module 5: childhood study guide Flashcards
what is BMI?
BMI is a surrogate measure of adiposity
BMI = weight/height x height
how is BMI different in children and adults?
Calculated the same in children, but children are compared to their peers:
* Categories: underweight, normal weight, overweight, obesity class 1, class 2, and class 3
* We use percentiles in children since they are constantly growing
contributors to obesity
Genetic factors
Lack of sleep
Decrement in physical activity
Drug induced obesity
Dietary patterns
Sedentary lifestyle
developmental perspective on obesity (2 prongs)
- predictive adaptive response
- pathological response
predictive adaptive response
maternal undernutrition + stress leads to long term obesity risk
Secondary to reduced nutrient availability in utero
pathological response
maternal overnutrition + maternal/gestational diabetes leads to long-term obesity risk
Secondary to excess nutrient availability in utero
negative effects of childhood obesity
Inflammation
Hypertension
Dyslipidemia
Dysglycemia
Emotional toll: social stigma, discrimination, bullying
life course perspective
Sensitive windows of opportunity:
Preconception to 3 years
Adolescence
Discuss the importance of early childhood nutritional intervention and why the first 1000 days are essential for healthy intervention.
- Important stage of child development that provides the physical and cognitive foundation for health, learning and well being.
- Healthy eating and physical activity patterns also help promote learning and academic success and reduce the risk of chronic diseases (CVD, type 2 DM, cancer, obesity and osteoporosis)
- First 1000 days:
- 80% of brain development occurs in first 1000 days
- While baby grows during this time and reaches developmental milestones, there are also important feeding milestones as well (feeding on demand to pincer grasp and truncal stability, transitioning to family meals, walking and structured feeding schedules)
Why are growth charts used for children? How are growth issues identified on the growth charts?
- Children are constantly growing, so it would be hard to put them into categories
- Comparing them to their same-sex, same-aged peers allows us to see if they are keeping up with their development
- 50th percentile is goal, anything above or below may be of concern
Why are structured meals important? How would you recommend structuring meal times to parents? What feeding schedule would you recommend?
Family meal model
- Meals give children structure, sets limits, access to parents and emotional reassurance
- Tell parents not to feed in a rush (right before work or their own meal) instead let the child eat when the family eats, expect meal time to be messy time, minimize distractions during meal time such as tv, avoid a power trip ok if they don’t eat everything at once just measure over the course of the week, serve new foods w/ food’s the child already “mastered”
- Limit snack time/grazing throughout the day and have the child join the family for 3 meals. - Be sure to set an example for them during meal time
What defines “Slow Weight Gain?”
Slow weight gain = aka failure to thrive
Inadequate physical growth diagnosed by observation of growth over time
Weight for age <5%-ile or if weight crosses two major percentile lines
Weight for height, height for age or BMI <5%-ile
Discuss some causes for slow weight gain with examples?
Inadequate nutritional intake
Inadequate absorption
Increased metabolism/metabolic demand
Inadequate nutritional intake
Unsuitable feeding habits
Behavior problems affecting eating
Poverty and food shortages
Neglect
Disturbed parent-child relationship
Mechanical feeding difficulties
GER
Inadequate absorption
Celiac disease
Cystic fibrosis
Cow’s milk protein allergy
Liver disease
IBS
Short-gut syndrome
Increased metabolism/metabolic demand
Hyperthyroidism
Chronic infection (HIV)
Hypoxemia
Genetic abnormalities (Prader-Willi)
Metabolic disorders
treatment for slow weight gain
Medical evaluation
- History is sufficient
- Blood work (<5% of time is helpful in diagnosis)
High calorie diet
- Multivitamin
- Children with FTT need a lot of extra calories
Feeding tubes
What are some nutritional concerns for children on a vegetarian/vegan based diet?
Infants: breast fed or soy formula
Tend to be higher in fiber and lower in cholesterol than diets that include meat
May or may not be appropriate depending on child’s diet
Nutritional concerns
Protein: non-animal proteins should come from multiple sources to provide a complete mixture of amino acids
Vitamins and minerals: Zinc, iron, Vit B12, Vit D
May need other supplementation
What are some nutritional concerns for children on a paleo diet?
Avoid grains, legumes, soy, fruit juice, ionized salt, highly processed oils and refined salts.
Consume meats, fish, fruits, eggs, non-starchy vegetables, seeds and natural oils (olive/coconut)
Nutritional Concerns:
Inadequate carbohydrates for a growing child
Vitamins and minerals: calcium, vitamin D, B vitamins and Iodine
What are some nutritional concerns for children on a gluten-free diet?
Avoid wheat, barley, rye
Nutritional concerns
Inadequate carbohydrates for a growing child
Vitamins and minerals: iron, vitamin D, B vitamins
Potential for poor fiber intake
What is a concern with caregivers providing milk alternatives to young children?
Milk alternatives don’t have as much Vitamin D, protein, micronutrients
Homemade Milk alternatives are not fortified with vitamins
In the Ellyn Satter model of responsibility what is the role of the parents?
Parent’s role: WHAT, WHEN, and WHERE
Choose and make the food: balanced, variety of healthy choices
Offer food and drinks only at meal and snack times (besides water)
Lead by example
Serve new foods with mastered foods
Don’t cater and let the child grow up in the body that is right for them
Make eating times pleasant
In the Ellyn Satter model of responsibility what is the role of the children?
Children’s role: HOW MUCH
Eat the amount they need, innately regulating their own food intake
Behave at meals
Eat what their parents eat
constipation definition
Constipation = delay or difficulty in defecation, present for two or more week
Less than every other day
Less than 7 times in 14 days
Straining, incomplete evacuation
constipation phase (non-meds)
Phase 1
Reduce constipating foods (dairy, starches)
Encourage water, whole grains, beans, fruits and veggies
Phase 2
Fiber: age plus 5
Starches and dairy are increased to moderate levels
Phase 3
Wean medications
constipation phases (meds)
Treatment phase 1: disimpaction
Enemas
Magnesium
Miralax
Treatment phase 2: sustain evacuation
Goal: allow distended colon to return to normal caliber and tone
Stool softener
Miralax
Lubricate with mineral oil
Stimulants: dulcolax, senna
what should not be used as a reward for potty training?
food
What are the limitations of the CDC growth chart for children?
CDC lacks diversity and doesn’t follow children overtime to show a more accurate, consistent growth trend, better for children over 2 years of age [reflects formula-fed infants which grow faster, but breast-fed grow at a slower rate]
