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fn 3344 > Lecture 9 - Nutrition Assessment of Infants, Children, and Adolescents > Flashcards

Lecture 9 - Nutrition Assessment of Infants, Children, and Adolescents Flashcards

1
Q

When we are looking at the history information, what info are we looking for?

A 
Past/Present diagnosis and medical conditions
Pregnancy
Delivery
Breastfed/formula/eating behaviours
Growth
Family and social history 
Physical and emotional environment
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2
Q

What are we looking for in the history of medication and supplements?

A

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

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3
Q

What is the anthropometric data for infancy growth?

A 
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
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4
Q

How much does weight and length increase in the first year?

A

Wt 200%

Ht 50%

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5
Q

What is the weight velocity for an infant?

A

Rapid
0-6 15-35g/day
6-12 10-15g/day

Slower
12motnh-10years 1.7-3kg/year

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6
Q

What does birth weight indicate?`

A

Indicator for future health status

  • LBW <2500g
  • VLBW <1500g
  • ELBW< 1000g
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7
Q

How dow weeks correlates with what term gestational you are?

A 
Extremely preterm <28wks
Very preterm 28-32wks
Preterm <37wks
Term 38-42wks
Post term >42wks
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8
Q

What are the percentiles for gestational birth weight?

A

Small for gestational age <10%tile

Appropriate (10-90%)

Large for gestational age >90%tile

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9
Q

What is the main tool for assessing growth in infants/kids?

A

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
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10
Q

What are the 2 kinds of growth charts?

A

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%
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11
Q

What is the difference between Wt gain in breast fed vs formula?

A

Wt gain in breastfed infants is healthy and slower than that of formula fed infants

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12
Q

What is the age cut off for CDC growth charts?

A

Birth to 36months & 2-20yrs

8 charts for boys
8 charts for girls
2 new for BMI for age 2-20yrs

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13
Q

In CDC curves what replaced wt for ht curves in kids greater than 2 y.o.

A

BMI for age

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14
Q

What standards to kids following the WHO curve have to have?

A

Breastfed for 6 months, then formula fed

-raised according to Current Canadian and international health an nutrition recommendations

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15
Q

Which index does WHO emphasize?

A

BMI for age ans index of Wt relative to Ht starting at 2 yrs

-for normal healthy population

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16
Q

How do you correct growth standards for postnatal age for prematurity?

A

weeks-[40weeks-gestaitonal age in weeks] and compare it with a chart
-until 24 or 36months

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17
Q

Why was the WHO chart updated?

A

revised in 2014 of growth reference for school age children and adolescents 5-19yrs
-updated to address obesity epidemic

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18
Q

What are the change in percentiles for the revised WHO charts?

A

BMI for age suggestive of overweight (85-97th%) and obesity >97th%

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19
Q

When plotting a point on a growth curve what do you need to remember?

A

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
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20
Q

How soften should we measure growth?

A

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

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21
Q

How do we interpretation of length/stature for age?

A

<3rd%tile results in stunting or shortness

-stunting can result from long term malnutrition

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22
Q

How do we interpretation HC for age on growth charts?

A

<3rd%tile or >97%tile can lead to potential health nutrition or developmental issues

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23
Q

How do we interpret Wt for length/stature on growth charts?

A

<3rd%tile leads to underweight or wasting due to recent malnutrition, dehydration, genetic disorders

> 97%tile higher chance of obesity

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24
Q

How do we interpret BMI for age?

A

<5th%tile leads to underweight or wasting due to recent malnutrition, dehydration, genetic disorder

> 85% but <95% overweight

> 95% obesity

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25
Q

What happens when there is unexpected crossing of >2% lines?

A

Cross downward of 2% is reflective of FFT or growth failure

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26
Q

When we are looking for anthropometric and body comp data what dow e need to analyze risk of?

A 
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
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27
Q

What tool is BMI for age not used for?

A

Not a diagnostic tool, more of an effective screening tool

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28
Q

When does BMI for age become gender and age specific and how is is measured?

A

For children 2-20yrs
Measured using:
-Amount of body fat changes with age
-Amount go body fat differs between girls and boys

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29
Q

When should BMI for age be used for all children?

A

For all children after age 10

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30
Q

When on the BMI for Age curve do we see changes?

A

BMI decrease during preschool years (4-6yrs) and gradually increase through adolescence
-Reflects rebound adiposity

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31
Q

What is rebound adiposity?

