnosis and medical conditions Pregnancy Delivery Breastfed/formula/eating behaviours Growth Family and social history Physical and emotional environment
What are we looking for in the history of medication and supplements?
Meds
- Drug nutrient interactions
- Some meds can increase or decrease appetite
Vitamin and mineral supplementation
- depends on breast-fed/bottle
- Vitamin D
Alternatives therapies
-what are they using and why
What is the anthropometric data for infancy growth?
Most rapid growth Average Birth weight 7 1/2lbs BW x 2 by 5-6 months BW x 3 by 1 yr Length increases by 50% by 1yr Head circumference increases by 40% -Growth and development of internal organs
How much does weight and length increase in the first year?
Wt 200%
Ht 50%
What is the weight velocity for an infant?
Rapid
0-6 15-35g/day
6-12 10-15g/day
Slower
12motnh-10years 1.7-3kg/year
What does birth weight indicate?`
Indicator for future health status
- LBW <2500g
- VLBW <1500g
- ELBW< 1000g
How dow weeks correlates with what term gestational you are?
Extremely preterm <28wks Very preterm 28-32wks Preterm <37wks Term 38-42wks Post term >42wks
What are the percentiles for gestational birth weight?
Small for gestational age <10%tile
Appropriate (10-90%)
Large for gestational age >90%tile
What is the main tool for assessing growth in infants/kids?
Growth charts because we can see the growth patten from birth
- asses past and present growth
- predict future
- Trends very important than single point in time
What are the 2 kinds of growth charts?
CDC
- only American babies (Breast and formula), didn’t look at them over a long period of time, just one.
- 5% and 95%
WHO
- World babies, breastfed, looked at over a period of time
- 3rd and 97%
What is the difference between Wt gain in breast fed vs formula?
Wt gain in breastfed infants is healthy and slower than that of formula fed infants
What is the age cut off for CDC growth charts?
Birth to 36months & 2-20yrs
8 charts for boys
8 charts for girls
2 new for BMI for age 2-20yrs
In CDC curves what replaced wt for ht curves in kids greater than 2 y.o.
BMI for age
What standards to kids following the WHO curve have to have?
Breastfed for 6 months, then formula fed
-raised according to Current Canadian and international health an nutrition recommendations
Which index does WHO emphasize?
BMI for age ans index of Wt relative to Ht starting at 2 yrs
-for normal healthy population
How do you correct growth standards for postnatal age for prematurity?
weeks-[40weeks-gestaitonal age in weeks] and compare it with a chart
-until 24 or 36months
Why was the WHO chart updated?
revised in 2014 of growth reference for school age children and adolescents 5-19yrs
-updated to address obesity epidemic
What are the change in percentiles for the revised WHO charts?
BMI for age suggestive of overweight (85-97th%) and obesity >97th%
When plotting a point on a growth curve what do you need to remember?
Round age to nearest 1/4 year or month for kids <2yrs
Ages 0-36 plot all:
- Wt
- Length
- HC
- Wt for Length
> 2years
- Wt
- Ht
- BMI
How soften should we measure growth?
1,2,4,6,9,12,18,24,36 months
-to monitor patterns of growth over time
Wt, length then HC are affected by malnutrition in that orders
How do we interpretation of length/stature for age?
<3rd%tile results in stunting or shortness
-stunting can result from long term malnutrition
How do we interpretation HC for age on growth charts?
<3rd%tile or >97%tile can lead to potential health nutrition or developmental issues
How do we interpret Wt for length/stature on growth charts?
<3rd%tile leads to underweight or wasting due to recent malnutrition, dehydration, genetic disorders
> 97%tile higher chance of obesity
How do we interpret BMI for age?
<5th%tile leads to underweight or wasting due to recent malnutrition, dehydration, genetic disorder
> 85% but <95% overweight
> 95% obesity
What happens when there is unexpected crossing of >2% lines?
Cross downward of 2% is reflective of FFT or growth failure
When we are looking for anthropometric and body comp data what dow e need to analyze risk of?
