Nutrition

Question 0

Name some good diet sources of iron

Answer 0

Human milk (for first 6 months)
Iron fortified formula
Fortified cereals
Meat, chicken, fish
Legumes
Spinach

Question 1

Name some good sources of folate

Answer 1

Green leafy vegetables
Orange juice and citrus fruits
Legumes
Fortified grains

Question 2

When are birth stores of iron depleted by?

Answer 2

6 months

If breast fed need to start iron fortified cereals

Question 3

What are some consequences of iron deficiency?

Answer 3

Impaired growth
Anemia (ages 6-24 months)
Delayed cognitive development
delayed speech

Question 4

Name 5 nutrients important for brain growth

Answer 4

DHA
Choline
Taurine
Iron
Folate

Question 5

How do you interpret BMI < 5%

Answer 5

Underweight

Question 6

Define growth faltering

Answer 6

Child with observed growth over time with any of the following:

• wt below 2% for gestation corrected and sex on more than 1 occasion
• wt < 80% ideal body weight
• rate of wt gain causes a decrease of 2 or more major percentile lines over time
• no wt gain if < 12 months old
• significant wt loss if < 2 years
• loss of developmental milestones with wt or length plateau
• greater than 5% wt loss in 2 weeks or during hospitalization

Question 7

Define weight faltering (wasting). What does it imply?

Answer 7

• wt crossing > 2 major percentiles
• rate of wt gain < normal for age
• weight/length < 5%

Wt faltering implies acute under nutrition, esp inadequate calorie intake

Question 8

What’s the normal range of daily weight gain during 1st 3 years?

Answer 8

0-3 months: 30 g/day
3-6 months: 15 g/day
6-9 months: 10-15 g/day
9-12 months: 10 g/day
12-36 months: 6 g/day

Question 9

What does linear growth faltering (stunting) imply?

Answer 9

Implies chronic undernutrition but could also be:

• endocrinopathy
• IUGR
• constitutional
• GI
• chronic illness

Differentiate short w/ appropriate wt vs short and skinny

Question 10

What are the Waterlow criteria?

Answer 10

Way to classify undernutrition severity based on % ideal body weight

Question 11

Describe the components of a growth problem assessment

Answer 11

1. History
   - nutritional
   - medical
2. Anthropometry (growth measurements)
3. Physical exam
4. Lab eval

Question 12

What are the components of a nutrition history?

Answer 12

1. Early feeding (any hex breast feeding, formula)
2. Intro of solids (when, easy or hard)
3. Intro of self feeding (any hx of forced feed)
4. Intake (types, amounts, variety)
5. Routines (high chair, grazing, duration, stress at meals, tv/ distractions)
6. Intolerance (GERD, abd pain, rashes, allergies, vomiting)

Question 13

What are the 3 potential problems in growth faltering?

Answer 13

1. Inadequate intake
2. Increased losses ( ex malabsorption)
3. High requirements

Question 14

Describe 3 major categories of environmental/social/ behavioral issues associated with growth faltering

Answer 14

1. Nutritional ignorance
   - inadequate amounts,types, unusual diets, perceived allergies, health food beliefs
2. Family chaos
   - inconsistent feeding/grazing, no meal routines, unstable home environment
3. Child/parent conflict
   - child turns parent into short order cook, poor limit setting, tv on during meals, force feeding

Question 15

What do you focus on during physical exam for nutrition

Answer 15

• wasting of fat vs muscle mass
• organomegaly, distended abd
• murmur
• developmental delay, neuro
• oral motor control, observed feeding
• signs micronutrient def ( rash, decreased DTRs, edema)

Question 16

What are some ways to boost caloric intake?

Answer 16

• concentrate formula
• fortify breastmilk
• add carnation instant breakfast to milk
• eat energy dense foods
• add butter, cheese, cream cheese, oils to foods (ex vegetables)
• supplements (pediasure)