Nutrition Flashcards
Fat soluble vitamins?
Vitamins A, D, E, K
-Come in gelatin tablet with oil in center
Vitamin A
Retinol
Vitamin E
Tocopherol
“Toke-of-ethanol”
Vitamin K
Phylloquinone
-“File-o-kanines”
File cabinet of dogs shaped like K
Vitamin B1
Thiamine
Vitamin B2
Riboflavin
Vitamin B3
Niacin
Vitamin B5
Pantothenic acid
Pentothenic acid
Vitamin B6
Pyridoxine
Pyrido6ine
Vitamin B9
Folate
Fool comes late it is benign
Vitamin B12
Cyanocobalamin
Weird B vitamin?
Biotin
Ascorbic Acid
Vitamin C
Most common cause of blindness in young children?
Vitamin A deficiency
Retinol is very similar to retina
Xerophthalmia (dry eyes), nyctalopia (night blindness), complete blindness
Vitamin A deficiency
What can cause intracranial hypertension (pseudotumor cerebri)?
Vitamin A intoxication
-Giant A causing intracranial pressure
Large tongue and macrocytic anemia?
Vitamin B9 (folate) deficiency
What can vitamin B9 (folate) toxicity cause?
Irritability
If you give folate (B9) for macrocytic anemia, what can it mask?
B12 Deficiency
B12 deficiency?
Macrocytic anemia
-Bowel disease can lead to pernicious anemia due to poor B12 absorption secondary to decreased intrinsic factor
Can B12 in excess be toxic?
No
Bleeding gums, scurvy, leg tenderness, poor wound healing
Vitamin C deficiency
What can excessive mega doses of vitamin C cause?
Oxalate and cysteine nephrocalcinosis
Excreted through kidneys
What vitamin can trigger a hemolytic crisis in someone with G6PD deficiency?
Vitamin C
Hemolytic anemia in preemies and neurological effects in older kids
Vitamin E deficiency
Has to be a severely prolonged deficiency
-E is a fork puncturing red cells
Neuropathies, peripheral edema, thrombocytosis, muscle weakness
Vitamin E deficiency
Vitamin E toxicity?
Liver toxicity
Hemorrhagic disease of the newborn
Vitamin K deficiency
What vitamin doesn’t cross the placenta well?
Vitamin K
Why can’t a newborn produce vitamin K well?
Gut flora hasn’t been established
Vitamin K dependent factors are only what % of normal in first 2-3 days of life?
30%
Are breast fed or formula fed babies babies more vulnerable to vitamin K deficiency?
Breast fed- Breast milk doesn’t contain much vitamin K
Child born at home (did not get vitamin K at birth), exclusively breast fed, bleeding
Give vitamin K followed by FFP
K to make factors 10, 9, 7, 2
FFP for instant clotting factors (active bleeding)
What are the vitamin K dependent factors?
2, 7, 9, 10
Edema, erythrocyte explosion (hemolytic anemia), elevated platelet count
Triple E of vitamin E deficiency
What is isotretinoin an analog of?
Vitamin A
What is isotretinoin used to treat?
Acne
Which drug used for teens is a significant teratogen?
Isotretinoin
HAVE TO RULE OUT PREGANCY
Teen with symptoms of a brain tumor who takes isotretinoin
Vitamin A toxicity (pseudotumor cerebri)
Yellow toddler who eats lots of beta-carotene (carrots, sweet potatoes, apricots), but sclerae and oral mucosa aren’t yellow
No further evaluation or change diet
NOT jaundice or icteric, don’t get serum bili
What is common finding between B12 and B9 deficiency?
Macrocytic anemia
What is beta carotene converted to in the body?
Vitamin A (retinol)
It’s a precursor to vitamin A
Vitamin D2
Ergocalciferol (2 Cs, D2)
Vitamin D3
Cholecalciferol (3 Cs, D3)
25-Hydroxy Vitamin D
Calcidiol
Where is calcidiol (25-Hydroxy Vitamin D) hydroxylated?
