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Pediatric Primary Care Exam 2 > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Before 12 months nutrition (3)

A
  1. In first 6 months of life, bottle should begin to be weaned
  2. Needs to be a set time every day in which the child gets fed
  3. Introduce a food 10 times before deciding that the child doesn’t like it
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2
Q

12-18 Months Nutrition (3)

A

INDEPENDENCE

  1. Stop bottle
  2. Practice eating from a spoon
  3. 1 year olds don’t eat much and mother’s will be concerned about this; during second year of life you gain less weight so you eat less as well; will be OK if they eat 2 meals a day and don’t make portions too large (guidance for parents)
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3
Q

18-2 Years Nutrition (3)

A
  1. Growth slows
  2. Not as interested in eating.
  3. Encourage self-feeding with utensils.
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4
Q

2-3 Year Old Nutrition (8)

A
  1. At 2, autonomy comes in and child will say exactly what they want and when they want it
  2. Intake varies
  3. Will be independent and want to exert control
  4. Extensive guidelines on hyperlipidemia
  5. After 2 years old is to switch to non-fat or 1% milk
  6. Limit snacking if the child is sedentary
  7. Limit screen time of TV to 1-2 hours for children over 2 and no screen time under 2 years old
  8. Look at self-regulation; if child says they aren’t hungry then they aren’t hungry
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5
Q

1 year old (calories, fat%cal, milk cups, lean meat oz, fruit cups, veggie cups, grain oz)

A
  1. Calories: 900
  2. Fat % of total kcal: 30-40
  3. Milk/dairy cups: 2 cups
  4. Lean meat: 1.5 oz
  5. Fruit cups: 1 cup
  6. Vegetable cups: 3/4 cup
  7. Grains oz: 2 oz
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6
Q

2-3 year old (calories, fat%cal, milk cups, lean meat oz, fruit cups, veggie cups, grain oz)

A
  1. Calories: 1,000 calories
  2. Fat % of total kcal: 30-35
  3. Milk/dairy cups: 2 cups
  4. Lean meat: 2 oz
  5. Fruit cups: 1 cup
  6. Vegetable cups: 1 cup
  7. Grains oz: 3 oz
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7
Q

4-8 (calories, fat%cal, milk cups, lean meat oz, fruit cups, veggie cups, grain oz)

A
  1. Calories:
    * Female: 1200
    * Male: 1400
  2. Fat % of total kcal: 25-35
  3. Milk/dairy cups: 2
  4. Lean meat:
    * Female: 3
    * Male: 4
  5. Fruit cups: 1.5 cups
  6. Vegetable cups:
    * Female: 1 cup
    * Male: 1.5 cups
  7. Grains oz:
    * Female: 4oz
    * Male: 5oz
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8
Q

9-13 (calories, fat%cal, milk cups, lean meat oz, fruit cups, veggie cups, grain oz)

A
  1. Calories:
    * Female: 1600
    * Male: 1800
  2. Fat % of total kcal: 25-35
  3. Milk/dairy cups: 3 cups
  4. Lean meat: 5 oz
  5. Fruit cups: 1.5 cups
  6. Vegetable cups:
    * Female: 2
    * Male: 2.5
  7. Grains oz:
    * Female: 5
    * Male: 6
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9
Q

14-18 (calories, fat%cal, milk cups, lean meat oz, fruit cups, veggie cups, grain oz)

A
  1. Calories:
    * Female: 1800
    * Male: 2200
  2. Fat % of total kcal: 25-35
  3. Milk/dairy cups: 3 cups
  4. Lean meat:
    * Female: 5oz
    * Male: 6oz
  5. Fruit cups
    * Female: 1.5 cups
    * Male: 2 cups
  6. Vegetable cups:
    * Female: 2.5 cups
    * Male: 3 cups
  7. Grains oz:
    * Female: 6oz
    * Male: 7oz
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10
Q

MALE 3 year old daily physical activity with calorie level food plan (2)

A
  1. Less than 30 min activity: 1200 calories

2. 30-60 or more than 60 minutes of activity: 1400 calories

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11
Q

Female 3 year old daily physical activity with calorie level food plan (3)

A
  1. Less than 30 min activity: 1000 calories
  2. 30-60 minutes of activity: 1200 calories
  3. More than 60 minutes of activity: 1400 calories
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12
Q

MALE 4-5 year old daily physical activity with calorie level food plan (3)

A
  1. Less than 30 min activity: 1200 calories
  2. 30-60 minutes of activity: 1400 calories
  3. More than 60 minutes of activity: 1600 calories
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13
Q

FEMALE 4-5 year old daily physical activity with calorie level food plan (3)

A
  1. Less than 30 min activity: 1200 calories
  2. 30-60 minutes of activity: 1400 calories
  3. More than 60 minutes of activity: 1400 calories
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14
Q

2 year olds with any level of physical activity should have how many calories/day?

