nutrition Flashcards
how do probiotics modify gut flora?
- lower colonic PH
- produce antimicrobial compounds and antitoxins
- compete with other bacteria
- enhance gut barrier function
- play role in immunomoduation
Ho do you define abx associated diarrhea?
> = 3 loose stools per day for up to 2 weeks after initial Abx
what percent of kids with CP are overnurished?
8-14%
in what situation can probiotics potentially work?
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
how is nutritional rehab beneficial?
- improved overall halth
- improves circulation
- helps heal decubitus ulcers
- decreases spasticity
- improves GERD
whatb are the 4 causes of malnutrition?
inadequate intake
inc losses
alt metabolism
oromotor dysfunction
what is superior mesenteric artery syndrome?
common in pt with severe soliosis
or pt with rapid weight loss
what are contributing factors for the dev of osteopenia and osteoporosis in neurologically impaired
reduced ambulation reduced weight bearing malnutrition limited sun exposure AED which effect vit D met
what are local complications of NG tubes?
sinusitis
congestion
otitis
skin breakdown
if a patient is bedridden, what would be an appropriate growth urve for them to follow?
10%
for a patient who is wheelchair bound, what would be an appropriate growth curve for them to folow?
25%
What are 5 nutrition recommendations regarding 0-6 mo
- 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
by what age should lumpy texture be offered?
no later than 9 month
Family food by 1 year
when should we introduce cow milk?
9-12 month
what are nutrition suggestions for > 1 year old
regular scheduled meals no added sugar or salt high fat foods homo milk 500 ml/day limit juice parents are role models
when can a child receive skim milk?
Not before 2 years of age
what % of kids are felt to be picky eaters?
25 - 35%
what is the expected wgt gain and hgt for 1st, 2nd and 3 rds of life
- 7 gk and 21 cm
- 2.3kg and 12 cm
- 1-2kg and 6-8cm per year after that
if a toddler does not like sushi for the first time what should you do?
- repeatedly offer
- neutral exposure
- do not pressure them
- model
- praise
what advice can you tell a parent of a well child who is picky?
- 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
what are major plant sources of protein?
legumes -beans cereals nuts seeeds seedbutter
do vegetarian children need more protein
YES
need 10-15% more - babies need more
soy matches animal protein but wheat only 50% of animal protein equivalent
do kids with restrictede diet need more Fe?
yes
Need 1.8 x more Fe for vegans and lacto ov
Vit C helps
What may inhibit Fe absorption?
fibers
phytates
tannins
what limits zinc absorption?
phytates
does BM have enough zinc?
yes, up until 7 month
rare def so don’t need supp
what are foods high in zinc?
legumes nuts yeast fermented soy sprouting seeds
How are vegans getting calcium?
BM until transition fortified soy creeal juice leafy veg may need supp
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
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
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
how much sun exposure is needed for Vit D
20 min 3 times per week
how do vegans get Vitamin A
yellow/orange vegetables
leafy green
fruits
need 3 servings per day
what is the max fibre intake
0.5 g/kg/day
what supplements might be required for a pregnant or lactating vegan
Vitamin B12 Vit D 2000 IU during winter Fe linoleic acid calcium
if a child has neurodev and less than 3 , where do you want them on the growth curve
50%
what does Vit A do?
maintains growth and functional integrity in cells
in eyes, GI, resp and Gu system
helps the immune system
how does Vit A def present
- night blindness from conjunctival xerosis progressing to ulceration (keratomalacia) once that is present - non reversible
- follicular hyperkeratosis - scaly patches
- FTT
- Inc risk of severe diarrhea and resp infection
- More likely to die from MEASLES!!!!
what children are at higher risk of Vit A def?
malnutrition
malabsorption - Crohn”s, celiac and hepatic failure
Rx with supp
how does hypervitaminosis A present?
drowsy jt pain loss of hair inc ICP Carotenemia
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
who gets Vit B1 def
Thiamine
loop diuretic - chronic
TPN with no thiamine
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
what is Vit B3
what do we find it in
what is the def?
- NIACIN
- milk and eggs
- Pellagra: 3D - Diarrhea, dermatitis, dementia
Drematitis is photosensitive
who gets Vit B3 def
malnutrition tryptophan def alcoholism AN INH 6MP 5-fluorouracyl
what is Vit B6 and who gets def?
pyroxidine from: malabsorption diarrhea INH steroids AED OCP exclusive BF baby with mom who is deficient
what are the clinical features of Vit B6 def?
refractory seizures irritable vomiting FTT dermatitis periph neuritis MICROCYTIC anemia
what are 3 Vit B6 dep syndromes
Vit B6 dep seizures
Vit B6 responsive anemia
homocystenuria
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
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
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!!!!!
how do you manage a Vit B12 def
Cyanocobalamin SC
who gets folate def
goat milk diet evaporated milk MTX phenytoin Crohn's Celiac small bowel resection
what are the CF of folate def?
macrocytic anemia hypersegmented neutrophils low retic low Nt low plt high Fe
who gets Vit C def?
evaporated boiled milk diet
DM
short gut syndrome
chronic diarrhea
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
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
what are CF of Vit E def
pigmented retinopathy/vision loss ataxia loss of vibratory sens hyporeflexia weakness HEMOLYTIC anemia
when should Ginkgo not be used
pt on anticoagulants or antiplt
avoid in pt with bleeding disorder
why is St John’s Wort dangerous
Activates P450 and will interact with:
- warfarin
- OCP
- cyclosporine
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
what are + factors that protect kids from dieting
self esteem sense of control over own life family connectedness school involvement \+ role models
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