Liver
1,25 Hydroxy Calciferol
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
Where is 1,25 Hydroxy-calciferol formed?
Kidney
What is the active metabolite of vitamin D?
1,25 Hydroxy-calciferol
What is the only vitamin known to be converted to hormone form?
Vitamin D
If I child is exposed to sufficient UV sunlight do they need any dietary vitamin D?
No
What is the primary storage form of vitamin D and the one you will measure?
25-Hydroxy Vitamin D
Who do you supplement vitamin D for?
Exclusively breast fed infants (by 2 weeks)
Low vitamin D causes?
Rickets
What electrolyte problems are from vitamin D excess?
Hypercalcemia and hyperphosphatemia
Symptoms of vitamin D excess?
Nausea, vomiting, weakness, polyuria, polydipsia, elevated BUN, nephrolothiasis, renal failure
It can be fatal
Similar symptoms to diabetes (both have D)
How to treat vitamin D toxicity
Hydration, lasix, correct sodium/potassium depletion
-It causes mobilization of calcium and phosphorous from bones and deposition into soft tissue
Calorie requirements
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
What is caloric intake for children based on?
Body surface area
Which varies child to child
Recommended daily allowance (RDA) is starting point for estimating caloric requirements in kids.
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?
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)
What are calorie requirements for term/preterm infants?
100-120 kcal/kg/day
-Preemies closer to 120, large term closer to 100
How much protein for premature infants?
3.5 g/kg/day
Protein for full term infants?
2.0-2.5 g/kg/day for first 6 months
Why do premature infants have trouble maintaining appropriate body temperature?
Lower levels of fat storage
-Expend more energy in heat production than term babies
Premature babies require more energy for what 2 things?
Organogenesis and developing fat stores
-This all increases nutritional and energy requirements in comparison to term babies
When does catch up growth in preemies happen?
First 2 years (Should attain normal height at 2 and beyond)
Post-op infant not gaining weight… Cause?
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)
What are 4 important components of renal solute load?
-Sodium, potassium, chloride, phosphorus
What electrolyte doesn’t play a major role in renal solute load?
Calcium
If you are choosing an essential fatty acid, which one is it?
Linoleic Acid
No cow milk before…?
12 months
What milk from age 1-2?
Whole milk
Low fat milk when?
Overweight children after age 12 months
Does formula have adequate fluoride?
No, it needs to come from outside sources, like drinking water
What is the recommended concentration of iron in iron fortified formula?
12 mg/L
What can cause iron deficiency anemia in a toddler?
Drinking too much milk
Who needs iron supplementation at birth?
Only those at high risk (LBW or preterm, even if breastfed)
-Full term babies have adequate iron stores
When should all babies (even breast fed infants) get iron supplementation in their food (iron-fortified cereals)?
Start around 4-6 months of age
What blood problem is associated with obesity in children?
Iron deficiency anemia
When do you use low iron formula (1.5 mg/L)?
NEVER
Does iron fortified formula cause constipation?
No
Kid in iron fortified formula has constipation… What do you do?
Add fruit juice to increase osmotic load
-Don’t use low iron formula, dilute the formula, switch to whole milk, or add more cereal
Which is IgE mediated, milk protein allergy or milk intolerance?
Milk protein allergy
Which two formula intolerance can cause rash, vomiting, and irritability?
Milk protein allergy and milk intolerance
Due to IgE mediated response, presents with rash, vomiting, and irritability
Milk protein allergy
What formula intolerance causes irritability, but no rash or vomiting?
Lactose intolerance
When can a secondary lactase deficiency causing lactose intolerance in kids develop?
After GI infection (like rotavirus)
With true milk allergy what is there significant cross reactivity with?
Soy-based formula, use elemental formula
Infant with bloating and worsening diarrhea after formula is reintroduced into diet following episode of viral gastroenteritis?