A

1,000 calories (boys and girls)

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15
Q

Endocrine/Immune Response to Obesity: Effects of Adipoopathy (13)

A
  1. Impaired fasting glucose
  2. Metabolic syndrome
  3. Hypertension
  4. Menstrual dysfunction (girls)
  5. Early puberty (girls)
  6. Delayed puberty (boys)
  7. NAFLD
  8. Dyslipidemia
  9. Insulin resistance
  10. Type 2 Diabetes Mellitus
  11. Increased uric acid, microalbuminuria
  12. Gynecomastia
  13. Cholecystitis
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16
Q

Physical Response to Obesity: Effects of Fat Mass Disease (6)

A
  1. Asthma
  2. Immobility
  3. Lipomastia
  4. Tissue compression(sleep apnea, GERD, HTN)
  5. Tissue friction (intertrigo)
  6. Stress on weight bearing joints (slipped capital femoral epiphysis, Blount disease, scoliosis, osteoarthritis)
17
Q

Psychological Response to Obesity: Effects on Quality of Life (8)

A
  1. Isolation from peers
  2. Decrease in ability to participate in normal childhood activities
  3. Subject to bullying
  4. Lack of social/ageappropriate relationships
  5. Anxiety/depression
  6. Binge-eating disorder
  7. Night-eating disorder
  8. Bulimia
18
Q

Prader Willie Disease

A

failure to thrive toddler –> obese child

19
Q

Obesity is a disease when…(5)

A
  1. The patient has an abnormal increase in body fat as assessed by a reliable measure
  2. Increased body fat is caused by genetic or developmental errors, infections, hypothalamic injury adverse reactions to medications, nutritional imbalance, and/or unfavorable environmental factors
  3. Multiple pathogenic adipocyte and/or adipose tissue endocrine and immune dysfunctions contribute to metabolic disease (adiposopathy or “sick fat” disease)
  4. Multiple pathogenic physical forces from excessive body fat cause damage to other body tissues (fat mass disease)
  5. The adverse health consequences of increased body fat are not simply “co-morbidities” or “associated risk factors”
20
Q

Differential Dx for obesity with Linear Growth in Pre-Pubertal or Pubertal Children is consistent or Accelerated Growth (2)

A
  1. Considered exogenous obesity- Nutritional origin
  2. Considered precocious puberty if -Secondary sexual development at <8 years old in girls (breast development) and <9 year old in boys (enlarged testicles)
    * Consider bone age
21
Q

Differential dx for obesity if there is decreased linear growth (3)

A
  1. Consider endocrinopathy
  2. Test for TSH, free T4, dexamethasone suppression,
  3. 24-hour urinary free cortisol if indicated
22
Q

Differential dx for obesity if there are developmental delays

A

Suspect Syndromal Obesity

  • Can be associated with decreased linear growth
  • Evaluation dependent on presentation and family history
  • Refer to genetics
23
Q

Common physical findings with obesity (4)

A
  1. Acanthosis Nigricans; a skin condition characterized by dark, velvety patches in body folds and creases.
  2. Gynecomastia
  3. Abdominal striae
  4. Hirsutism
24
Q

Common physical and radiological findings with obesity (3)

