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Paediatrics STG > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Fuel Supply in Foetus

A
  • In the womb, it is an anabolic process so the foetus has a continuous supply of food and grows the most it will ever grow which is around 20 weeks gestation
  • Glucose crosses the placenta via facilitated diffusion according to diffusion gradient so more glucose in mother more goes across to the baby and we use approximately 5g/glucose/kg/day
  • Substrates are principally glucose and amino acids
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2
Q

Action of Insulin

A
  • In foetus insulin acts as an anabolic hormone with less direct control of blood glucose
  • Takes baby from a foetal, anabolic metabolic state into a neonatal state where the baby must rely on body stores (catabolism) between feeds
  • Catabolic enzyme systems (not needed in utero) must be switched on in order for this
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3
Q

Establishing Breastfeeding

A

•Little milk is available at
first
•A new born initially has to meet demands from stores
•The energy requirement for a new born is about 4-6 g glucose/kg/day

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4
Q

Conversion of Stores

A

• Have a huge surge of stress hormones and adrenaline which switches on the counter regulatory metabolism and that allows you to switch on enzymes that help you break down the stores that you need after you’re born

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5
Q

Which hormones oppose the counter-regulatory hormones?

A

– glucagon
– adrenaline
– (cortisol)
– (growth hormone)

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6
Q

What happens to blood hormone levels

A
  • Get a sharp fall in plasma glucose after you’re born
  • Even if you don’t feed babies the glucose will come up to normal levels
  • Baby manage hypoglycemia better than older
  • As plasma glucose levels fall at birth, plasma glucagon levels rise rapidly.
  • This activates gluconeogenesis, opposing insulin
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7
Q

Postnatal Fast

A
  • The baby will need to utilise stores to provide glucose as an energy source for the tissues.
  • Gluconeogenesis is the process of providing glucose from stores – muscle (amino acids and glycogen) and fat via substrates such as lactate, pyruvate, alanine and glycerol.
  • Ketogenesis is the process of providing ketone bodies (which act as a fuel) from the breakdown of fat
  • New borns able to use ketones which you can produce from your fat stores
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8
Q

How do babies manage to not become hypoglycaemic

A

While the brain accounts for higher proportion of resting energy expenditure, you also have a far lower cerebral metabolic rate in the new born period than at any other time in your life

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9
Q

Describe the fed state

A
  • Infant diet is 50% fat and 40% carbohydrate
  • CHO is mainly lactose
  • Breast milk contains a lipase
  • Blood glucose will be high after a meal and will be mostly lactose broken down into glucose
  • Insulin will act on glucose to lay down glucose as body stores
  • Converted into fat and is utilized in muscles as glycogen and building block for amino acids
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10
Q

What types of babies have problems with metabolism?

A
  • Demand exceeds supply
  • Hyperinsulinism
  • Counter-regulatory hormone deficiency
  • Inborn errors of metabolism
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11
Q

Managing Extremely Small Preterm Baby

A
  • High demands & Small nutrient stores
  • Immature intermediary metabolism
  • Establishment of enteral feeding delayed
  • Poor fat absorption
  • Start with very small amount of breast milk then gradually increase
  • Support baby with iv glucose and amino acids and vitamins an fats
  • Aim to be on full feed by day 7 of life
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12
Q

Infant of Diabetic Mother

A
  • High maternal glucose  high foetal glucose
  • Foetal and neonatal hyperinsulinism
  • Neonatal macrosomia and hypoglycaemia.
  • Small head and big trunk
  • High circulating levels of insulin that doesn’t drop in the way it is supposed to
  • Can get really low levels of glucose and hypoglycemia
  • Insulin also means won’t get any ketone bodies being made so brain isn’t protected from hypoglycemia
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13
Q

Other causes of hyperinsulinism

A
  • Islet cell dysregulation: Nesiodioblastosis

* Beckwith Wiedemann:

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14
Q

Features of Beckwith Wiedemann

A 
–macroglossia (large tongue),
–macrosomia 
–midline abdominal wall defects (exomphalos, umbilical hernia, diastasis recti),
–ear creases or ear pits
–hypoglycaemia
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15
Q

Inborn Errors of Metabolism

A

•Causes of neonatal hypoglycaemia include:
– Glycogen storage disease (usually Type 1)
– Galactosaemia
– MCAD (medium chain acyl-coA dehydrogenase deficiency)

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16
Q

Glycogen Storage Disease (Type 1)

A
  • Deficiency of glucose-6-phosphatase
  • Hypoglycaemia and lactic acidosis in newborn
  • Hepatomegaly in older child
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17
Q

Galactosemia

A
  • Lactose in milk is broken down to Galactose and Glucose.
  • Galactose is then broken down to Glucose by Galactose-1-phosphate Uridyl Transferease (Gal-I-put) which is missing in Galactosaemia, leading to toxic levels of galactose-1-phosphate.
18
Q

Galactosemia: Clinical Features

A 
–Hypoglycaemia
–Jaundice and liver disease
–Poor feeding and vomiting
–Cataracts and brain damage
–E Coli sepsis
19
Q

Calorie intakes for babies

A
  • A baby of 0 – 3 months should have a calorie intake of 100 kcal/kg/day
  • This should then decrease to 95 kcal/kg/day up to 12 months
20
Q

How do babies’ weight change?

