Malnutrition in children

Question 1

What is obesity in children (RF and Ix)

Answer 1

Increasing epidiemology in world and UK -like 30% have issue
class (BMI adjusted -overweigh -85-99th centile), Obese >95th, Severely >99th

RF - low socioeconomic status, poor diet, genetics, low exercise

Ix - grwoth chart plotting- BMI centile chart adjusted age and gender -what does the classification
Nutritional assessment - BMI, triceps skinfold thickness
Bloods -chol, triagicerides,
endocrine assay for conditon (adrenal, metabolic, etc)
Uruine -glucose for T2DM
radiology - USS/CT/MRI head for specific causes/syndrome

GOOD EATING/SNACKING Hx
good social Hx -for cause

Question 2

Management of obesity in children

Answer 2

Mx - investigate all the medical causes
Hypothyroidism, endocrine (leptin def, etc), Congenital syndromes (turners, downs),

discuss anxiety/self esteem etc

conservative - self esteem and confidence building -early intervention is key
address lifestyle -food diary, locate where eating too much and change
Physch support
Social prescribing

therapeutic aims - reduce excess weight without compromising growth
diet concelling with vitamins
Behaviour modification
Stepwise physical activity
Adherance to plan needs strong support
fat not being  >30% of cals

Question 3

Complications of obesity in children

Answer 3

Psychosocial -bullying, discim, isolation
Growth -have advanced bone age, increased height and early menarche
Resp- Sleep apnea
Orthopedic -SUFE, bowing of legs

METABOLIC - insulin resis, artherogenic dyslipedemia
hepta= hepatis steatosis, gallstones

Question 4

What is rickets in children (RF and Sx)

Answer 4

Impaired skeletal growth from inadequatee mineralisation of bone at growth plates
causes -

calcium def (diet, malabsorption, renal excrete)
Vit D- deficiency (diet, malab, lack of sun, iatrogenic (phenytoin)
Metabolic defects  (1a hydroxylase def, liver disease, renal disease)
Defect in action -Hereditary vit D receptor resisitance (HVDRR)
Phosph def (reduced intake, increase renal tubular loss (hypophosphatemic rickets (genetic -xlinked, AR or AD)
Acquired hypophosphatemic rickets -fanconi, renal tubular acidosis, nephrotoxic drugs

Sx
Growth delay/arrest
bone pain and reccuring fractures (weird places)
Swelling wrists, bowed long bones (leg), frontal bossing

Question 5

Ix and Mx of rickets in children

Answer 5

Xray -thichened and widenes epiphysis, cupping metaphysis, bowing diaphysis

Biochem -
vit D def -main cause
Low Ca and PO  (if Ca x PO <2.4 -diagnostic)
raised ALP
PTH high (normal)

(25OHD, 1,25OHD are precursors to Vit D)
Renal tubular acidosis - Ca low normal, PO DOWN, ALP high, but all OHD levels normal, PTH NORMAL -

Mx -
prevent with daily vit D in formula/multivitamins, –esp pregnant women (400IU/day)
best diet sources -fatty fish, egg yolk, fortified food, milk, cereal

correct low levels -calcium supplements
oral vit D2 (ergocalfiferol) or Vit D3 (cholecalciferol)
Remeasure serum Ca, PO, ALP, Urine Ca and creat ratio