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Peds > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Fat soluble vitamins?

A

Vitamins A, D, E, K

-Come in gelatin tablet with oil in center

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2
Q

Vitamin A

A

Retinol

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3
Q

Vitamin E

A

Tocopherol

“Toke-of-ethanol”

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4
Q

Vitamin K

A

Phylloquinone

-“File-o-kanines”
File cabinet of dogs shaped like K

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5
Q

Vitamin B1

A

Thiamine

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6
Q

Vitamin B2

A

Riboflavin

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7
Q

Vitamin B3

A

Niacin

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8
Q

Vitamin B5

A

Pantothenic acid

Pentothenic acid

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9
Q

Vitamin B6

A

Pyridoxine

Pyrido6ine

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10
Q

Vitamin B9

A

Folate

Fool comes late it is benign

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11
Q

Vitamin B12

A

Cyanocobalamin

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12
Q

Weird B vitamin?

A

Biotin

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13
Q

Ascorbic Acid

A

Vitamin C

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14
Q

Most common cause of blindness in young children?

A

Vitamin A deficiency

Retinol is very similar to retina

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15
Q

Xerophthalmia (dry eyes), nyctalopia (night blindness), complete blindness

A

Vitamin A deficiency

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16
Q

What can cause intracranial hypertension (pseudotumor cerebri)?

A

Vitamin A intoxication

-Giant A causing intracranial pressure

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17
Q

Large tongue and macrocytic anemia?

A

Vitamin B9 (folate) deficiency

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18
Q

What can vitamin B9 (folate) toxicity cause?

A

Irritability

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19
Q

If you give folate (B9) for macrocytic anemia, what can it mask?

A

B12 Deficiency

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20
Q

B12 deficiency?

A

Macrocytic anemia

-Bowel disease can lead to pernicious anemia due to poor B12 absorption secondary to decreased intrinsic factor

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21
Q

Can B12 in excess be toxic?

A

No

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22
Q

Bleeding gums, scurvy, leg tenderness, poor wound healing

A

Vitamin C deficiency

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23
Q

What can excessive mega doses of vitamin C cause?

A

Oxalate and cysteine nephrocalcinosis

Excreted through kidneys

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24
Q

What vitamin can trigger a hemolytic crisis in someone with G6PD deficiency?

A

Vitamin C

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25
Q

Hemolytic anemia in preemies and neurological effects in older kids

A

Vitamin E deficiency

Has to be a severely prolonged deficiency
-E is a fork puncturing red cells

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26
Q

Neuropathies, peripheral edema, thrombocytosis, muscle weakness

A

Vitamin E deficiency

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27
Q

Vitamin E toxicity?

A

Liver toxicity

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28
Q

Hemorrhagic disease of the newborn

A

Vitamin K deficiency

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29
Q

What vitamin doesn’t cross the placenta well?

A

Vitamin K

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30
Q

Why can’t a newborn produce vitamin K well?

A

Gut flora hasn’t been established

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31
Q

Vitamin K dependent factors are only what % of normal in first 2-3 days of life?

A

30%

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32
Q

Are breast fed or formula fed babies babies more vulnerable to vitamin K deficiency?

A

Breast fed- Breast milk doesn’t contain much vitamin K

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33
Q

Child born at home (did not get vitamin K at birth), exclusively breast fed, bleeding

A

Give vitamin K followed by FFP

K to make factors 10, 9, 7, 2
FFP for instant clotting factors (active bleeding)

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34
Q

What are the vitamin K dependent factors?

A

2, 7, 9, 10

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35
Q

Edema, erythrocyte explosion (hemolytic anemia), elevated platelet count

A

Triple E of vitamin E deficiency

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36
Q

What is isotretinoin an analog of?

A

Vitamin A

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37
Q

What is isotretinoin used to treat?

A

Acne

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38
Q

Which drug used for teens is a significant teratogen?

A

Isotretinoin

HAVE TO RULE OUT PREGANCY

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39
Q

Teen with symptoms of a brain tumor who takes isotretinoin

A

Vitamin A toxicity (pseudotumor cerebri)

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40
Q

Yellow toddler who eats lots of beta-carotene (carrots, sweet potatoes, apricots), but sclerae and oral mucosa aren’t yellow

A

No further evaluation or change diet

NOT jaundice or icteric, don’t get serum bili

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41
Q

What is common finding between B12 and B9 deficiency?