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
Vomiting, rash, diarrhea, irritability
Milk protein allergy/intolerance
Flatulence, bloating, diarrhea, irritability
Lactose intolerance
Where are 3 places lactose is found?
Human milk, cow based formula, evaporated cow milk
Infants fed “non-traditional” formula will suffer from what?
Nutritional deficiencies
Who do you give protein hydrolysate formula to?
Infants with allergy to intact milk protein or allergy or soy protein
Non IgE mediated severe cow milk protein intolerance
FPIES: Food protein induced enterocolitis syndrome
How does FPIES present?
In first 3 months with either heme positive stools or hematochezia along with normal abdominal exam
Can FPIES affect breast fed infants?
Yes, cow milk protein ingested by mom can get into breast milk, (this is primarily due to cow milk intolerance)
What do you do for a kid with FPIES?
Switch to protein hydrolysate formula or completely eliminate implicated protein from Moms diet
Do not switch to soy formula (symptoms frequently continue with this)
Scaly dermatitis, alopecia, thrombocytopenia
Essential fatty acid deficiency
-Thin fish with scales coming off (scaly rash), that turn into platelets (low platelet count), fish is bald (alopecia)
Treatment for essential fatty acid deficiency
IV lipids (focus on linoleic acid)
Mineral deficiency presenting with dermatitis and alopecia?
Acrodermatitis enteropathica (Inherited condition where zinc isn’t absorbed well)
Infant with dermatitis and alopecia who was recently weaned from breast milk…
Zinc deficiency
Breast milk contains a protein which facilitates zinc absorption
Typical presentation of zinc deficiency?
Infant with extensive eczematous eruption, growing poorly, lesions around mouth, sometimes in perianal area
What is inheritance of acrodermatitis enteropathica?
AR
What differentiates eczema from acrodermatitis enteropathica?
Acrodermatitis enteropathica has no lichenification
Low serum copper, low serum ceruloplasmin, high tissue copper, twisted hairs (pili torti)
Menkes kinky hair syndrome
Inheritance of menkes kinky hair syndrome
X-linked
“Liver deterioration” ( jaundice, large liver), acute neurological deterioration, Kayser Fletcher rings, low ceruloplasmin
Wilson’s disease
What causes Wilson’s disease?
Deposition of copper in liver and brain
Also affects eyes and kidney
Does Wilson’s disease have visual deficits?
No
How to diagnose Wilson’s disease?
Liver biopsy
Ceruloplasmin levels low, not diagnostic
When do you consider mineral deficiencies (magnesium and chromium)?
Hospitalized patients with increased metabolic demands and underlying conditions (malnutrition, malabsorption, short bowel, burns, TPN)
What to do if mom wants to breast feed a preemie?
Have mom pump so milk is there for infant, then begin breast feeding when baby ready
Who has higher vitamin D requirements?
Premature infants
Non fat-soluble vitamins?
B & C
What do preterm infants taking formula high in polyunsaturated fatty acids have to have supplemented?
Vitamin E (to avoid hemolysis)
Why do premature infants have a difficult time absorbing long chain triglycerides and fat-soluble vitamins?
They have decreased amounts of bile acids
Premature babies can lose up to what % of ingested fat through the stool?
20%
-Fat is absorbed less efficiently in premature babies
What triglycerides are absorbed best by premature babies?
Medium chain triglycerides (they don’t require bile salts)
What % of total fat in preemie formula is from medium chain triglycerides?
50%
What % of total fat in mature breast milk if from medium chain triglycerides?
12%
Why doesn’t breast milk contain or need a high amount of medium chain triglycerides?
It has high absorptive abilities…breast milk has sufficient linoleic and linolenic acid (these are both essential long chain fatty acids)
Are medium chain triglycerides sufficient to provide the essential fatty acids?
