N&M 4

Question 1

What are the guidelines regarding when a child is ready to switch to skim
milk?

Answer 1

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Question 2

calculate age stuff

Answer 2

Postnatal age Corrected age 
1 month        36 weeks gest 
2 months    term 
3 months  1 month 
4 months  2 months 
 Calculate the # of wks the infant was 
premature 
 40 wks - Number of weeks at birth 
 ex. Baby born 28 wks 
 40-28 = 12 wks early or 3 months 
 Baby chronological age 4 months 
Adjusted age: 4-3 = 1 month

Question 3

introducing foods

Answer 3

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Question 4

whey vs bm

Answer 4

The composition of human milk is different from that of cow’s milk; for this reason, unmodified cow’s milk is not recommended for infants until at least 1 year of age. Both provide 20 kcaUoz; however, the nutrient sources of the energy are different. For example, protein provides 6./o to 7% of the energy in human milk and 20o/oof the energy in cow’s milk. Human milk is 600/owhey proteins (mainly lact- albumins) and 40o/” casein; by contrast, cow’s milk is 20% whey and 80o/ocasein.Gaseinforms a tough, hard-to-digest curd in the infant’s stomach,whereaslactalbumin in human milk forms soft, flocculent, easy-to-digest curds. The amino acids taurine and cystine are present in higher concentra- tions in human milk than in cow’s milk.

Question 5

skim milk in infancy

Answer 5

Low-fat (1o/”to 2”/”) au;’dn,onfat milk are also inappropri- ate for infants during the first 12 months of life. The infants may ingest excessive amounts of protein in large volumes of milk in an effort to meet their energy needs, and the de- crease amount of essential fattyacids^

Question 6

foods kids cant eat

Answer 6

Foodswith skinsor rinds and foodsthat stick to the roofofthemouth(e.g.,hotdogs,grapesb,readwithpeanut butter) may causechoking and should not be offered to younginfants

Question 7

table of foods

Answer 7

check picture

Question 8

What are the guidelines regarding when a child is ready to switch to skim
milk?

Answer 8

after 2

Question 9

• Know how to convert from ounces to ml and ml to ounces

Answer 9

1 ml = 0.033814 oz

1 0z = 29.5735 ml

Question 10

Iron

Answer 10

iron store last 4 months. Additional sources may needed between
4-6 month

Question 11

Flouride

Answer 11

6 months or when baby 1st
tooth erupted (.25 mg of
fluoride/kg/d

Question 12

Waterlow’s classification of malnutrition

Answer 12

Mild malnutrition: 
 weight at 80 – 89% of expected 
weight(50th
 tile) 
– Moderate malnutrition: 
 weight at 70 – 79% of expected weight 
– Severe malnutrition: 
 <70% of expected weight

Question 13

causes of failure to thrive

Answer 13

Inadequate intake 
– Biological, social, poor appetite 
 Excessive loses 
– Malabsorption, vomiting, reflux 
 Increased caloric needs 
– Various disorders 
Caretaker causes: 
– Inadequate understanding of infant/child 
feeding or nutritional needs 
– Psychosocial stress 
– Inadequate duration or number of feedings 
– Inattention to or misinterpretation of hunger 
Difficult temperament 
– Slow feeder 
– Delayed feeding skills 
– Subtle hunger cues 
– Apathy due to neglect or inadequate 
stimulation

Question 14

Why they add MCT oil to the premature infant formula

Answer 14

When a high-energy formula is needed, MCT oil and Polycose can be added to a base that has a concentration of 24kcaUoz or greater (either full-strength premature formula or a concentrated standardformula), with a maximum of 50% of total calories from fat and a minimum of 9o/oof total calo⁄ries from protein

Question 15

What are the additional EAA for premature infants?