Obesity PEM -Severe PEM stunted growth * Ht for age <3% * Long term food deprivation
- Sever PEM wasting
- Wt for age <3rd%
- BMI for age <5%
- Recent short term malnutrition
What tool is BMI for age not used for?
Not a diagnostic tool, more of an effective screening tool
When does BMI for age become gender and age specific and how is is measured?
For children 2-20yrs
Measured using:
-Amount of body fat changes with age
-Amount go body fat differs between girls and boys
When should BMI for age be used for all children?
For all children after age 10
When on the BMI for Age curve do we see changes?
BMI decrease during preschool years (4-6yrs) and gradually increase through adolescence
-Reflects rebound adiposity
What is rebound adiposity?
Body fat amount velocity increases
- weight growth slowing down but height keeps increasing
- the earlier this happens the tiger the risk of obesity
What does Percent Wt for age compare against?
Compare patient BW to the average of the reference population (50%)
What does Percent Wt for age reflect?
Acute nutritional status and can be used to determine degree of eating
- comparing Childs weight and comparing to other children weight at the same age
- does not take into account Ht
What is the equation for Percent Wt for Age?
(Current wt/Wt at 50%) x 100
What is the IBW?
Measures the risk or degree of malnutrition
- Independent of age
- Takes into account height/length
- focusing on one individual, not taking into account age, just height
What are the methods used for IBW?
Wt as the same % as Ht % (Moore Method)**
-Factors in if individual is tall or very short
Wt for length 50%
BMI at 50% for age
“Standard Wt” weight at 50% at Ht age
What is the %IBW equation?
(CBW/IBW)x100
What is the %IBW interpretations?
>140- Severe Obesity 120-139- Obesity 110-119- Overweight 90-109- Normal 85-89- Underweight 80-84- Mild Underweight 75-79- Moderate underweight <75- Severe underweight
What are the expected Wt gains in normal healthy children?
2 yrs- puberty: 2-3kg/yr
Puberty (Average Wt gain over next 6yrs)
- Girls: 10-15kg
- Boy: 15-25kg
What determines kids length/height?
Primarily genetic determined
-consider parent height
Only 10% of height determines genetics in malnourished
-if not malnourished, genetics primarily determines hight/length
Why do we need to look at length/Ht?
Indicator of bone growth
Sensitive to chronic malnutrition
How do you measure kids height above 2 and less than 2?
Less than 2 supine
Greater than 2 Stating height
- or knee if unable to stand
- there will be a 2cm decrease when standing
What is the normal Ht gain velocity for kids?
0-12months: 23-28cm/yr 12-24months: 7-13cm/yr 2yrs-puberty 5-8cm/yr Puberty (max growth spurt) -Girls: 8.4-9.0cm/yr -Boys: 9.5-10.3cm/yr
What is percent Ht for age?
Comopares patient height to the average of the reference population at the 50%
What does percent Ht for age reflect/show?
Chronic nutritional status and can be used to determine. degree of stunting
-Doesnt take into account Wt
What is the percent height for age equation?
(Current height/Height at 50%ile) x 100
How do you interpret % height for age (stunting?)
95-100 Normal malnutrition
90-94 Mild
85-89 Moderate
<85 Severe
How do you interpret % weight for age (wasting)?
90-100 Normal
75-89 Mild
60-74 Moderate
<60 Severe
How do you interpret % weight for height (Wasting)?
90-100. Normal
80-89 Mild
70-79 Moderate
<70 Severe
What is head circumference an index of?
Brain growth
Less sensitive indicator of nutritional status
-last to be affected by malnutrition
Based on HC what can serious malnutrition lead to down the road?
Serious malnutrition In the first 2 years of life can lead to significant cognitive and behavioural problems
What is the normal expected HC growth?
0-12months: 12-14cm/yr
12-24months 2-4cm/yr
-max circumference reached at 2 years
What are all of the markers in blood work?
CBC Electrolytes GLucose BUN& Creatinine Albumin Ca, Phos, Mg Ferriting Sweat test (CF)
How might malnutrition cause abnormal appearance?
