module 5: childhood study guide

Question 1

what is BMI?

Answer 1

BMI is a surrogate measure of adiposity
BMI = weight/height x height

Question 2

how is BMI different in children and adults?

Answer 2

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

Question 3

contributors to obesity

Answer 3

Genetic factors
Lack of sleep
Decrement in physical activity
Drug induced obesity
Dietary patterns
Sedentary lifestyle

Question 4

developmental perspective on obesity (2 prongs)

Answer 4

1. predictive adaptive response
2. pathological response

Question 5

predictive adaptive response

Answer 5

maternal undernutrition + stress leads to long term obesity risk
Secondary to reduced nutrient availability in utero

Question 6

pathological response

Answer 6

maternal overnutrition + maternal/gestational diabetes leads to long-term obesity risk
Secondary to excess nutrient availability in utero

Question 7

negative effects of childhood obesity

Answer 7

Inflammation
Hypertension
Dyslipidemia
Dysglycemia
Emotional toll: social stigma, discrimination, bullying

Question 8

life course perspective

Answer 8

Sensitive windows of opportunity:
Preconception to 3 years
Adolescence

Question 9

Discuss the importance of early childhood nutritional intervention and why the first 1000 days are essential for healthy intervention.

Answer 9

• 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)

Question 10

Why are growth charts used for children? How are growth issues identified on the growth charts?

Answer 10

• 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

Question 11

Why are structured meals important? How would you recommend structuring meal times to parents? What feeding schedule would you recommend?

Answer 11

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

Question 12

What defines “Slow Weight Gain?”

Answer 12

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

Question 13

Discuss some causes for slow weight gain with examples?

Answer 13

Inadequate nutritional intake
Inadequate absorption
Increased metabolism/metabolic demand

Question 14

Inadequate nutritional intake

Answer 14

Unsuitable feeding habits
Behavior problems affecting eating
Poverty and food shortages
Neglect
Disturbed parent-child relationship
Mechanical feeding difficulties
GER

Question 15

Inadequate absorption

Answer 15

Celiac disease
Cystic fibrosis
Cow’s milk protein allergy
Liver disease
IBS
Short-gut syndrome

Question 16

Increased metabolism/metabolic demand

Answer 16

Hyperthyroidism
Chronic infection (HIV)
Hypoxemia
Genetic abnormalities (Prader-Willi)
Metabolic disorders

Question 17

treatment for slow weight gain

Answer 17

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

Question 18

What are some nutritional concerns for children on a vegetarian/vegan based diet?

Answer 18

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

Question 19

What are some nutritional concerns for children on a paleo diet?

Answer 19

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

Question 20

What are some nutritional concerns for children on a gluten-free diet?

Answer 20

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

Question 21

What is a concern with caregivers providing milk alternatives to young children?

Answer 21

Milk alternatives don’t have as much Vitamin D, protein, micronutrients
Homemade Milk alternatives are not fortified with vitamins

Question 22

In the Ellyn Satter model of responsibility what is the role of the parents?

Answer 22

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

Question 23

In the Ellyn Satter model of responsibility what is the role of the children?

Answer 23

Children’s role: HOW MUCH
Eat the amount they need, innately regulating their own food intake
Behave at meals
Eat what their parents eat

Question 24

constipation definition

Answer 24

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

Question 25

constipation phase (non-meds)

Answer 25

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

Question 26

constipation phases (meds)

Answer 26

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

Question 27

what should not be used as a reward for potty training?

Answer 27

food

Question 28

What are the limitations of the CDC growth chart for children?

Answer 28

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]