A
  1. Tonsillar hypertrophy
  2. Steatosis and Increased Abdominal Visceral Fat
    * Steatosis: fatty liver disease
  3. Blount’s Disease; Abnormal growth of plate of the tibia; tibia grows outward and causes bowwed leg
25
Management for an infant/child that is getting overweight (5)
1. Sleep (need adequate amounts of sleep) 2. No juice! (4oz max per day in toddlerhood) 3. Don’t let them watch too much TV 4. Don’t force child to finish their food 5. Keep the child active & let them run around
26
Management of Infant with Obesity 0-24 months with appropriate weight/length percentile (2)
1. Exclusive breastfeeding for as long as possible, complimentary foods begin at 6 months 2. No media
27
Management of Infant with Obesity 0-24 months with weight/length percentile crossing lines (3)
1. Exclusive breastfeeding for as long as possible 2. If formula feeding, review dietary history; if no complementary foods, intake 2747 oz/day; if complementary foods (after 6 months) then intake 24-32oz/day 3. No media
28
Management of Infant with Obesity 0-24 months with weight/length in 85th percentile for age (3)
1. Exclusive breastfeeding for as long as possible 2. If formula feeding, reduce intake to lower limits of 24oz/day, feedings should be every 4-5 hours for less than 6 months OR 3 times per day for over 6 months * Consider limiting cereal 3. No media
29
Management of Infant with Obesity 0-24 months with weight/length exceeds 95th percentile for age (3)
1. Exclusive breastfeeding for as long as possible 2. If formula feeding, reduce intake to lower limits; 24oz/day 3 times per day and minimal intake of complementary food after 6 months * consider excluding cereal 3. No media
30
Management of the Toddler with Obesity: 2-4 Years Old when BMI is less than 85th percentile (4)
1. 1-1.5 cups each of fruits and vegetables/day 2. Less than 2 hours screen time/day if 2-4 years 3. Free play for as many hours as possible/day 4. No sugar-sweetened beverages
31
Management of the Toddler with Obesity: 2-4 Years Old when BMI is 85th-95th percentile (4)
1. 1-1.5 cups each of fruits and vegetables/day 2. Less than 1 hours of screen time/day if 2-4 years 3. Free play for as many hours as possible/day 4. No sugar-sweetened beverages
32
Management of the Toddler with Obesity: 2-4 Years Old when BMI is 95th-120th percentile (5)
1. Restricted carbohydrate (CHO)/lowglycemic index (LGI) /elimination diet 2. Less than 1 hour of screen time/day 3. Reduce sedentary activity 4. Free play for as many hours as possible/day 5. No sugar-sweetened beverages
33
Management of the Toddler with Obesity: 2-4 Years Old when BMI is over 120th percentile (4)
1. Restricted carbohydrate (CHO)/lowglycemic index (LGI) /elimination diet 2. Screen time 50% of active time up to 1 hour per day 3. Reduce sedentary activity 4. Free play for as many hours as possible/day 5. No sugar-sweetened beverages
34
Obesity stats (3)
1. Children from wealthiest 20% of families had lower prevalence of obesity 2. Research showed that overweight kindergarten children who were obese at age 5 had a 4 X greater risk of being obese at age 14 3. If at a kindergarten age the child is overweight or obese, they ran a 4x greater risk of being overweight and obese at age 14
35
Activity Recommendations for Normal Weight Child 12-36 months old (5)
1. Toddlers should engage in a total of at least 30 minutes of structured physical activity each day. 2. Toddlers should engage in at least 60 minutes (and up to several hours) per day of unstructured physical activity and should not be sedentary for more than 60 minutes at a time, except when sleeping. 3. Toddlers should be given ample opportunities to develop movement skills that will serve as the building blocks for future motor skillfulness and physical activity. 4. Toddlers should have access to indoor and outdoor areas that meet or exceed recommended safety standards for performing large-muscle activities. 5. Those in charge of toddlers' well-being are responsible for understanding the importance of physical activity and promoting movement skills by providing opportunities for structured and unstructured physical activity and movement experiences
36
Active Play Recommendations for Normal Weight Child 12-36 months old (3)
1. Walking in the neighborhood 2. Unorganized free play outdoors 3. Walking through a park or zoo
37
Activity Recommendations for Normal Weight Child 3-5 years old
1. Preschoolers should accumulate at least 60 minutes of structured physical activity each day. 2. Preschoolers should engage in at least 60 minutes (and up to several hours) of unstructured physical activity each day, and should not be sedentary for more than 60 minutes at a time, except when sleeping. 3. Preschoolers should be encouraged to develop competence in fundamental motor skills that will serve as the building blocks for future motor skillfulness and physical activity. 4. Preschoolers should have access to indoor and outdoor areas that meet or exceed recommended safety standards for performing large-muscle activities. 5. Caregivers and parents in charge of preschoolers' health and well-being are responsible for understanding the importance of physical activity and for promoting movement skills by providing opportunities for structured and unstructured physical activity.
38
Active play recommendations for normal weight child 3-5 years old (5)
1. Throwing/catching 2. Running 3. Swimming 4. Tumbling 5. Walking

Pediatric Primary Care Exam 2 (12 decks)

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