A

Macrocytic anemia

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42
Q

What is beta carotene converted to in the body?

A

Vitamin A (retinol)

It’s a precursor to vitamin A

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43
Q

Vitamin D2

A

Ergocalciferol (2 Cs, D2)

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44
Q

Vitamin D3

A

Cholecalciferol (3 Cs, D3)

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45
Q

25-Hydroxy Vitamin D

A

Calcidiol

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46
Q

Where is calcidiol (25-Hydroxy Vitamin D) hydroxylated?

A

Liver

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47
Q

1,25 Hydroxy Calciferol

A

1,25-Dihydroxycholecalciferol or calcitriol

-Calcitriol tries to help the body by increasing calcium absorption in the gut and releasing it into the blood from bone

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48
Q

Where is 1,25 Hydroxy-calciferol formed?

A

Kidney

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49
Q

What is the active metabolite of vitamin D?

A

1,25 Hydroxy-calciferol

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50
Q

What is the only vitamin known to be converted to hormone form?

A

Vitamin D

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51
Q

If I child is exposed to sufficient UV sunlight do they need any dietary vitamin D?

A

No

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52
Q

What is the primary storage form of vitamin D and the one you will measure?

A

25-Hydroxy Vitamin D

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53
Q

Who do you supplement vitamin D for?

A

Exclusively breast fed infants (by 2 weeks)

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54
Q

Low vitamin D causes?

A

Rickets

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55
Q

What electrolyte problems are from vitamin D excess?

A

Hypercalcemia and hyperphosphatemia

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56
Q

Symptoms of vitamin D excess?

A

Nausea, vomiting, weakness, polyuria, polydipsia, elevated BUN, nephrolothiasis, renal failure

It can be fatal

Similar symptoms to diabetes (both have D)

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57
Q

How to treat vitamin D toxicity

A

Hydration, lasix, correct sodium/potassium depletion

-It causes mobilization of calcium and phosphorous from bones and deposition into soft tissue

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58
Q

Calorie requirements

A

1500kcal for first 20kg, then 20kcal/kg for each additional kg

  • 100kcal/kg for first 10kg
  • 50kcal/kg for next 10kg
  • 20kcal/kg for any more kg
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59
Q

What is caloric intake for children based on?

A

Body surface area

Which varies child to child

Recommended daily allowance (RDA) is starting point for estimating caloric requirements in kids.

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60
Q

Why can infants still lose weight even if they are receiving adequate nutrition, there are no increases insensible losses, and there is no evidence of renal failure?

A

Due to renal fluid loss as a result of increased solute load…infants kidneys can’t handle the same osmotic load of an adult during times of stress (relationship with dietary protein and renal solute load)

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61
Q

What are calorie requirements for term/preterm infants?

A

100-120 kcal/kg/day

-Preemies closer to 120, large term closer to 100

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62
Q

How much protein for premature infants?

A

3.5 g/kg/day

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63
Q

Protein for full term infants?

A

2.0-2.5 g/kg/day for first 6 months

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64
Q

Why do premature infants have trouble maintaining appropriate body temperature?

A

Lower levels of fat storage

-Expend more energy in heat production than term babies

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65
Q

Premature babies require more energy for what 2 things?

A

Organogenesis and developing fat stores

-This all increases nutritional and energy requirements in comparison to term babies

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66
Q

When does catch up growth in preemies happen?

A

First 2 years (Should attain normal height at 2 and beyond)

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67
Q

Post-op infant not gaining weight… Cause?

A

Increased urine output secondary to increased renal solute load (Even is surgery was for big GI procedure like malrotation implying poor absorption or protein losing enteropathy)

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68
Q

What are 4 important components of renal solute load?

A

-Sodium, potassium, chloride, phosphorus

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69
Q

What electrolyte doesn’t play a major role in renal solute load?

A

Calcium

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70
Q

If you are choosing an essential fatty acid, which one is it?

A

Linoleic Acid

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71
Q

No cow milk before…?

A

12 months

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72
Q

What milk from age 1-2?

A

Whole milk

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73
Q

Low fat milk when?

A

Overweight children after age 12 months

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74
Q

Does formula have adequate fluoride?

A

No, it needs to come from outside sources, like drinking water

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75
Q

What is the recommended concentration of iron in iron fortified formula?

A

12 mg/L

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76
Q

What can cause iron deficiency anemia in a toddler?