Answer 15

( Histidine,

Tyrosine, cystine and taurine)

Question 16

birth weights

Answer 16

Classification definitions: 
– Preterm - < 37 weeks gestation 
– Term - 37 – 42 weeks gestation 
– Postterm - > 42 weeks gestation 
 Birth weight 
– Full term birth – 2870 – 4000 grams 
– Low birth weight – <1000 grams

Question 17

Fat percentage

Answer 17

Up to 54% of total calories or 30

gm/day

Question 18

cystic fibrosis

Answer 18

Individuals with CF are at high risk for malnutrition. Mal- digestion and malabsorption, as well as the progressive complications of the disease,make it difficult to meet in- creased nutrient needs. Factors interfering with adequate intake and retention ofnutriens include dyspnea,coughing and cough-induced vomiting, gastrointestinal discomfort, anorexia during episodes of infection, possible impaired senseof smell and taste,and glucosuria.

Question 19

pku

Answer 19

Formuln. For PKU dietary therapy is planned around the use of a formula/medical food with Phe removed from the protein. The formulas or medical foods described in Thble 44-3 provide a major portion of the daily protein and energy needsfor affectedinfants, children, and adults. In general, the protein source in the formula or medical food is r.-amino acids,with the critical amino acid (i.e., Phe) omit- ted. Carbohydrate sources are corn symp solids, modified tapioca starch, sucrose, and hydrolyzed cornstarch. Fat is provided by a variety of oils.
range of 2 to 6 mg/dl
Many adults with PKU have had the benefits of early diag- nosis and treatment and are less likely to be affected by neurologic damage. However, among those who have had some degree of mental retardation, hyperactivity and self- abuseare often major concerns.Not all patients have re- sponded to the late institution of treatment with improved behavioral or intellectual function. For the difficult-to- manage older patient, a trial of a low-Phe food pattern is recommended.If successfulc, ontinued Phe restriction ther- apy may facilitate behavioral management.

Question 20

maple syrup urine disease

Answer 20

Maplesyrupurinedisease(MSUD),or branched-chaikneto- aciduria,resultsfrom a defectin enzy-rnaticactivity,specifi- cally the branched chain cr-ketoaciddehydrogenasecom- plex. This decarboxylation defect prevenrs metabolism of the branched-chain amino acids (BCAAs) leucine, isoleu- cine, and valine
Nutrition therapy requires very careful monitoring of blood concentrations of leucine, isoleucine, and valine; growth and general nutritional adequary.

Question 21

galactosemia

Answer 21

a h i g h l e v e l o f p l a s m a g a l a c o s e -I - p h o s p h a t e combined with galactosuria-is found in rwo autosomal- recessivemetabolic disorders: salactokinasedeficiencv and galactose-I -phosphateuridyl trinsferase(CALT) deficiency, which is also called classicgalactosemia.Galactosemiare- sults from a disturbance in the conversion of galactose to glucosebecauseof the absenceor inactivity of one of the enzyrnes

Question 22

developmental delay

Answer 22

the condition of a child being less developed mentally or physically than is normal for its age.

Question 23

premature infant vit and min

Answer 23

Therefore prematureinfantsmay be at risk for vitamin E deficiencybecausethey typically have a limited lipid absorptivecapacityfor sometime
vit a
iron
calcium and phosphorus
vit d 
folic acid

Question 24

tolerance of feeding

Answer 24

All preterm babies receiving enteral nutrition should be monitored for signs of feeding intolerance. Vomiting of feedings usually signals the infant’s inability to retain the provided amount of milk. When not associatedwith other signs of a systemic illness, vomiting may indicate that feed- ing volumes were increased too quickly or are excessivefor the infant’s size and maturity. Simply reducing the feeding volume may resolve the problem. If it does not or if the in- fant has signs of a systemic illness, feedings may need to be interrupted until the infant’s condition has stabilized.Bile- stained emesismay indicate that the infant has an intestinal blockage and needsadditional evaluation or that the feeding tube has slipped into the intestine.
Abdominal distention may be caused by excessivefeed- ing, organic obstruction, excessiveswallowing of air, resus- citation, or sepsis(i.e., systemic infection). Observing in- fants for abdominal distention should be a routine practice for nurses.

Question 25

Mention 3 ways that will tell you that the breast fed infant is getting enough
calories?

Answer 25

dirty diapers

weight gain