No, they enhance lipid absorption in formulas, but aren’t sufficient to provide essential fatty acids
What can lead to osteopenia and rickets in premature infants?
Poor calcium and phosphorous intake
Preemies require supplementation in large amounts (both are poorly absorbed in gut of preemies)
What can cause demineralization of bone in a very low birthweight preterm infant?
Inadequate phosphorous (often secondary to prolonged parenteral nutrition)
Inadequate calcium can lead to…
Bone demineralization
When will you see bone demineralization and what are the initial lab finding?
Can occur after 1 month of TPN, normal serum calcium and phosphorous, elevated alkaline phosphatase
Too much phosphorous given to a very low birthweight infant can lead to…
Hypocalcemia, tetany, seizures
Exclusive breast feeding until?
At least 6 months
Continued use of breast milk up until…
12 months
When breastfeeding, what milk is higher in calories?
Hind milk (at end of breastfeeding session)
Do you ever supplement with water?
No
What 2 acids decrease in mature milk?
Arachidonic acid (AA) and Docosahexaenoic acid (DHA)
This is true for Moms of preemies too
What are AA and DHA important for?
Neurological development
What along with AA is needed in preemies to help prevent skin lesions, poor wound healing, and decreased immune function?
Zinc
What has low levels in colostrum and thus increases the risk for rickets?
Ergo-cholecalciferol
Hind milk is higher in what?
Fat (milk at end of feeding)
What is colostrum over the first few days postpartum higher in?
Protein
What makes colostrum over first few days postpartum higher in protein?
High levels of immune globulins (secretory IgA)
What does high levels of immune globulins including secretory IgA provide?
Initial protection against infection
Why is colostrum yellow?
High in carotene
What does colostrum do to the gut?
Gives a dose of enzymes that stimulate gut maturation and facilitates digestion (especially fats)
Stimulates gut to mass meconium
Does colostrum or mature milk have more…
- Protein
- Fat
- Lactose
- Energy content
- Minerals
- Colostrum (2.3g/dL v. 1.2g/dL)
- Mature milk (4g/dL v. 1.7g/dL)
- Mature milk (7g/dL v. 6g/dL)
- Mature milk (69kcal/dL v. 49kcal/dL)
- Both constant throughout lactation
Which is sweeter, breast or cow milk, and why?
Breast, contains more lactose
Which has more phosphorous, cow or human milk?
Cow
What can occur if an infant starts cow’s milk before age 1?
Hypocalcemia
Infant kidney can get rid of phosphorous in cow milk fast enough…increased phosphorous causes decreased calcium
“Hypo-cow-lcemia”
What antibiotic is contraindicated with breast feeding?
Metronidazole (Flagyl) for Trichomonas vaginalis
What can diazepam do to baby if Mom is taking it while breastfeeding?
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
What vitamin deficiency are breast fed infants at risk for?
Vitamin D
What vitamin does breast milk contain a small amount of that can contribute to hemorrhagic disease of the newborn?
Vitamin K (especially if they haven’t received IM vitamin K at birth)
How long do you stop breastfeeding for if you received technetium-99?
24-48 hours
Half life is only 6 hours
This is an exception to radioactive contraindication to breast feeding rule
What’s the BAD BREAST pneumonic for contraindications to breast feeding?
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
Can you keep breast feeding with things like candidiasis, contact dermatitis, fibrocystic breast disease, or mastitis?
Yes, if properly managed
What problem with mom can cause unsuccessful breast feeding?
Inverted nipples
What is the protein concentration in human milk, cow milk, and modified cow formula?
Human: 0.9g/dL
Cow: 3.5g/dL
Modified cow: 1.4g/dL
What is the whey:casein ratio in human milk, cow milk, and modified cow formula?
Human: 70% whey, 30% casein (human milk is WHEY better)
Cow: 20% whey, 80% casein
Modified cow: Variable
What is the type of whey protein in human milk?
Alpha lactalbumin
What milk contains beta lactalbumin as its whey protein?