A

Drinking too much milk

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77
Q

Who needs iron supplementation at birth?

A

Only those at high risk (LBW or preterm, even if breastfed)

-Full term babies have adequate iron stores

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78
Q

When should all babies (even breast fed infants) get iron supplementation in their food (iron-fortified cereals)?

A

Start around 4-6 months of age

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79
Q

What blood problem is associated with obesity in children?

A

Iron deficiency anemia

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80
Q

When do you use low iron formula (1.5 mg/L)?

A

NEVER

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81
Q

Does iron fortified formula cause constipation?

A

No

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82
Q

Kid in iron fortified formula has constipation… What do you do?

A

Add fruit juice to increase osmotic load

-Don’t use low iron formula, dilute the formula, switch to whole milk, or add more cereal

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83
Q

Which is IgE mediated, milk protein allergy or milk intolerance?

A

Milk protein allergy

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84
Q

Which two formula intolerance can cause rash, vomiting, and irritability?

A

Milk protein allergy and milk intolerance

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85
Q

Due to IgE mediated response, presents with rash, vomiting, and irritability

A

Milk protein allergy

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86
Q

What formula intolerance causes irritability, but no rash or vomiting?

A

Lactose intolerance

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87
Q

When can a secondary lactase deficiency causing lactose intolerance in kids develop?

A

After GI infection (like rotavirus)

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88
Q

With true milk allergy what is there significant cross reactivity with?

A

Soy-based formula, use elemental formula

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89
Q

Infant with bloating and worsening diarrhea after formula is reintroduced into diet following episode of viral gastroenteritis?

A

Lactose intolerance due to secondary lactase deficiency (usually doesn’t happen, but it can)

-You can hold off on lactose-containing formula in young infant until diarrhea resolves, but DONT hold hold off on breastfeeding

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90
Q

Vomiting, rash, diarrhea, irritability

A

Milk protein allergy/intolerance

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91
Q

Flatulence, bloating, diarrhea, irritability

A

Lactose intolerance

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92
Q

Where are 3 places lactose is found?

A

Human milk, cow based formula, evaporated cow milk

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93
Q

Infants fed “non-traditional” formula will suffer from what?

A

Nutritional deficiencies

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94
Q

Who do you give protein hydrolysate formula to?

A

Infants with allergy to intact milk protein or allergy or soy protein

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95
Q

Non IgE mediated severe cow milk protein intolerance

A

FPIES: Food protein induced enterocolitis syndrome

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96
Q

How does FPIES present?

A

In first 3 months with either heme positive stools or hematochezia along with normal abdominal exam

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97
Q

Can FPIES affect breast fed infants?

A

Yes, cow milk protein ingested by mom can get into breast milk, (this is primarily due to cow milk intolerance)

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98
Q

What do you do for a kid with FPIES?

A

Switch to protein hydrolysate formula or completely eliminate implicated protein from Moms diet

Do not switch to soy formula (symptoms frequently continue with this)

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99
Q

Scaly dermatitis, alopecia, thrombocytopenia

A

Essential fatty acid deficiency

-Thin fish with scales coming off (scaly rash), that turn into platelets (low platelet count), fish is bald (alopecia)

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100
Q

Treatment for essential fatty acid deficiency

A

IV lipids (focus on linoleic acid)

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101
Q

Mineral deficiency presenting with dermatitis and alopecia?

A

Acrodermatitis enteropathica (Inherited condition where zinc isn’t absorbed well)

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102
Q

Infant with dermatitis and alopecia who was recently weaned from breast milk…

A

Zinc deficiency

Breast milk contains a protein which facilitates zinc absorption

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103
Q

Typical presentation of zinc deficiency?

A

Infant with extensive eczematous eruption, growing poorly, lesions around mouth, sometimes in perianal area

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104
Q

What is inheritance of acrodermatitis enteropathica?

A

AR

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105
Q

What differentiates eczema from acrodermatitis enteropathica?

A

Acrodermatitis enteropathica has no lichenification

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106
Q

Low serum copper, low serum ceruloplasmin, high tissue copper, twisted hairs (pili torti)

A

Menkes kinky hair syndrome

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107
Q

Inheritance of menkes kinky hair syndrome

A

X-linked

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108
Q

“Liver deterioration” ( jaundice, large liver), acute neurological deterioration, Kayser Fletcher rings, low ceruloplasmin

A

Wilson’s disease

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109
Q

What causes Wilson’s disease?

