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nutrition Flashcards

0
Q

how do probiotics modify gut flora?

A
  1. lower colonic PH
  2. produce antimicrobial compounds and antitoxins
  3. compete with other bacteria
  4. enhance gut barrier function
  5. play role in immunomoduation
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1
Q

Ho do you define abx associated diarrhea?

A

> = 3 loose stools per day for up to 2 weeks after initial Abx

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2
Q

what percent of kids with CP are overnurished?

A

8-14%

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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
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4
Q

how is nutritional rehab beneficial?

A
  1. improved overall halth
  2. improves circulation
  3. helps heal decubitus ulcers
  4. decreases spasticity
  5. improves GERD
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5
Q

whatb are the 4 causes of malnutrition?

A

inadequate intake
inc losses
alt metabolism
oromotor dysfunction

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6
Q

what is superior mesenteric artery syndrome?

A

common in pt with severe soliosis

or pt with rapid weight loss

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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
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8
Q

what are local complications of NG tubes?

A

sinusitis
congestion
otitis
skin breakdown

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9
Q

if a patient is bedridden, what would be an appropriate growth urve for them to follow?

A

10%

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10
Q

for a patient who is wheelchair bound, what would be an appropriate growth curve for them to folow?

A

25%

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11
Q

What are 5 nutrition recommendations regarding 0-6 mo

A
  1. BF for 6 mo
  2. promote BF - protect and support
  3. Vit D 400 IU
  4. first food should be iron rich
  5. monitor growth via WHO growth curve for Canada
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12
Q

by what age should lumpy texture be offered?

A

no later than 9 month

Family food by 1 year

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13
Q

when should we introduce cow milk?

A

9-12 month

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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
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15
Q

when can a child receive skim milk?

A

Not before 2 years of age

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16
Q

what % of kids are felt to be picky eaters?

A

25 - 35%

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17
Q

what is the expected wgt gain and hgt for 1st, 2nd and 3 rds of life

A
  1. 7 gk and 21 cm
  2. 2.3kg and 12 cm
  3. 1-2kg and 6-8cm per year after that
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18
Q

if a toddler does not like sushi for the first time what should you do?

A
  1. repeatedly offer
  2. neutral exposure
  3. do not pressure them
  4. model
  5. praise
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19
Q

what advice can you tell a parent of a well child who is picky?

A
  1. 2-5 yrs is when appetite decrease is normal
  2. parent isresponsible for what foods, the child is responsible for how much
  3. portion size-one tablespoon of each food per year of age
  4. no juice and no grazing
  5. eating should be enjoyable - no bribe…
  6. meal time is 20 min, and if not done, take away
  7. give 10-15 min notice before a meal
  8. no distraction
  9. age appropriate table manners
  10. eat as a family
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20
Q

what are major plant sources of protein?

A 
legumes -beans
cereals
nuts
seeeds
seedbutter
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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

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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

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23
Q

What may inhibit Fe absorption?

A

fibers
phytates
tannins

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24
Q

what limits zinc absorption?

A

phytates

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25
Q

does BM have enough zinc?

A

yes, up until 7 month

rare def so don’t need supp

26
Q

what are foods high in zinc?

A 
legumes
nuts
yeast
fermented soy
sprouting seeds
27
Q

How are vegans getting calcium?

A 
BM until transition
fortified soy
creeal
juice
leafy veg
may need supp
28
Q

what type of added fat is required in a vegan diet?

A 
linolenic acid: Precursor to DHA omega 3
flaxseed
canola oil
walnuts
soy products
limit shortening and margerine
29
Q

what vitamin are vagna babies at high risk of being low?

A

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
Q

who needs Vit D supp

A

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
Q

how much sun exposure is needed for Vit D

A

20 min 3 times per week

32
Q

how do vegans get Vitamin A

A

yellow/orange vegetables
leafy green
fruits
need 3 servings per day

33
Q

what is the max fibre intake

A

0.5 g/kg/day

34
Q

what supplements might be required for a pregnant or lactating vegan

A 
Vitamin B12
Vit D 2000 IU during winter
Fe
linoleic acid
calcium
35
Q

if a child has neurodev and less than 3 , where do you want them on the growth curve

A

50%

36
Q

what does Vit A do?