A

Body fat amount velocity increases

  • weight growth slowing down but height keeps increasing
  • the earlier this happens the tiger the risk of obesity
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32
Q

What does Percent Wt for age compare against?

A

Compare patient BW to the average of the reference population (50%)

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33
Q

What does Percent Wt for age reflect?

A

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
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34
Q

What is the equation for Percent Wt for Age?

A

(Current wt/Wt at 50%) x 100

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35
Q

What is the IBW?

A

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
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36
Q

What are the methods used for IBW?

A

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

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37
Q

What is the %IBW equation?

A

(CBW/IBW)x100

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38
Q

What is the %IBW interpretations?

A 
>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
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39
Q

What are the expected Wt gains in normal healthy children?

A

2 yrs- puberty: 2-3kg/yr

Puberty (Average Wt gain over next 6yrs)

  • Girls: 10-15kg
  • Boy: 15-25kg
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40
Q

What determines kids length/height?

A

Primarily genetic determined
-consider parent height

Only 10% of height determines genetics in malnourished
-if not malnourished, genetics primarily determines hight/length

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41
Q

Why do we need to look at length/Ht?

A

Indicator of bone growth

Sensitive to chronic malnutrition

42
Q

How do you measure kids height above 2 and less than 2?

A

Less than 2 supine

Greater than 2 Stating height

  • or knee if unable to stand
  • there will be a 2cm decrease when standing
43
Q

What is the normal Ht gain velocity for kids?

A 
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
44
Q

What is percent Ht for age?

A

Comopares patient height to the average of the reference population at the 50%

45
Q

What does percent Ht for age reflect/show?

A

Chronic nutritional status and can be used to determine. degree of stunting
-Doesnt take into account Wt

46
Q

What is the percent height for age equation?

A

(Current height/Height at 50%ile) x 100

47
Q

How do you interpret % height for age (stunting?)

A

95-100 Normal malnutrition
90-94 Mild
85-89 Moderate
<85 Severe

48
Q

How do you interpret % weight for age (wasting)?

A

90-100 Normal
75-89 Mild
60-74 Moderate
<60 Severe

49
Q

How do you interpret % weight for height (Wasting)?

A

90-100. Normal
80-89 Mild
70-79 Moderate
<70 Severe

50
Q

What is head circumference an index of?

A

Brain growth

Less sensitive indicator of nutritional status
-last to be affected by malnutrition

51
Q

Based on HC what can serious malnutrition lead to down the road?

A

Serious malnutrition In the first 2 years of life can lead to significant cognitive and behavioural problems

52
Q

What is the normal expected HC growth?

A

0-12months: 12-14cm/yr
12-24months 2-4cm/yr

-max circumference reached at 2 years

53
Q

What are all of the markers in blood work?

A 
CBC
Electrolytes
GLucose
BUN&amp; Creatinine
Albumin
Ca, Phos, Mg
Ferriting
Sweat test (CF)
54
Q

How might malnutrition cause abnormal appearance?

A

Dry cracked skin
Dry dull brittle hair
Decayed discoloured teeth
Gums bleeding easily

55
Q

What are behaviour changes related to malnutrition?

A 
Fatigue
Weakness
Apathy 
Lack of Energy/interest/concentration
Confusion
Depression
Mood Swing
56
Q

What are the recommendations for infant in regards to feeding?

A

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

57
Q

What is the composition of breast milk?

A

Composition changes over time

-Colostrum: high protein, fat soluble vitamins, minerals, electrolytes, antibodies and low fat and energy

58
Q

What supplementation is needed for infants?

A

Daily Vit D supplement of 400IU(10ug/d) only for breastfed babies

59
Q

When should Vitmamin D supplementation begin for breastfed babies?

A

At birth and continue until the infants diet includes at least 400IU/d from other dietary sources or until 1 year old

60
Q

What is cronobacter?

A

Germ found naturally in dry conditions

Can cause severe blood infections or meningitis

61
Q

Who is most likely to get infected by Chronobacter?

A

Infants <2months, premed and those with weakened immune systems
-outbreak rom powdered formula because you cane sterilize the powder

62
Q

What foods do Health Canada and other recommend to be introduced at 6months?

A

Fe rich

-because Fe stores only last for 6 months in infants

63
Q

How do you prevent Fe deficiency in infants?

A

By breastmilk or Fe fortified formula, cereals, meat or legumes
-add Vit C with all those options

64
Q

what are we looking for when doing a dietary assessmentt?

A 
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
65
Q

In terms of food allergies what does the Canadian Paediatric Society Recommend if your infant is high risk??