A

Deposition of copper in liver and brain

Also affects eyes and kidney

110
Q

Does Wilson’s disease have visual deficits?

A

No

111
Q

How to diagnose Wilson’s disease?

A

Liver biopsy

Ceruloplasmin levels low, not diagnostic

112
Q

When do you consider mineral deficiencies (magnesium and chromium)?

A

Hospitalized patients with increased metabolic demands and underlying conditions (malnutrition, malabsorption, short bowel, burns, TPN)

113
Q

What to do if mom wants to breast feed a preemie?

A

Have mom pump so milk is there for infant, then begin breast feeding when baby ready

114
Q

Who has higher vitamin D requirements?

A

Premature infants

115
Q

Non fat-soluble vitamins?

A

B & C

116
Q

What do preterm infants taking formula high in polyunsaturated fatty acids have to have supplemented?

A

Vitamin E (to avoid hemolysis)

117
Q

Why do premature infants have a difficult time absorbing long chain triglycerides and fat-soluble vitamins?

A

They have decreased amounts of bile acids

118
Q

Premature babies can lose up to what % of ingested fat through the stool?

A

20%

-Fat is absorbed less efficiently in premature babies

119
Q

What triglycerides are absorbed best by premature babies?

A

Medium chain triglycerides (they don’t require bile salts)

120
Q

What % of total fat in preemie formula is from medium chain triglycerides?

A

50%

121
Q

What % of total fat in mature breast milk if from medium chain triglycerides?

A

12%

122
Q

Why doesn’t breast milk contain or need a high amount of medium chain triglycerides?

A

It has high absorptive abilities…breast milk has sufficient linoleic and linolenic acid (these are both essential long chain fatty acids)

123
Q

Are medium chain triglycerides sufficient to provide the essential fatty acids?

A

No, they enhance lipid absorption in formulas, but aren’t sufficient to provide essential fatty acids

124
Q

What can lead to osteopenia and rickets in premature infants?

A

Poor calcium and phosphorous intake

Preemies require supplementation in large amounts (both are poorly absorbed in gut of preemies)

125
Q

What can cause demineralization of bone in a very low birthweight preterm infant?

A

Inadequate phosphorous (often secondary to prolonged parenteral nutrition)

126
Q

Inadequate calcium can lead to…

A

Bone demineralization

127
Q

When will you see bone demineralization and what are the initial lab finding?

A

Can occur after 1 month of TPN, normal serum calcium and phosphorous, elevated alkaline phosphatase

128
Q

Too much phosphorous given to a very low birthweight infant can lead to…

A

Hypocalcemia, tetany, seizures

129
Q

Exclusive breast feeding until?

A

At least 6 months

130
Q

Continued use of breast milk up until…

A

12 months

131
Q

When breastfeeding, what milk is higher in calories?

A

Hind milk (at end of breastfeeding session)

132
Q

Do you ever supplement with water?

A

No

133
Q

What 2 acids decrease in mature milk?

A

Arachidonic acid (AA) and Docosahexaenoic acid (DHA)

This is true for Moms of preemies too

134
Q

What are AA and DHA important for?

A

Neurological development

135
Q

What along with AA is needed in preemies to help prevent skin lesions, poor wound healing, and decreased immune function?

A

Zinc

136
Q

What has low levels in colostrum and thus increases the risk for rickets?

A

Ergo-cholecalciferol

137
Q

Hind milk is higher in what?

A

Fat (milk at end of feeding)

138
Q

What is colostrum over the first few days postpartum higher in?

A

Protein

139
Q

What makes colostrum over first few days postpartum higher in protein?

A

High levels of immune globulins (secretory IgA)

140
Q

What does high levels of immune globulins including secretory IgA provide?

A

Initial protection against infection

141
Q

Why is colostrum yellow?

A

High in carotene

142
Q

What does colostrum do to the gut?

A

Gives a dose of enzymes that stimulate gut maturation and facilitates digestion (especially fats)

Stimulates gut to mass meconium

143
Q

Does colostrum or mature milk have more…

  1. Protein
  2. Fat
  3. Lactose
  4. Energy content
  5. Minerals
A
  1. Colostrum (2.3g/dL v. 1.2g/dL)
  2. Mature milk (4g/dL v. 1.7g/dL)
  3. Mature milk (7g/dL v. 6g/dL)
  4. Mature milk (69kcal/dL v. 49kcal/dL)
  5. Both constant throughout lactation
144
Q

Which is sweeter, breast or cow milk, and why?