Dry cracked skin
Dry dull brittle hair
Decayed discoloured teeth
Gums bleeding easily
What are behaviour changes related to malnutrition?
Fatigue Weakness Apathy Lack of Energy/interest/concentration Confusion Depression Mood Swing
What are the recommendations for infant in regards to feeding?
Exclusive great feeding for first 6months and sustained up to 2 years or longer with appropriate complementary feeding as breastmilk is important for the nutrition immunologic protection, growth and development of infants and toddlers
What is the composition of breast milk?
Composition changes over time
-Colostrum: high protein, fat soluble vitamins, minerals, electrolytes, antibodies and low fat and energy
What supplementation is needed for infants?
Daily Vit D supplement of 400IU(10ug/d) only for breastfed babies
When should Vitmamin D supplementation begin for breastfed babies?
At birth and continue until the infants diet includes at least 400IU/d from other dietary sources or until 1 year old
What is cronobacter?
Germ found naturally in dry conditions
Can cause severe blood infections or meningitis
Who is most likely to get infected by Chronobacter?
Infants <2months, premed and those with weakened immune systems
-outbreak rom powdered formula because you cane sterilize the powder
What foods do Health Canada and other recommend to be introduced at 6months?
Fe rich
-because Fe stores only last for 6 months in infants
How do you prevent Fe deficiency in infants?
By breastmilk or Fe fortified formula, cereals, meat or legumes
-add Vit C with all those options
what are we looking for when doing a dietary assessmentt?
Type, quantity and frequency of feeding Brestfed vs formula Energy intake Protein intake Intake of Fe, Ca, Fit D Solid food intake Patter of meals/snacks Eating behaviour Allergies
In terms of food allergies what does the Canadian Paediatric Society Recommend if your infant is high risk??
Introduce allergen foods at 4 month but 6 still recommend
-no evidence to support antigen avoidance during gestation and lactation
In terms of food allergies what does the Canadian Paediatric Society Recommend for infant formula?
High risk infants are not breastfed
There is no advantage of soy based formula
In terms of food allergies what does the Canadian Paediatric Society Recommend for solid food intro?
No evidence that delayed into of solids beyond 4-6 months it protective
No advantage of delaying highly allergenic foods
-may actually increase risk
What are the protein requirements determined by IAAO?
Indicator amino acid oxidation method for Children 6-10yrs EAR DRI0.76g/kg/day IAAO 1.3g/kg/day IAAO %kcal ~9
RDA
DRI 0.95g/kg/day
IAAO 1.55g/kg/day
IAAO %kcal ~10
current recommendations are ~70% underestimated
To avoid Fe deficiency, what is recommended that infants take after 4 months?
Oral Fe supplement until complimentary Fe containing foods are introduced
What does Fe deficiency cause?
Leading cause of Anemia
Why is monitoring Fe important?
Because as infants grow rapidly, there is a Demond for more blood and more Fe to make blood and transport O2
What is the cause of Fe deficiency anemia in infants?
Non fortified infant formula
Cows milk under 1yo (can’t digest casein in cow milk)
What does a lack of Fe result in?
Energy crisis because Fe carries O2 in blood and energy is released from nutrients
A lack of Fe also affects behaviour, mood, attention span and learning ability
How do you detect Fe deficiency anemia in infants?
CPA and AAP recommend:
Measure Hgb status (<110g/L)
Fe Status
-serum ferritin
To prevent Fe deficiency in a young child what should be done?
Food must driver 7-10mg/day
Only 2 cups of cow milk/day in toddlers because the Ca is essential
what is FFT?
Failure to Thrive
- One of the most common paediatric problems, identified in the first 3 months
- makes up 1-5% of all admissions for children <2
What are the different definitions of FFT as you age?
0-3yrs FTT
3yrs-puberty Growth failure
Puberty- delay in sexual maturation
how do characterize FFT?
No set definition
- Wt less than 3rd% of Wt for age
- Wt less than 80% of expected wt for age
- A deceleration of growth velocity across 2 major % lines
What is FTT more of?
A Symptom rather than a diagnosis
What is the difference between non organic and organic FFT?