A

Introduce allergen foods at 4 month but 6 still recommend

-no evidence to support antigen avoidance during gestation and lactation

66
Q

In terms of food allergies what does the Canadian Paediatric Society Recommend for infant formula?

A

High risk infants are not breastfed

There is no advantage of soy based formula

67
Q

In terms of food allergies what does the Canadian Paediatric Society Recommend for solid food intro?

A

No evidence that delayed into of solids beyond 4-6 months it protective

No advantage of delaying highly allergenic foods
-may actually increase risk

68
Q

What are the protein requirements determined by IAAO?

A 
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

69
Q

To avoid Fe deficiency, what is recommended that infants take after 4 months?

A

Oral Fe supplement until complimentary Fe containing foods are introduced

70
Q

What does Fe deficiency cause?

A

Leading cause of Anemia

71
Q

Why is monitoring Fe important?

A

Because as infants grow rapidly, there is a Demond for more blood and more Fe to make blood and transport O2

72
Q

What is the cause of Fe deficiency anemia in infants?

A

Non fortified infant formula

Cows milk under 1yo (can’t digest casein in cow milk)

73
Q

What does a lack of Fe result in?

A

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

74
Q

How do you detect Fe deficiency anemia in infants?

A

CPA and AAP recommend:
Measure Hgb status (<110g/L)

Fe Status
-serum ferritin

75
Q

To prevent Fe deficiency in a young child what should be done?

A

Food must driver 7-10mg/day

Only 2 cups of cow milk/day in toddlers because the Ca is essential

76
Q

what is FFT?

A

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
77
Q

What are the different definitions of FFT as you age?

A

0-3yrs FTT
3yrs-puberty Growth failure
Puberty- delay in sexual maturation

78
Q

how do characterize FFT?

A

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
79
Q

What is FTT more of?

A

A Symptom rather than a diagnosis

80
Q

What is the difference between non organic and organic FFT?

A

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)
81
Q

What are the exceptions to the rules in terms of growth?

A

Some children do not follow standard growth curves and can still be healthy

  • Familial short stature
  • constitutional growth delay
  • Intrauterine growth
  • preterm infants
82
Q

What are the general recommendation for 0-6months?

A

Exlusive breastfeeding

Vitamin D supplement 400IU

83
Q

What are the general recommendation for 6-12 months?

A

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

84
Q

What does a nutritional assessment of adolescents look like?

A

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
85
Q

What are the biological changes of puberty?

A

Sexual maturation
Increases in Ht and wt
Accumulation of skeletal mass
Changes in body comp

86
Q

Are the sequence of sexual maturation events different?

A

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

87
Q

What is the Tanner stages?

A

Sexual maturation rating - a scale of secondary sexual characteristics used to assess the degree of pubertal maturation

88
Q

What are the 3 different SMR stages?

A

SMR1: prepubertal growth and development
SMR2-4: Occurrences of puberty
SMR5: Sexual maturation has concluded

89
Q

When do adolescent shave their growth spurt?

A

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)

90
Q

How does weight change in adolescent growth spurt?

A

Increases first then followed by 4-6 months of rapid increase in height
-for boys limbs grow first W

91
Q

What doe hormones affect in adolescents?

A

Intensity and duration of growth
Organ maturation
Mood and sexual feelings

92
Q

For boys growth spurts, when does it begin, how much Ht and Wt gained?

A

Starts 12-13yrs
Lasts 2 1/2yrs
Growth: 8” peak at 14yrs
Weight: 45lbs

93
Q

For girls growth spurts, when does it begin, how much Ht and Wt gained?

A

Starts: 10-11yrs
Lasts 2 1/2 yrs
Growth: 6” peak at 12yrs
Weight: 35lbs

94
Q

How does malnutrition affect the physical growth development in adolescents?

A

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
95
Q

What are the energy needs of adolescent determined by?

A

Energy needs determined by degree of sequel and biological maturation not chronological age
-needs vary greatly

96
Q

What are the energy needs of adolescent girls and boys?

A

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

97
Q

In general what are some unusual/irregular eating habits of teens?

A 
Skip meals
Enjoy snacks
More involved inprearing meals
Eat at some or restaurants
Boys usually eat meat and grains, not enough F&amp;V and milk
98
Q

What is the problem with snacks?

A

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

99
Q

What are the common nutrition issues in adolescents?

A

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

100
Q

In adolescents wheat do nutrition needs carry according to?

A

Sex

Sexual and biological maturation, not chronological age

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