A

Breast, contains more lactose

145
Q

Which has more phosphorous, cow or human milk?

A

Cow

146
Q

What can occur if an infant starts cow’s milk before age 1?

A

Hypocalcemia

Infant kidney can get rid of phosphorous in cow milk fast enough…increased phosphorous causes decreased calcium

“Hypo-cow-lcemia”

147
Q

What antibiotic is contraindicated with breast feeding?

A

Metronidazole (Flagyl) for Trichomonas vaginalis

148
Q

What can diazepam do to baby if Mom is taking it while breastfeeding?

A

Sedate them…diazepam is sufficiently concentrated and absorbed by a breast-feeding infant so it is contraindicated

Any medications with sedative effects can make its way into breast milk

149
Q

What vitamin deficiency are breast fed infants at risk for?

A

Vitamin D

150
Q

What vitamin does breast milk contain a small amount of that can contribute to hemorrhagic disease of the newborn?

A

Vitamin K (especially if they haven’t received IM vitamin K at birth)

151
Q

How long do you stop breastfeeding for if you received technetium-99?

A

24-48 hours

Half life is only 6 hours

This is an exception to radioactive contraindication to breast feeding rule

152
Q

What’s the BAD BREAST pneumonic for contraindications to breast feeding?

A

B: Bad bugs (CMV, HIV, TB)
A: Anti-thyroid meds
D: Diseases/STDs (HSV lesions on breast)

B: Bad bugs (CMV, HIV, TB)
R: Radioactive and other chemicals (radioactive meds and chemotherapy)
E: Errors of metabolism, galactosemia, PKU, urea cycle defects (in the baby)
A: Antibiotics and anti-seizures (Flagyl and diazepam)
S: Sulfonamides
T: Tetracycline

153
Q

Can you keep breast feeding with things like candidiasis, contact dermatitis, fibrocystic breast disease, or mastitis?

A

Yes, if properly managed

154
Q

What problem with mom can cause unsuccessful breast feeding?

A

Inverted nipples

155
Q

What is the protein concentration in human milk, cow milk, and modified cow formula?

A

Human: 0.9g/dL
Cow: 3.5g/dL
Modified cow: 1.4g/dL

156
Q

What is the whey:casein ratio in human milk, cow milk, and modified cow formula?

A

Human: 70% whey, 30% casein (human milk is WHEY better)
Cow: 20% whey, 80% casein
Modified cow: Variable

157
Q

What is the type of whey protein in human milk?

A

Alpha lactalbumin

158
Q

What milk contains beta lactalbumin as its whey protein?

A

Cow milk

159
Q

What does the whey protein in human milk contain that makes it easier to digest and promotes gastric emptying?

A

Larger amounts of lactoferrin, lysozyme, and IgA?

160
Q

What does modified cow formula have higher amounts of than human milk?

A

Minerals (calcium, phosphorous, iron)

161
Q

What is the calcium:phosphorous ratio in human milk?

A

2:1

162
Q

What is the calcium phosphorous ratio in modified cow formula?

A

1.5:1

163
Q

What has better iron absorption, human milk or modified cow formula?

A

Human milk

164
Q

Which has higher amounts of vitamins A, B, and C, human milk or modified cow formula?

A

They are the same

165
Q

What has higher amounts of vitamins D, E, and K, human milk or modified cow formula?

A

Modified cow formula (but this is clinically insignificant in mothers with an adequate diet who get sunlight exposure)

166
Q

What has a lower renal solute load, human milk or modified cow formula?

A

Human milk

167
Q

Which has more lipase, human milk or modified cow formula?

A

Human milk

168
Q

Even though breast milk is lower in iron, it has higher bioavailability (iron in breast milk is absorbed better than iron I’m formula) for how many months?

A

First 4

169
Q

During the first four months, is the iron stored during fetal life compensate for an iron deficiency in breast milk?

A

Yes

170
Q

Which contains more iron, formula or breast milk?

A

Formula

171
Q

What is the better source, or results in better absorption of iron, formula or breast milk?

A

Breast milk

172
Q

Standard formula and breast milk are both what-based?

A

Lactose

173
Q

What is the calorie content of breast milk and standard formula?

A

20 kcal/oz = 20 kcal/30cc = 0.67 kcal/cc

174
Q

What has higher protein content, formula or cow milk?

