Nutrition Flashcards
Why are infants and children more vulnerable to poor nutrition?
Low nutritional stores (particular preterm)
High nutritional demands for growth (particularly in first 6 months)
Rapid neuronal development (first 2 years of life)
How does paediatric surgery or acute illness affect nutrition?
Following an acute illness or surgery infants are prone to recurrent infections, which reduce food intake and increase nutritional demands
How does the body respond to surgery?
After a brief anabolic phase, catecholamine secretion is increased, causing the metabolic rate and energy requirement to increase. Urinary nitrogen losses may become so great that there is not a positive nitrogen balance and weight is lost.
What environmental factors affect height?
Height is adversely affected by lower socioeconomic status and increasing number of children in families.
What are the advantages of breast feeding?
Reduced GI infection
Reduced incidence of NEC in preterm infants
Establish an intimate, loving relationship with their baby
Reduced incidence of obesity, DM and HTN in later life.
Reduced maternal risk of breast cancer
What are the potential complications of breast feeding?
Cannot tell how much milk a baby is taking (check baby weight regularly) More difficult to feed twins Difficult for preterm infants to suckle Difficult to maintain the supply of milk Restrictive for the mother
What is colostrum?
It is produced for the first few days of breast feeding, it has a much higher content of protein and Ig that normal milk. Volumes are low.
When should breast feeding start?
ASAP after birth, after this frequent suckling is beneficial as it enhances the secretion of the hormones and promotes lactation
Do infants not being breast-fed need any formula milk or is normal milk okay?
Normal milk contains too much proteins and electrolytes and inadequate iron and vitamins
How long is breast feeding or formula feeding recommended?
For the first 12 months, and there are advantages in continuing to 18 months of age. Cows milk can be given from 1 year of age but is quite vitamin deficient so supplements will be needed.
When are solid foods recommended?
Solid foods are recommended to be introduced after 6 months of age. If it takes place before 6 months, wheat, eggs and fish should be avoided. Honey should not be given before 1 year.
What is mild and severe failure to thrive?
Mild - a fall across two centile lines
Severe - a fall across three centile lines
What would a history on failure to thrive focus on?
A food diary What happens at mealtimes Any associated symptoms (diarrhoea, vomiting, cough, lethargy) Birth (preterm, IUGR) Growth of other family members Other development
What would you look for when examining a child with potential failure to thrive?
Malabsorption - distended abdomen, thin buttocks, misery
Chronic respiratory disease - chest deformity, clubbing
Signs of heart failure
Evidence of nutritional deficiencies
How would you manage failure to thrive?
Health visitors
A dietician - recommending strategies for increasing energy intake
In extreme cases , hospital admission to show child will gain weight if fed properly
What are the causes of failure to thrive?
Inadequate intake (inadequate availability of food, psychosocial deprivation, neglect or child abuse, impaired suck/swallow, chronic illness) Inadequate retention (vomiting) Malabsorption Failure to utilise nutrients Increased requirements
Which children are at increased risk of malnutrition?
Those with chronic illness - preterm, CHD, malignant disease, chronic GI disease, IBS, chronic renal faiure, cerebral palsy.
What are the causes of malnutrition?
Anorexia, malabsorption and increased energy requirements because of infection of inflammation. Eating disorders
How would you assess nutritional status?
Dietary assessment (food diary) Anthropometry (measure skinfold thickness of the triceps reflects subcutaneous fat stores)
What are the consequences of malnutrition?
Wound healing is delayed, operative morbidity and mortality increase. Less active, less exploratory and more apathetic. Prolonged and profound malnutrition can cause permanent delay in intellectual development
What is parenteral nutrition?
It provides a nutritionally complete feed in an appropriate volume of IV fluid. Short term, can be given via a peripherally sited cannula. Long term, delivered via a central venous catheter as it does not require repeat resitting of the cannula.
What is marasmus?
Severe protein-energy malnutrition in children. Weight for height more than 3 SD below the median. Waster, wizened appearance, apathetic.
What is kwashiorkor?
Severe protein malnutrition - generalised oedema, sparse and depigmented hair, skin rash, angular stomatitis, distended abdomen and enlarged liver, diarrhoea.
How would you manage severe acute protein malnutrition?
Treat associated deficiencies. Diet is initially low in protein as high protein feeds are not tolerated. Too rapid feeding may result in diarrhoea.
What usually causes vitamin D deficiency?
Deficient intake or defective metabolism of vitamin D, causing a low serum calcium
What are the consequences of vitamin D deficiency?
Lowe serum calcium, increased secretion of parathyroid hormone and normalises the serum calcium but demineralises the bone. Parathyroid hormone causes renal losses of phosphate and consequently, low serum phosphate levels, further reducing the potential for bone calcification
How does vitamin D deficiency present?
Usually with a bony deformity and the classical picture of rickets. It can also present without bone abnormalities but with symptoms of hypocalcaemia e.g. seizures, neuromuscular irritability (tetany), apnoea and stridor
What is rickets?
It signifies a failure of mineralisation of the growing bone or osteoid tissue.
Which children are at risk of developing rickets?
Fully breast-fed children in late infancy. Extremely preterm infants. Children with malabsorptive conditions such as cystic fibrosis, coeliac disease and pancreatic insufficiency. Hepatic and renal disease.
What are the clinical manifestations of rickets?
Ping-pong ball sensation of the skull elicited by pressing firmly over the occipital or posterior parietal bones. The costochondral junctions may be palpable, wrists and ankles may be widened and there may be a horizontal depression on the lower chest corresponding to attachment of the softened ribs to the diaphragm. The legs may become bowed.
How do you diagnose rickets?
Dietary history for vitamin and calcium intake. Blood tests (calcium, phosphorous low and plasma alkaline phosphatase greatly increased, low vit D, high parathyroid hormone) X-ray of the wrist joint
What would a wrist X-ray of rickets show?
Cupping and fraying of the metaphyses and a widened epiphyseal plate
How would you manage rickets?
Advice about a balanced diet, correction of risk factors, administration of vitamin D. Healing occurs in 2-4 weeks but complete reversal of bony deformities may take years.
What is a cause of vitamin A deficiency?
Vitamin A deficiency is seen as a complication of fat malabsorption when supplementation has been inadequate
What are the clinical features of vitamin A deficiency?
Impaired adaptation to dark light. It causes eye damage (xerophthalmia), which may progress from night blindness to corneal ulceration and scarring. It also results in increased susceptibility to infection, especially measles.
What are the complications of obesity?
Orthopaedic (bow legs, abnormal foot structure and function) Idiopathic intracranial HTN (headaches) Hypoventilation syndrome (sleep apnoea, snoring, heart failure) Gallbladder disease PCOS T2DM HTN Psychological sequelae
What are some endogenous causes of obesity that should be explored?
Cushing syndrome in short, obese children.
Prader-Willi is children with learning difficulties
In severely obese children under 3, gene defects such as leptin deficiency should be considered
What causes dental caries?
They occur as a result of exposure to organic acids, produced from bacterial fermentation of carbohydrate, particularly sucrose.
How can you prevent dental caries?
Reduce plaque bacteria (brush and floss)
Less frequent ingestion of carbs
Regular dentist appointments
Discourage ‘prop-feeding’ milk before bed