A

maintains growth and functional integrity in cells
in eyes, GI, resp and Gu system
helps the immune system

37
Q

how does Vit A def present

A
  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
Q

what children are at higher risk of Vit A def?

A

malnutrition
malabsorption - Crohn”s, celiac and hepatic failure
Rx with supp

39
Q

how does hypervitaminosis A present?

A 
drowsy
jt pain
loss of hair
inc ICP
Carotenemia
40
Q

what is Vit B1 and what are the features of the def

A

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
Q

who gets Vit B1 def

A

Thiamine
loop diuretic - chronic
TPN with no thiamine

42
Q

what is Vit B2 and where do we find it?

what does a def look like

A 
Riboflavin
meat, fish, eggs, milk, green veg, yeast
Def: Cheilosis/glossitis
photophobia
seborrheic dermatitis
sore throat
edema
Normocytic ANEMIA
43
Q

what is Vit B3
what do we find it in
what is the def?

A
  1. NIACIN
  2. milk and eggs
  3. Pellagra: 3D - Diarrhea, dermatitis, dementia
    Drematitis is photosensitive
44
Q

who gets Vit B3 def

A 
malnutrition
tryptophan def
alcoholism
AN
INH
6MP
5-fluorouracyl
45
Q

what is Vit B6 and who gets def?

A 
pyroxidine
from:
malabsorption
diarrhea
INH
steroids
AED
OCP
exclusive BF baby with mom who is deficient
46
Q

what are the clinical features of Vit B6 def?

A 
refractory seizures
irritable
vomiting
FTT
dermatitis
periph neuritis
MICROCYTIC anemia
47
Q

what are 3 Vit B6 dep syndromes

A

Vit B6 dep seizures
Vit B6 responsive anemia
homocystenuria

48
Q

how do you get Vit B12 def

A

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
Q

How do you Dx a VitB12 def

A

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
Q

what is the CF of Vit B12 def

A

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
Q

how do you manage a Vit B12 def

A

Cyanocobalamin SC

52
Q

who gets folate def

A 
goat milk diet
evaporated milk
MTX
phenytoin
Crohn's
Celiac
small bowel resection
53
Q

what are the CF of folate def?

A 
macrocytic anemia
hypersegmented neutrophils
low retic
low Nt
low plt
high Fe
54
Q

who gets Vit C def?

A

evaporated boiled milk diet
DM
short gut syndrome
chronic diarrhea

55
Q

what are clinical features of Vit C def

A 
poor wound healing
Bleeding - into jt, muscle, ...
muscle pain
pseudoparalysis
GDD
FTT
dystrophic hair/alopecia
follicular keratosis
weakness
cardiac hypertrophy
OSTEOPENIA
56
Q

how do you Dx Vit C def

A

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
Q

what are CF of Vit E def

A 
pigmented retinopathy/vision loss
ataxia
loss of vibratory sens
hyporeflexia
weakness
HEMOLYTIC anemia
58
Q

when should Ginkgo not be used

A

pt on anticoagulants or antiplt

avoid in pt with bleeding disorder

59
Q

why is St John’s Wort dangerous

A

Activates P450 and will interact with:

  • warfarin
  • OCP
  • cyclosporine
60
Q

what is an option for a child with ADHD who has significant SE, poor response or refuses Rx?

A

Neurofeedback=EEG biofeedback
OR
Hypnosis- inc sense of control/self-esteem/reduces stress

61
Q

what are + factors that protect kids from dieting

A 
self esteem
sense of control over own life
family connectedness
school involvement
\+ role models
62
Q

what are the most important risk factors for unhealthy wgt control behaviours?

A

dissatisfaction with wgt
obesity
low self-esteem

these kids are at risk for smoking, drugs, sex

CPS (10 decks)

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