A

Cows milk (3% versus 1%)

Cow milk has more protein than human milk, but it is a quality over quantity thing…protein quality is different between cow and human milk

175
Q

What is the protein requirement of a newborn?

A

2-3 g/kg/day

176
Q

What is the protein requirement of a preemie?

A

3-4 g/kg/day

177
Q

What do you want to prevent in very low birthweight infants since it causes weight loss, and how do you do this?

A

Negative nitrogen balance, give them lots of non-protein calories

178
Q

Why do you not add more powder than indicated when mixing formula?

A

This increases the protein load, which stresses the kidneys (lipid and carbohydrate supplements are available to enhance calorie content of formula)

179
Q

Adding carbohydrate supplement to milk can lead to what?

A

Diarrhea

180
Q

Adding lipid supplement to milk can increase the risk for what?

A

Diarrhea or delayed gastric emptying

181
Q

What amount do you never increase calorie content beyond in formula?

A

30 kcal/oz

182
Q

What form of protein is better for infants and has a higher content of protein in human milk?

A

Whey

“Whey is way better for infants and weighs heavier in the protein content of human milk”

183
Q

What % of cow milk and human milk fat?

A

3-4% for cow milk, human milk varies with Mom diet but is similar to cow’s milk

184
Q

High concentrations of what in breast milk protect against infectious disease (including local GI immunity)?

A

IgA and other antibodies

185
Q

What inhibits bacterial adhesions to mucosal surfaces and reduces the risk of bacterial infection?

A

Lactose-derived oligosaccharides (case with both colostrum and mature milk)

Bacteria lack toes (lactose) to adhere to mucosal surfaces

186
Q

Average full term newborns will gain how much weight per day?

A

20-30 g/day (after initial weight loss during first few days of life)

187
Q

What is the caloric requirement for a newborn?

A

Close to 100 kcal/kg/day

188
Q

Conversion of pounds to kg?

A

Divide by 2.2

189
Q

What is the caloric requirement for a preemie?

A

120 kcal/kg/day

190
Q

How much is a preemie expected to gain each day?

A

15-20g/day

191
Q

What is the optimal whey/casein ratio for a preemie?

A

60:40

192
Q

What is absorbed better than lactose in preemies?

A

Glucose polymers

193
Q

Since preemies absorb glucose polymers better than lactose, what is needed in preemie formula?

A

Medium chain triglycerides

194
Q

Preemie formula has higher amounts of what 2 electrolytes?

A

Calcium and phosphorous

195
Q

Preemie formula contains how many kcal/oz?

A

24 kcal/oz

196
Q

Preemie breast milk contains higher amounts of everything except for what when compared to full term breast milk?

A

Carbohydrates

197
Q

Feeding solid foods like cereals to breastfed infants before 4-6 months of age increases the likelihood of what?

A

GI infection

198
Q

Infants have low levels of what in the gut that make it more difficult to digest solid foods?

A

Amylase

199
Q

Does the introduction of solid foods help an infant sleep through the night?

A

No

200
Q

Introducing solids early increases the chances of developing what? (This is now considered controversial)

A

Food allergies and obesity

201
Q

Do artificial flavor and colors have any role in the development of ADHD?

A

No

202
Q

Artificial flavors and colors may have a role in causing what 2 things?

A

Urticaria and angioedema

203
Q

What are 4 things to remember for home-prepared foods?

A
  1. Foods need to be cleaned and puréed so there are no solid chunks inadvertently left behind
  2. Food should be fully cooked
  3. Serve fresh or freeze for later
  4. No salt seasoning and no honey
204
Q

Do home prepared foods reduce the risk for food allergies?

A

No

205
Q

What is overweight defined as for children?

A

BMI between 85 and 95 percentiles for age and gender

206
Q

What is obesity defined as for kids?

A

BMI greater than 95 percentile for age and gender

207
Q

A child who is obese at age 6 has what % chance of being obese as an adult?

A

25%

208
Q

A child who is obese at age 12 has what % chance of being obese as an adult?

A

75%

209
Q

Is the teen tall/short and delayed/advanced bone age with obesity due to exogenous (overeating) sources?

A

Tall and advanced bone age

210
Q

If a child is overweight due to hormonal/genetic (endogenous) reasons what is their height and bone age?

A

Short with delayed bone age

211
Q

A work up is not warranted for obesity in a child who is obese with what 3 features?

