nutrition Flashcards
0
Q
how do probiotics modify gut flora?
A
- lower colonic PH
- produce antimicrobial compounds and antitoxins
- compete with other bacteria
- enhance gut barrier function
- play role in immunomoduation
1
Q
Ho do you define abx associated diarrhea?
A
> = 3 loose stools per day for up to 2 weeks after initial Abx
2
Q
what percent of kids with CP are overnurished?
A
8-14%
3
Q
in what situation can probiotics potentially work?
A
Prem > 1 kg at risk of NEC prevent Abx related diarrhea shorten duration of acute infectious viral diarrhea - rota decrease symptoms of colic decrease some symptoms of IBS
4
Q
how is nutritional rehab beneficial?
A
- improved overall halth
- improves circulation
- helps heal decubitus ulcers
- decreases spasticity
- improves GERD
5
Q
whatb are the 4 causes of malnutrition?
A
inadequate intake
inc losses
alt metabolism
oromotor dysfunction
6
Q
what is superior mesenteric artery syndrome?
A
common in pt with severe soliosis
or pt with rapid weight loss
7
Q
what are contributing factors for the dev of osteopenia and osteoporosis in neurologically impaired
A
reduced ambulation reduced weight bearing malnutrition limited sun exposure AED which effect vit D met
8
Q
what are local complications of NG tubes?
A
sinusitis
congestion
otitis
skin breakdown
9
Q
if a patient is bedridden, what would be an appropriate growth urve for them to follow?
A
10%
10
Q
for a patient who is wheelchair bound, what would be an appropriate growth curve for them to folow?
A
25%
11
Q
What are 5 nutrition recommendations regarding 0-6 mo
A
- BF for 6 mo
- promote BF - protect and support
- Vit D 400 IU
- first food should be iron rich
- monitor growth via WHO growth curve for Canada
12
Q
by what age should lumpy texture be offered?
A
no later than 9 month
Family food by 1 year
13
Q
when should we introduce cow milk?
A
9-12 month
14
Q
what are nutrition suggestions for > 1 year old
A
regular scheduled meals no added sugar or salt high fat foods homo milk 500 ml/day limit juice parents are role models
15
Q
when can a child receive skim milk?
A
Not before 2 years of age
16
Q
what % of kids are felt to be picky eaters?
A
25 - 35%
17
Q
what is the expected wgt gain and hgt for 1st, 2nd and 3 rds of life
A
- 7 gk and 21 cm
- 2.3kg and 12 cm
- 1-2kg and 6-8cm per year after that
18
Q
if a toddler does not like sushi for the first time what should you do?
A
- repeatedly offer
- neutral exposure
- do not pressure them
- model
- praise
19
Q
what advice can you tell a parent of a well child who is picky?
A
- 2-5 yrs is when appetite decrease is normal
- parent isresponsible for what foods, the child is responsible for how much
- portion size-one tablespoon of each food per year of age
- no juice and no grazing
- eating should be enjoyable - no bribe…
- meal time is 20 min, and if not done, take away
- give 10-15 min notice before a meal
- no distraction
- age appropriate table manners
- eat as a family
20
Q
what are major plant sources of protein?
A
legumes -beans cereals nuts seeeds seedbutter
21
Q
do vegetarian children need more protein
A
YES
need 10-15% more - babies need more
soy matches animal protein but wheat only 50% of animal protein equivalent
22
Q
do kids with restrictede diet need more Fe?
A
yes
Need 1.8 x more Fe for vegans and lacto ov
Vit C helps
23
Q
What may inhibit Fe absorption?
A
fibers
phytates
tannins
24
what limits zinc absorption?
phytates
25
does BM have enough zinc?
yes, up until 7 month
| rare def so don't need supp
26
what are foods high in zinc?
```
legumes
nuts
yeast
fermented soy
sprouting seeds
```
27
How are vegans getting calcium?
```
BM until transition
fortified soy
creeal
juice
leafy veg
may need supp
```
28
what type of added fat is required in a vegan diet?
```
linolenic acid: Precursor to DHA omega 3
flaxseed
canola oil
walnuts
soy products
limit shortening and margerine
```
29
what vitamin are vagna babies at high risk of being low?
vit B12
If breastfeeding - need supplementation
if older, need fortified cereals, yeast, soy, nut beverage
need 3 servings of B 12 daily or supplementation
30
who needs Vit D supp
BF infants
infants consuming < 500 ml of fortified milk/day
if < 2 yrs and above 55 parallel, dark skin or those avoiding sun need 800 IU from Oct - April
from 2-teens - 200IU
31
how much sun exposure is needed for Vit D
20 min 3 times per week
32
how do vegans get Vitamin A
yellow/orange vegetables
leafy green
fruits
need 3 servings per day
33
what is the max fibre intake
0.5 g/kg/day
34
what supplements might be required for a pregnant or lactating vegan
```
Vitamin B12
Vit D 2000 IU during winter
Fe
linoleic acid
calcium
```
35
if a child has neurodev and less than 3 , where do you want them on the growth curve
50%
36
what does Vit A do?
maintains growth and functional integrity in cells
in eyes, GI, resp and Gu system
helps the immune system
37
how does Vit A def present
1. night blindness from conjunctival xerosis progressing to ulceration (keratomalacia) once that is present - non reversible
2. follicular hyperkeratosis - scaly patches
3. FTT
4. Inc risk of severe diarrhea and resp infection
5. More likely to die from MEASLES!!!!
38
what children are at higher risk of Vit A def?
malnutrition
malabsorption - Crohn"s, celiac and hepatic failure
Rx with supp
39
how does hypervitaminosis A present?