Cow milk
What does the whey protein in human milk contain that makes it easier to digest and promotes gastric emptying?
Larger amounts of lactoferrin, lysozyme, and IgA?
What does modified cow formula have higher amounts of than human milk?
Minerals (calcium, phosphorous, iron)
What is the calcium:phosphorous ratio in human milk?
2:1
What is the calcium phosphorous ratio in modified cow formula?
1.5:1
What has better iron absorption, human milk or modified cow formula?
Human milk
Which has higher amounts of vitamins A, B, and C, human milk or modified cow formula?
They are the same
What has higher amounts of vitamins D, E, and K, human milk or modified cow formula?
Modified cow formula (but this is clinically insignificant in mothers with an adequate diet who get sunlight exposure)
What has a lower renal solute load, human milk or modified cow formula?
Human milk
Which has more lipase, human milk or modified cow formula?
Human milk
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?
First 4
During the first four months, is the iron stored during fetal life compensate for an iron deficiency in breast milk?
Yes
Which contains more iron, formula or breast milk?
Formula
What is the better source, or results in better absorption of iron, formula or breast milk?
Breast milk
Standard formula and breast milk are both what-based?
Lactose
What is the calorie content of breast milk and standard formula?
20 kcal/oz = 20 kcal/30cc = 0.67 kcal/cc
What has higher protein content, formula or cow milk?
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
What is the protein requirement of a newborn?
2-3 g/kg/day
What is the protein requirement of a preemie?
3-4 g/kg/day
What do you want to prevent in very low birthweight infants since it causes weight loss, and how do you do this?
Negative nitrogen balance, give them lots of non-protein calories
Why do you not add more powder than indicated when mixing formula?
This increases the protein load, which stresses the kidneys (lipid and carbohydrate supplements are available to enhance calorie content of formula)
Adding carbohydrate supplement to milk can lead to what?
Diarrhea
Adding lipid supplement to milk can increase the risk for what?
Diarrhea or delayed gastric emptying
What amount do you never increase calorie content beyond in formula?
30 kcal/oz
What form of protein is better for infants and has a higher content of protein in human milk?
Whey
“Whey is way better for infants and weighs heavier in the protein content of human milk”
What % of cow milk and human milk fat?
3-4% for cow milk, human milk varies with Mom diet but is similar to cow’s milk
High concentrations of what in breast milk protect against infectious disease (including local GI immunity)?
IgA and other antibodies
What inhibits bacterial adhesions to mucosal surfaces and reduces the risk of bacterial infection?
Lactose-derived oligosaccharides (case with both colostrum and mature milk)
Bacteria lack toes (lactose) to adhere to mucosal surfaces
Average full term newborns will gain how much weight per day?
20-30 g/day (after initial weight loss during first few days of life)
What is the caloric requirement for a newborn?
Close to 100 kcal/kg/day
Conversion of pounds to kg?
Divide by 2.2
What is the caloric requirement for a preemie?
120 kcal/kg/day
How much is a preemie expected to gain each day?
15-20g/day
What is the optimal whey/casein ratio for a preemie?
60:40
What is absorbed better than lactose in preemies?
Glucose polymers
Since preemies absorb glucose polymers better than lactose, what is needed in preemie formula?
Medium chain triglycerides
Preemie formula has higher amounts of what 2 electrolytes?
Calcium and phosphorous
Preemie formula contains how many kcal/oz?
24 kcal/oz
Preemie breast milk contains higher amounts of everything except for what when compared to full term breast milk?
Carbohydrates
Feeding solid foods like cereals to breastfed infants before 4-6 months of age increases the likelihood of what?
GI infection
Infants have low levels of what in the gut that make it more difficult to digest solid foods?
Amylase
Does the introduction of solid foods help an infant sleep through the night?
No
Introducing solids early increases the chances of developing what? (This is now considered controversial)
Food allergies and obesity
Do artificial flavor and colors have any role in the development of ADHD?