A
  1. Unremarkable PE
  2. Normal linear growth
  3. Normal developmental milestones
212
Q

What is the most common metabolic explanation for an overweight child?

A

Hypothyroidism

Overweight kids who have a normal physical exam and normal linear growth don’t need routine testing

213
Q

Child who is obese with small hands, hypogonadism, delayed developmental milestones, and/or cognitive deficits?

A

Prader-Willi syndrome or Bardet-Biedel syndrome

214
Q

Does genetics play a role in obesity?

A

Yes (correlation in adopted kids, identical twins end up with similar weights, even if raised in different homes/locations)

215
Q

Parental obesity makes it how much more likely that a child younger than 10 will be obese as an adult?

A

Twice as likely

Even if the child isn’t obese, but obesity in childhood increases the risk

216
Q

What is the most common cause of obesity?

A

Excessive food intake

217
Q

What is needed to treat obesity?

A

Child and family have to recognize problem and want to change

  1. Changing diet (without impacting growth)
  2. Increase exercise (most effective when combined with dietary changes)
  3. Modify behavior (support inside and outside family)
218
Q

What should you eliminate first in a kid trying to lose weight so you don’t impact growth?

A

Snacks and sugary drinks

219
Q

What is the best obesity therapy available for children?

A

Prevention… Behavior modification that encourages a healthy diet and appropriate exercise (since roots of obesity are found in childhood)

220
Q

Vegetarian teenage girl with low hemoglobin, SMR of 5, what other physical findings?

A

NONE…vegetarians have low iron stores (a mild iron deficiency anemia will have no other physical findings)

Don’t be tempted by tachycardia, pallor, weakness, and oral lesions

221
Q

What are some health risks involved in obesity in kids?

A
  1. Depression (unclear if obesity causes depression or depression causes obesity)
  2. Avascular necrosis of the hip
  3. Diabetes
  4. HTN
  5. Cardiac disease
  6. Osteoarthritis (secondary to strain on joints, especially LE)
222
Q

A kid who drinks lots of diet sodas (with high phosphoric acid content) is at high risk for what?

A

Osteopenia (risk is even higher if kid has been treated with steroids)

223
Q

What is the best way to reduce risk for fractures in a kid with osteopenia?

A

Vitamin D and calcium supplements

224
Q

What 2 places make you think kwashiorkor or marasmus?

A

Refugee camps or communes

225
Q

What vitamin deficiency are kids who eat vegan diets at risk for?

A

B12

226
Q

If a kid is drinking goat’s milk, what will they be at risk for?

A

Folate deficiency

227
Q

A vegan breastfeeding mom needs to take prenatal vitamins with what in them?

A

B12

228
Q

Non-breastfed vegan infants should get what type of formula?

A

Iron fortified soy formula

229
Q

Kwashiorkor is a deficiency of what?

A

Protein

230
Q

Kid with a pot belly from starvation, pitting edema, rash, thin/frail hair, pallor, overall thin appearance?

A

Kwashiorkor

231
Q

Low protein causes less what, that causes edema?

A

Intravascular osmotic pressure

232
Q

Marasmus is a deficiency of what?

A

General nutrition

233
Q

Muscle wasting without edema and normal hair?

A

Marasmus

234
Q

Can there be a combination of marasmus and kwashiorkor?

A

Yes

235
Q

Which is preferred, enteral or parenteral?

A

Enteral if possible

If gut functions, use it…enteral trumps parenteral wherever possible

236
Q

When are parenteral feedings via central line indicated?

A
  1. When enteral or oral feedings cannot be administered for 7 days or more
  2. When partial oral feedings and standard peripheral IV either can’t meet nutritional requirements or will be needed for prolonged periods of time
237
Q

Why do you want to maintain some enteral feedings in an infant whenever possible?

A

If you don’t, infants may lose the will and/or ability to feed orally

238
Q

What can prolonged periods without enteral nutrition do to the GI tract?

A

Leave the GI mucosa more vulnerable to infection

239
Q

Kid with diarrhea and vomiting, tolerating minimal fluids, intermittent vomiting, pasty mouth, good bounding pulses, good HR…most appropriate management?

A

Oral rehydration and D/C with regular diet as soon as tolerated

No BRAT diet, it lacks adequate nutrition
Do not dilute formula
Do not get serum bilk

240
Q

What is the most common complication of NG feeding?