```
drowsy
jt pain
loss of hair
inc ICP
Carotenemia
```
40
what is Vit B1 and what are the features of the def
Thiamine
Beriberi: CHF, cyanosis, dyspnea, vomiting, peircing cry, irritable, perih neuritis, decreased DTR, ataxia,
Wernicke's: encephalopathy and nystagmus
Korsakoff: short trem memory loss and confabulation
41
who gets Vit B1 def
Thiamine
loop diuretic - chronic
TPN with no thiamine
42
what is Vit B2 and where do we find it?
| what does a def look like
```
Riboflavin
meat, fish, eggs, milk, green veg, yeast
Def: Cheilosis/glossitis
photophobia
seborrheic dermatitis
sore throat
edema
Normocytic ANEMIA
```
43
what is Vit B3
what do we find it in
what is the def?
1. NIACIN
2. milk and eggs
3. Pellagra: 3D - Diarrhea, dermatitis, dementia
Drematitis is photosensitive
44
who gets Vit B3 def
```
malnutrition
tryptophan def
alcoholism
AN
INH
6MP
5-fluorouracyl
```
45
what is Vit B6 and who gets def?
```
pyroxidine
from:
malabsorption
diarrhea
INH
steroids
AED
OCP
exclusive BF baby with mom who is deficient
```
46
what are the clinical features of Vit B6 def?
```
refractory seizures
irritable
vomiting
FTT
dermatitis
periph neuritis
MICROCYTIC anemia
```
47
what are 3 Vit B6 dep syndromes
Vit B6 dep seizures
Vit B6 responsive anemia
homocystenuria
48
how do you get Vit B12 def
1) Not enough in: strict vegetarian, takes yrs to use up source of BF baby with mom who is def
2) abn abs: gastric resection, pernicious anemia, PPI, pancreatic insuf, bact overgrowth, parasite, Crohn's, celiac, ileum resection
49
How do you Dx a VitB12 def
viatmin B12 level
total homocysteine
methylmalonic acid - MMA
Once confirmed: need Schilling test, diet Hx, parasite, AA anlysis, Vit B12 binding capacity, Ab to parietal cells and IF
50
what is the CF of Vit B12 def
HEME:
Macrocytic anemia
pancytopenia
hypersegm Nt
```
NEURO:
GDD
regression
paraesthesia
hypotonia
proprioception
Sz
abn mov
personality change
poor school
May not see heme issue BC folate will help fix!!!!!
```
51
how do you manage a Vit B12 def
Cyanocobalamin SC
52
who gets folate def
```
goat milk diet
evaporated milk
MTX
phenytoin
Crohn's
Celiac
small bowel resection
```
53
what are the CF of folate def?
```
macrocytic anemia
hypersegmented neutrophils
low retic
low Nt
low plt
high Fe
```
54
who gets Vit C def?
evaporated boiled milk diet
DM
short gut syndrome
chronic diarrhea
55
what are clinical features of Vit C def
```
poor wound healing
Bleeding - into jt, muscle, ...
muscle pain
pseudoparalysis
GDD
FTT
dystrophic hair/alopecia
follicular keratosis
weakness
cardiac hypertrophy
OSTEOPENIA
```
56
how do you Dx Vit C def
give vitamin C and see if pee out. If decreased excretion = def
also see improvement in muscle pain and bleeding within 2-3 days
57
what are CF of Vit E def
```
pigmented retinopathy/vision loss
ataxia
loss of vibratory sens
hyporeflexia
weakness
HEMOLYTIC anemia
```
58
when should Ginkgo not be used
pt on anticoagulants or antiplt
| avoid in pt with bleeding disorder
59
why is St John's Wort dangerous
Activates P450 and will interact with:
- warfarin
- OCP
- cyclosporine
60
what is an option for a child with ADHD who has significant SE, poor response or refuses Rx?
Neurofeedback=EEG biofeedback
OR
Hypnosis- inc sense of control/self-esteem/reduces stress
61
what are + factors that protect kids from dieting
```
self esteem
sense of control over own life
family connectedness
school involvement
+ role models
```
62
what are the most important risk factors for unhealthy wgt control behaviours?
dissatisfaction with wgt
obesity
low self-esteem
these kids are at risk for smoking, drugs, sex