A

Babies will typically lose <10% of their body weight over the first 7 days of life, and then steadily gain weight (decreasing in velocity from 200g/week up to 3 months to 50g/week at 12 months)

21
Q

How should infants be fed?

A

Ideally, infants should be exclusively breast fed up to 6 months. However, infants who are not breastfed require formula feeds, these are usually modified cow’s milk protein preparations with added iron and vitamins A, C, and D

22
Q

How much should a 0-2 month old baby have?

A

800ml
2-4oz
6-10 feeds

23
Q

How much should a 3-5 month old baby have?

A

1050ml
5-6oz
6-7 feeds

24
Q

How much should a 6-8 month old baby have?

A

Varies depending on solids
6-8oz
5-6 feeds

25
Q

When should solids be introduced?

A

Solid foods should not be introduced prior to 4 months as infants have an immature gut and swallow. Food should be home prepared with no added sugar or salt. The baby should sit upright to eat, and eating with their hands is best. They should never be left alone while eating, and parents should eat with the baby to lead by example

26
Q

What is baby led weaning?

A

Baby led weaning is recommended, where the soft food is chopped to finger size and the baby can pick it up and interact with it by putting it in their mouth and set their own pace. Another option for baby led weaning is to give the baby themselves the spoon, and they can explore with the spoon

  • Baby led weaning encourages hand-eye coordination
  • Do not put food in the baby’s mouth or try to persuade them to eat more than they want. The key is to let the baby set their own pace
27
Q

What should be the first foods to introduce into a baby’s diet?

A

First foods should be a balanced diet of proteins, carbohydrates, fats, fruits and soft cooked vegetables. Full fat dairy products and cow’s milk can be used in cooking at this point
- A cup can be introduced with drinking water from 6 months, a fully breastfed baby doesn’t need extra drinks as long as they can breastfeed when they want

28
Q

Which foods should baby not eat?

A

Babies should not eat honey, salt, sugar, raw shellfish, or raw eggs before one year. They should not eat whole nuts before the age of five due to the risk of choking. Gluten products and nut products should not be given before six months due to allergy and intolerance risk
- Honey can lead to infantile botulism
- If the parent has allergy or atopy, they should be more cautious in introducing allergens. Staging of food introduction is important
It is important not to introduce solids too late as this is associated with feeding difficulties and nutritional deficiencies.

29
Q

What should children over 1 year be eating?

A
  • As they have small stomachs but high energy requirements, regular small meals are best
  • All children should take multivitamins (A, D & E) up to the age of 5
30
Q

Healthy Start Scheme

A
  • Women get vouchers that enable them to purchase healthy foods from participating supermarkets, this equates to £6.20 per child. Every 8 months they also get vitamin vouchers
  • Children’s vitamins include vitamins A, C and D. These are given from >6 months
  • Women’s vitamins include folic acid, vitamin C and vitamin D
31
Q

Which women qualify for the healthy start scheme?

A

All pregnant women under <18, and pregnant women receiving income support or job seekers allowance all qualify for the healthy start scheme

32
Q

How should malnutrition be assessed?

A

Malnutrition should be assessed by looking at the patient’s dietary intake, anthropometric calculations (e.g. height, weight, MUAC, skin-fold thickness), and by carrying out laboratory investigations to detect physiological adaptation to malnutrition

33
Q

What blood results suggest malnutrition?

A

Low albumin, WCC, and low mineral concentrations indicate malnutrition

34
Q

Indication of recent weight loss in children?

A

A wrinkled appearance to the axillae and wasting of the buttocks

35
Q

Marasmus

A

protein-energy malnutrition; this is a <70% weight predicted for height

36
Q

Kwashiorkor

A

Kwashiokor is caused by protein malnutrition, this leads to oedema and wasting. Weight may not be severely reduced

37
Q

Define obesity in under 12s

A
  • Obese is a BMI >98th centile, with very severe obesity >99.6th (>3.5 standard deviations from the mean) BMI of the UK 1990 reference chart for age and sex
  • Overweight is defined as >91st centile
38
Q

Defining obesity in over 12s

A
  • In children over 12 overweight BMI is >25, obese >30, and very severe obesity >40
39
Q

How can obesity be prevented?

A

Prevention of obesity should be encouraged by decreasing fat intake, increasing intake of fruit and vegetables, reducing time spent in front of small screens, and increasing exercise

40
Q

Management of Obesity

A

Management of obesity should be focussed on making small gradual lifestyle changes to maintain weight so that the child can ‘grow in to’ their weight
- This should include 60 minutes’ physical activity per day, decreasing portion size, discouraging snacking, and cutting out fizzy drinks
If children are severely obese or have complications from their obesity may benefit from drug treatment including orlistat and metformin. Bariatric surgery should not be considered until a young person has achieved maturity

Paediatrics STG (17 decks)

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