A

Diarrhea

241
Q

What is the second most common complication of NG feeding?

A

GE reflux

242
Q

What can reduce the risk of GE reflux with NG feeding?

A

Using elemental formula

243
Q

Is the diarrhea from NG feedings severe enough to cause dehydration?

A

Rarely

244
Q

What is the most severe complication of NG feeding?

A

Vomiting with aspiration

245
Q

What type of feedings can result in wound infections?

A

Ostomy feedings

246
Q

Infants who have gastroesophageal reflux might respond better to what type of feeds and gain weight better?

A

Continuous

After a short period of continuous feeds, the vomiting and reflux may stop (they can then tolerate regular PO feedings)

247
Q

What kind of feeds could a child with Crohn’s disease may need that could be helpful in reversing growth failure and inducing remission?

A

Continuous NG feedings

248
Q

What type of feeds for children with malabsorption syndrome?

A

Continuous

249
Q

Why do you use continuous feeds for infants with congenital heart disease?

A

Increased nutritional demands…they often have delayed gastric emptying and early satiety. Bolus feeds can lead to malnourishment and delay of corrective surgery…need to fatten them up ASAP.

250
Q

What type of feeds for infants with oral motor discoordination?

A

Bolus (as long as there are no gut responses, gastric residuals, or evidence of malabsorption or dumping syndrome)

251
Q

Patients with liver disease have decreased delivery of bile acids which results in what?

A

Malabsorption of fat soluble vitamins (A, D, E, K)

252
Q

Cholestatic disease results in what nutrition wise?

A

Malabsorption of fat soluble vitamins (A, D, E, K) due to decreased delivery of bile acids

253
Q

Kids with cholestatic disease (liver disease) have an increased risk for what because they can’t absorb fat soluble vitamins?

A

Rickets

254
Q

For a kid with ascites or portal hypertension , what do you do and how does this affect formula?

A

Fluid restriction, need to use a more concentrated formula

Concentrated formulas are gross… So sometimes you have to do NG or gastrostomy feedings

Have to maintain adequate calorie intake to reduce risk for growth failure

255
Q

What do you do with nutrition for kids with heart failure?

A

Increased caloric intake with restricted fluids

Increase concentration of formula (increases caloric density without increasing fluid causing appropriate weight gain)

These kids are also often on diuretics (balance tendency for fluid overload)

256
Q

What acute organ failure kids tend to be malnourished?

A

Acute renal failure

257
Q

In children in acute renal failure, what % of calories should come from carbohydrates?

A

70%

258
Q

In kids with acute renal failure lipids should comprise less than what % of calories?

A

20%

259
Q

Kids with acute renal failure can have what protein intake?

A

0.5-2 g/kg/day

260
Q

Infants in renal failure require what type of formula?

A

Low phosphorous formula

261
Q

Kids with adequate nutrition at the onset of treatment for malignancy may have reduced risk for what?

A

Infection and reduced severity of chemo side effects

262
Q

Neurologically impaired kids are at a higher risk for what GI issue?

A

GERD

Also more prone to ill effects when fundoplication surgery is done

263
Q

What is essential to wound healing from a nutritional standpoint?

A

Adequate caloric intake (especially protein), vitamin C, vitamin A, zinc, iron

264
Q

Is severe diet restriction in response to multiple food allergies ever the right answer?

A

No, because of the nutritional hazards of diet restriction

265
Q

If you substitute rice milk for standard formula in an infant, you can get what deficiencies?

A

Vitamin D, calcium, protein, fatty acid

266
Q

Older kids who restrict dairy intake due to lactose intolerance can have what?

A

Calcium and vitamin D deficiency

267
Q

Kids with cystic fibrosis have poor pancreatic function that leads to malabsorption of what?

A

Intestinal protein and fat (at risk for deficiency of vitamins A, D, E, K)

268
Q

Kids with CF almost always need what to maintain adequate growth during childhood?

A

Supplementation of calories

Better nutritional status in these patients correlates to better lung function

269
Q

What can be done to minimize protein catabolism and weight loss in burn patients?

A

Early and aggressive nutritional support to reduce resting energy expenditure

270
Q

Burn patients need lots of what in their diet?

A

High carbohydrates (due to relative inability to use fat)

271
Q

Burn patients need lots of what electrolytes to maintain normal serum levels?

A

Calcium and magnesium

Peds (35 decks)

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