Non organic: occurs in the absence of an identifiable disease
- psych issues
- lack of knowledge or misinformation
Organic: Associated with an identifiable disease
- inadequate intake dure to swallowing or chewing impairment
- increased energy requirements (infection)
What are the exceptions to the rules in terms of growth?
Some children do not follow standard growth curves and can still be healthy
- Familial short stature
- constitutional growth delay
- Intrauterine growth
- preterm infants
What are the general recommendation for 0-6months?
Exlusive breastfeeding
Vitamin D supplement 400IU
What are the general recommendation for 6-12 months?
Solid Fe rich foods paired with Vit C
No need to avoid allergen foods
Continue formula/breastfeeding to at least 1-2 years beyond
No cow milk before 12 months
What does a nutritional assessment of adolescents look like?
Determine stage of biological and sexual development
- Patient history info
- anthropometric and body comp (ht and wt) (BMI for age and sex)
- Biochemical data only used if something abnormal is going on
- clinical exam
- dietary assessment
What are the biological changes of puberty?
Sexual maturation
Increases in Ht and wt
Accumulation of skeletal mass
Changes in body comp
Are the sequence of sexual maturation events different?
They are consisted but there is considerable variation in the age of maturation
-sexual maturation or biological age should be used to assess growth and development and nutritional needs
What is the Tanner stages?
Sexual maturation rating - a scale of secondary sexual characteristics used to assess the degree of pubertal maturation
What are the 3 different SMR stages?
SMR1: prepubertal growth and development
SMR2-4: Occurrences of puberty
SMR5: Sexual maturation has concluded
When do adolescent shave their growth spurt?
2-3yars of intense growth, followed by few more years of slower growth (4.5years total)
-growth spurts start earlier in girls (7.5 or 12 years) boys (13years)
How does weight change in adolescent growth spurt?
Increases first then followed by 4-6 months of rapid increase in height
-for boys limbs grow first W
What doe hormones affect in adolescents?
Intensity and duration of growth
Organ maturation
Mood and sexual feelings
For boys growth spurts, when does it begin, how much Ht and Wt gained?
Starts 12-13yrs
Lasts 2 1/2yrs
Growth: 8” peak at 14yrs
Weight: 45lbs
For girls growth spurts, when does it begin, how much Ht and Wt gained?
Starts: 10-11yrs
Lasts 2 1/2 yrs
Growth: 6” peak at 12yrs
Weight: 35lbs
How does malnutrition affect the physical growth development in adolescents?
Growth retardation
- acute malnutrition= wasting
- Wt for stature<3rd% for age and sex
- BMI for age<5th% for sex
- Chronic malnutrition= stunting
- stature for age <3rd% for sex
- Delayed sexual maturation
- Anorexia–> amenorrhea (prevents period from occurring)
- Catch up growth may be possible
What are the energy needs of adolescent determined by?
Energy needs determined by degree of sequel and biological maturation not chronological age
-needs vary greatly
What are the energy needs of adolescent girls and boys?
Girls energy needs peak sooner (2370cal/day for active 14-18yo)
- start growth spurt earlier
- attain lower heigh and weight
Boys have high energy needs 33150cal/day for active 14-18yrs
-they have more scale and therefore a higher metabolic need
In general what are some unusual/irregular eating habits of teens?
Skip meals Enjoy snacks More involved inprearing meals Eat at some or restaurants Boys usually eat meat and grains, not enough F&V and milk
What is the problem with snacks?
Provide 1/4 teenagers daily energy intake
High fat low Fe,Ca,VitD/A/C folate
Vending machendes offer nutrient dense options
Promote a variety of snacks to meet nutrient needs especially Ca and Fe
Combine foods from different food groups to create health snacks
What are the common nutrition issues in adolescents?
Females more F&V less carb, protein Fe
Males more meat and grains, less F&V and dairy
Fluids are being replaced by energy drinks and coffee and sugar sweetened beverages
Body issues
Starting to gain control over diets
In adolescents wheat do nutrition needs carry according to?
Sex
Sexual and biological maturation, not chronological age