No
Artificial flavors and colors may have a role in causing what 2 things?
Urticaria and angioedema
What are 4 things to remember for home-prepared foods?
- Foods need to be cleaned and puréed so there are no solid chunks inadvertently left behind
- Food should be fully cooked
- Serve fresh or freeze for later
- No salt seasoning and no honey
Do home prepared foods reduce the risk for food allergies?
No
What is overweight defined as for children?
BMI between 85 and 95 percentiles for age and gender
What is obesity defined as for kids?
BMI greater than 95 percentile for age and gender
A child who is obese at age 6 has what % chance of being obese as an adult?
25%
A child who is obese at age 12 has what % chance of being obese as an adult?
75%
Is the teen tall/short and delayed/advanced bone age with obesity due to exogenous (overeating) sources?
Tall and advanced bone age
If a child is overweight due to hormonal/genetic (endogenous) reasons what is their height and bone age?
Short with delayed bone age
A work up is not warranted for obesity in a child who is obese with what 3 features?
- Unremarkable PE
- Normal linear growth
- Normal developmental milestones
What is the most common metabolic explanation for an overweight child?
Hypothyroidism
Overweight kids who have a normal physical exam and normal linear growth don’t need routine testing
Child who is obese with small hands, hypogonadism, delayed developmental milestones, and/or cognitive deficits?
Prader-Willi syndrome or Bardet-Biedel syndrome
Does genetics play a role in obesity?
Yes (correlation in adopted kids, identical twins end up with similar weights, even if raised in different homes/locations)
Parental obesity makes it how much more likely that a child younger than 10 will be obese as an adult?
Twice as likely
Even if the child isn’t obese, but obesity in childhood increases the risk
What is the most common cause of obesity?
Excessive food intake
What is needed to treat obesity?
Child and family have to recognize problem and want to change
- Changing diet (without impacting growth)
- Increase exercise (most effective when combined with dietary changes)
- Modify behavior (support inside and outside family)
What should you eliminate first in a kid trying to lose weight so you don’t impact growth?
Snacks and sugary drinks
What is the best obesity therapy available for children?
Prevention… Behavior modification that encourages a healthy diet and appropriate exercise (since roots of obesity are found in childhood)
Vegetarian teenage girl with low hemoglobin, SMR of 5, what other physical findings?
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
What are some health risks involved in obesity in kids?
- Depression (unclear if obesity causes depression or depression causes obesity)
- Avascular necrosis of the hip
- Diabetes
- HTN
- Cardiac disease
- Osteoarthritis (secondary to strain on joints, especially LE)
A kid who drinks lots of diet sodas (with high phosphoric acid content) is at high risk for what?
Osteopenia (risk is even higher if kid has been treated with steroids)
What is the best way to reduce risk for fractures in a kid with osteopenia?
Vitamin D and calcium supplements
What 2 places make you think kwashiorkor or marasmus?
Refugee camps or communes
What vitamin deficiency are kids who eat vegan diets at risk for?
B12
If a kid is drinking goat’s milk, what will they be at risk for?
Folate deficiency
A vegan breastfeeding mom needs to take prenatal vitamins with what in them?
B12
Non-breastfed vegan infants should get what type of formula?
Iron fortified soy formula
Kwashiorkor is a deficiency of what?
Protein
Kid with a pot belly from starvation, pitting edema, rash, thin/frail hair, pallor, overall thin appearance?
Kwashiorkor
Low protein causes less what, that causes edema?
Intravascular osmotic pressure
Marasmus is a deficiency of what?
General nutrition
Muscle wasting without edema and normal hair?
Marasmus
Can there be a combination of marasmus and kwashiorkor?
Yes
Which is preferred, enteral or parenteral?
Enteral if possible
If gut functions, use it…enteral trumps parenteral wherever possible
When are parenteral feedings via central line indicated?
