Nutrition

Question 0

Per unit body weight, the estimated energy requirement of an infant is __________ times that of an adult.

Answer 0

Two

Question 1

In the first year of life, weight increases ________ fold and length increases ________ fold.

Answer 1

Three; two

Question 2

Benefits of breastfeeding

Answer 2

Reduced incidence of GI and respiratory infections
Allergy prevention (especially for children at risk => i.e. Family Hx of atopy)
Emotional benefit
Inexpensive

???: enhanced cognitive development, benefit for chronic disease (obesity, CVD, diabetes)

Question 3

First choice formula for infants below 9-12 mo. (Examples)

Answer 3

Cow milk based, iron fortified

Ex. Similac, enfamil, good start

Question 4

Primary lactose intolerance is _______________ (rare/common); therefore there are ______________ (few/many) indications for lactose free formula.

Answer 4

Rare; very few

Question 5

Specialized formulas such as protein-hydrolysate may be considered for which indications (3). Examples of protein-hydrolysate include: (3)

Answer 5

Cow’s milk intolerance
Cystic fibrosis
Certain malabsorptive syndromes

Examples include: pregestamil, alimentum, nutramigen

Question 6

Elemental (amino acid based) formulas such as _________ and _________ could be considered for infants with __________ or ___________.

Answer 6

Neocate or PurAmino

Cow’s milk intolerance or short bowel syndrome

Question 7

Cow’s milk is NOT recommended before ____________. Why? (4)

Answer 7

Before age 9-12 months.

Higher protein and mineral load
Lower levels of essential fatty acids
Poor iron bioavilability

=> associated with occult blood loss in stools of infants less than 6 mo.

Question 8

When cow’s milk is introduced (after age 9-12 months), _________% milk should be given.

Answer 8

3.25%

Question 9

Can goat’s milk be used as an alternative to cow’s milk? What about soy milk?

Answer 9

Goat’s milk: No! Similar composition to cow’s milk and NOT fortified with Vitamin D; high incidence of cross reactivity with cow’s milk protein.

Soy milk, rice milk etc.: No! Suboptimal fat and protein composition.

Question 10

Preferred source of nutrition for premature infants? Why?

Answer 10

Breast milk! Yum! +/- human milk fortifier (vitamins, mineral, protein)
Lowers risk of NEC and sepsis

Question 11

Average number of feeds per day from birth to 2 weeks (avg volume per feed)

Answer 11

6-10 feeds/day; 60-90ml/feed

Question 12

Average number of feeds per day and average volume per feed from age 1-3 months.

Answer 12

5-6 feeds/days; 150-180 ml/feed

Question 13

Average number of feeds per day and average volume per feed from age 6-12 months.

Answer 13

3-4 feeds/day; 210-240ml/feed

Question 14

Complementary foods should be introduced at age __________. Start with __________. __________ should be introduced last. Most infants will take ________% of their calories from complementary foods by age 1 year.

Answer 14

Age 6 months; start with iron fortified cereals; meats and alternatives should be last; 50%

Question 15

Egg white is not usually given until after age __________.

Answer 15

1 year

Question 16

Head circumference should be tracked and plotted for all visits (under/over) age ___________.

Answer 16

Under 2 years.

Question 17

BMI should be tracked and plotted at all visits (under/over) age _________.

Answer 17

Over age 2 years.

Question 18

Current standard for growth charts

Answer 18

New WHO growth charts
Based on children from multiple countries who:
Raised under optimal conditions for growth
Breastfed for at least 3 months

Question 19

Assessment of underweight (based on growth charts)

Answer 19

<3rd percentile in weight-for-age (under 10 years) or BMI-for-age (10 years or older)

*wasting is defined in the same way but using BMI-for-age

Question 20

Expected weight gain for 0-3 months (g/day)

Answer 20

26-31 grams/day

Question 21

Expected weight gain for 3-6 months (g/day)

Answer 21

17-18 grams/day

Question 22

Expected weight gain for 12-36 months (g/day)

Answer 22

7-9 grams/day

Question 23

Definition(s) of Failure to Thrive (FTT)

Answer 23

NOT a Dx
Weight <80% ideal body weight

Look at growth velocity, adjusted weight for length if premature/IUGR etc.

Question 23

Approachto failure to thrive (aka. Inadequate weight gain) => three important things to consider

Answer 23

1. Inadequate intake? (What? How often? Difficulties feeding?)
2. Increased losses?
3. Increased requirements?

Question 24

Causes of poor intake (10)

Answer 24

Anatomic problems (ex. Cleft lip/palate)
Neurologic disorders
GERD 
Congenital heart disease 
Genetic syndrome
Chronic renal disease 
Oral hypersensitivity 
Feeding aversion
Lack of routine
Psychosocial factors 
Neglect

Question 25

Sources of increased losses (10)

Answer 25

Malabsorption (celiac, cow's milk protein intolerance, short bowel)
Pancreatic disease (cystic fibrosis)
Liver disease
Recurrent or chronic infection
Inflammatory conditions (ex. IBD)
Vomiting 
Severe GERD
Malrotation/atresia
Metabolic disease
DM (polydipsia/polyuria)
Hyperthyroidism 
Malignancy

Question 26

Useful tests in failure to thrive due to suspected increased losses

Answer 26

Three day fecal fat, fecal elastase => fat
Stool alpha-1-antitrypsin => protein
Reducing substances => CHO
Stool cultures
Fat soluble vitamin levels
CBC, iron studies, albumin
Celiac => TTG/IgA level
Cystic fibrosis => sweat test

Question 27

Reasons for increased requirements (7)

Answer 27

Congenital heart disease
Cystic fibrosis
IBD
Chronic renal disease
Liver disease
Prematurity
Catch up growth

Question 28

Celiac disease (laboratory findings)

Answer 28

TTG >3
Low albumin
Villous atrophy on upper endoscopy and duodenal biopsy

Tx: gluten free diet!!!

Question 29

Risk groups for iron deficiency

Answer 29

Premature infants, lower SES, infants of iron deficient mothers
Early introduction of cow's milk
Medications
Malabsorption
Poor dietary sources of iron

Question 30

Tx iron deficiency

Answer 30

Treat the cause!

3-4mg/kg/day of elemental iron for 3 months

Question 31

Age range when Vitamin D deficiency commonly presents

Answer 31

3 months to 3 years

Question 32

_______________ is the only supplement needed for term infants in the first 6 months of life.

Answer 32

Vitamin D 
400 IU (or 800 IU if in Northern communities) should be given to all breastfed infants until the diet provides this amount or until 1 year of age

Question 33

Definition overweight and obesity

Answer 33

Overweight: BMI > 85th percentile for age and sex
Obesity: BMI >95th percentile for age and sex

Question 34

Can obesity be “eyeballed”?

Answer 34

No! Need to take weight/height/BMI