- When enteral or oral feedings cannot be administered for 7 days or more
- When partial oral feedings and standard peripheral IV either can’t meet nutritional requirements or will be needed for prolonged periods of time
Why do you want to maintain some enteral feedings in an infant whenever possible?
If you don’t, infants may lose the will and/or ability to feed orally
What can prolonged periods without enteral nutrition do to the GI tract?
Leave the GI mucosa more vulnerable to infection
Kid with diarrhea and vomiting, tolerating minimal fluids, intermittent vomiting, pasty mouth, good bounding pulses, good HR…most appropriate management?
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
What is the most common complication of NG feeding?
Diarrhea
What is the second most common complication of NG feeding?
GE reflux
What can reduce the risk of GE reflux with NG feeding?
Using elemental formula
Is the diarrhea from NG feedings severe enough to cause dehydration?
Rarely
What is the most severe complication of NG feeding?
Vomiting with aspiration
What type of feedings can result in wound infections?
Ostomy feedings
Infants who have gastroesophageal reflux might respond better to what type of feeds and gain weight better?
Continuous
After a short period of continuous feeds, the vomiting and reflux may stop (they can then tolerate regular PO feedings)
What kind of feeds could a child with Crohn’s disease may need that could be helpful in reversing growth failure and inducing remission?
Continuous NG feedings
What type of feeds for children with malabsorption syndrome?
Continuous
Why do you use continuous feeds for infants with congenital heart disease?
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.
What type of feeds for infants with oral motor discoordination?
Bolus (as long as there are no gut responses, gastric residuals, or evidence of malabsorption or dumping syndrome)
Patients with liver disease have decreased delivery of bile acids which results in what?
Malabsorption of fat soluble vitamins (A, D, E, K)
Cholestatic disease results in what nutrition wise?
Malabsorption of fat soluble vitamins (A, D, E, K) due to decreased delivery of bile acids
Kids with cholestatic disease (liver disease) have an increased risk for what because they can’t absorb fat soluble vitamins?
Rickets
For a kid with ascites or portal hypertension , what do you do and how does this affect formula?
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
What do you do with nutrition for kids with heart failure?
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)
What acute organ failure kids tend to be malnourished?
Acute renal failure
In children in acute renal failure, what % of calories should come from carbohydrates?
70%
In kids with acute renal failure lipids should comprise less than what % of calories?
20%
Kids with acute renal failure can have what protein intake?
0.5-2 g/kg/day
Infants in renal failure require what type of formula?
Low phosphorous formula
Kids with adequate nutrition at the onset of treatment for malignancy may have reduced risk for what?
Infection and reduced severity of chemo side effects
Neurologically impaired kids are at a higher risk for what GI issue?
GERD
Also more prone to ill effects when fundoplication surgery is done
What is essential to wound healing from a nutritional standpoint?
Adequate caloric intake (especially protein), vitamin C, vitamin A, zinc, iron
Is severe diet restriction in response to multiple food allergies ever the right answer?
No, because of the nutritional hazards of diet restriction
If you substitute rice milk for standard formula in an infant, you can get what deficiencies?
Vitamin D, calcium, protein, fatty acid
Older kids who restrict dairy intake due to lactose intolerance can have what?
Calcium and vitamin D deficiency
Kids with cystic fibrosis have poor pancreatic function that leads to malabsorption of what?
Intestinal protein and fat (at risk for deficiency of vitamins A, D, E, K)
Kids with CF almost always need what to maintain adequate growth during childhood?
Supplementation of calories
Better nutritional status in these patients correlates to better lung function
What can be done to minimize protein catabolism and weight loss in burn patients?
Early and aggressive nutritional support to reduce resting energy expenditure
Burn patients need lots of what in their diet?
High carbohydrates (due to relative inability to use fat)
Burn patients need lots of what electrolytes to maintain normal serum levels?
Calcium and magnesium
