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Pediatrics > Nutrition > Flashcards

Nutrition Flashcards

1
Q

What organism is known to cause disease outbreaks with regards to powdered formula?

A

Cronobacter sakazaii

previously Enterobacter sakazakii

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2
Q

What are some medical indications for providing artificial nutrition/hydration?

A
  • neurological impairment leading to inability to feed orally and / or risk of aspiration
  • malnutrition due to inadequate intake or increased caloric requirements
  • malabsorption due to intestinal disease or short gut syndrome
  • support of chronic diseases such as cancer or congenital heart disease
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3
Q

What are some beneficial elements within breastmilk?

A
  • Secretory IgA
  • Lactoferrin: immunomodulation, iron chelation, antimicrobial action, antiadhesive, trophic for intestinal growth
  • κ-Casein: Antiadhesive, bacterial flora
  • Oligosaccharides: Prevention of bacterial attachment
  • Cytokines: Antiinflammatory
  • Growth factors i.e. Epidermal, transforming, nerve
  • Enzymes: platelet-activating factor, glutathione peroxidase
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4
Q

In what instances is breastfeeding contraindicated?

A
  • HIV infection in a high resource setting
  • Brucellosis infection
  • HTLV-1 or HTLV-2 infection
  • Infant galactosemia
  • the mother is on chemotherapy or radiopharmaceuticals
  • If the mother and child are on quinine containing medications and are G6PD deficient
  • Active TB without at least 2 weeks of medication
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5
Q

What is the nutritional density of breast milk?

A

20 kcal/oz

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6
Q

What is the nutritional difference between cow’s milk and human milk?

A

Human milk has more whey as compared to cow’s milk which has more protein (too much for young infants)

Type of whey is also different, α-lactalbumin vs β-globulin in cow’s milk

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7
Q

What micronutrients are missing or deficient in human milk?

A

Vitamin K and Vitamin D

Calcium and phosphorus levels are relatively low, but more bioavailable

Iron, zinc and copper are adequate only up to 6 months of age

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8
Q

What are some of the benefits of breastfeeding for baby and for mom?

A
  • reduced instance of SIDS
  • reduces rate of AOM, pneumonia, meningitis, diarrhea
  • reduces rate of breast and ovarian cancer for mom
  • improves bonding between mother and child
  • reduces stress in mother and baby
  • decreases rate of GERD
  • stimulates intestinal growth
  • improves cognitive functioning
  • helps with post-conception weight loss
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9
Q

How does breastmilk differ when a baby is born preterm rather than full term?

A

Preterm breastmilk contains more protein, lipids, sodium and free amino acids than it does with a term baby

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10
Q

In what time frame should formula be used?

A

Ready made: within 48 hours of opening

  • within 2 hours of removing from the fridge
  • within 1 hour of starting feed

Powered preparations: should be used within 4 weeks

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11
Q

What type of formula is contraindicated in patients with thyroid disease?

A

Soy formulas (as the phytoestrogens can inhibit thyroid peroxidase)

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12
Q

In what ways does the CPS suggest Paediatricians help improve nutrition in schools?

A

RIPE

  • Restrict on-site access to sugar-sweetened beverages and energy-dense, low-nutrient foods and beverages.
  • Increase children’s consumption of nutrient-rich foods via targeted on-site programs.
  • Promote healthier food choices as part of the regular curriculum
  • Establish a nutrition committee in every school or school board.
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13
Q

What are the top 5 dietary sources of sodium as per CPS?

A
  • Bakery products
  • Mixed dishes (anything from 2 or more groups in Canada’s food guide)
  • Processed meats
  • Cheese
  • Soups
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14
Q

What strategies should be used to reduce sodium intake in children?

A

LLC

Labeling - clearly label foods and flag those known to have more sodium
Limit it - petition manufacturers to reduce general sodium content
Cut down - reduce childhood exposures/choices to high sodium foods

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15
Q

What does the CPS suggest with regards to sugar sweetened beverages?

A
  • Encourage increased taxes to reduce incentives for consumption/purchasing
  • Tax revenue can then be used for educational programs and subsidizing fresh fruit and vegetables
  • Monitoring should be done to identify the effects of such a tax on rates of obesity, hypertension, diabetes and dental caries
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16
Q

Which enzyme deficiency cannot be identified via stool reducing substances?

A

Sucrase-isomaltase (as sucrose is a non-reducing sugar)

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17
Q

Which enzyme deficiency cannot be treated via enzyme replacement?

A

Glucose/galactose malabsorption - only carbohydrate that can be given safely in this instance is fructose

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18
Q

Name 4 conditions with exocrine pancreatic insufficiency

A
  • Cystic fibrosis
  • Shwachman- Diamond
  • Pearson Bone Syndrome
  • Autoimmune polyendocrinopathy syndrome type 1

• Johanson-Blizzard

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19
Q

At what age should birth weight be regained? Doubled? Tripled?

A

2 weeks
4 months
12 months

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20
Q

Name 3 conditions associated with growth hormone deficiency

A
  • Hall-Pallister syndrome
  • Septo-optic dysplasia
  • Holoprosencephaly
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21
Q

What nutrients is goat’s milk deficient in?

A
  • FOLATE
  • vitamin B12
  • vitamin D
  • iron
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22
Q

What are some potential causes of folate deficiency?

A
  • Inadequate intake/diet
  • Medication i.e. phenytoin
  • Poor absorption
  • Congenital dihydrofolate reductase deficiency
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23
Q

How much folate does the CPS recommend for women of childbearing age?

A
  • 0.4-0.8 mg of folic acid per day
  • For women who are at higher risk should take between 0.8 - 4.0 mg of folic acid (up to 5.0 mg)
  • This should be done for at least 3 weeks prior to conception and continued 10-12 weeks postconception

Higher risk: i.e. previous pregnancy with NTD, family hx of NTD, higher risk ethnic group, insulin-dependent diabetes, obesity, sz medications, difficulty with compliance, addiction to EtOH or drugs

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24
Q

What is the treatment dose for folate deficiency?

A

0.5-1 mg PO daily

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25
Q

Name 6 risk factors for developing iron deficiency

A
  • Preterm delivery - low iron stores at birth
  • Birth weight <2500 g - low iron stores at birth
  • Low SES, particularly Indigenous communities (10x higher)
  • Infants born to mothers with anemia or obesity
  • Early umbilical cord clamping
  • Male sex
  • Exclusive breastfeeding > 6 months
  • High cow’s milk intake
  • Prolonged bottle use
  • Chronic infection
  • Lead exposure
  • Low dietary intake of iron-rich complementary foods
26
Q

How much iron is required for preterm infants?

A
  • <2000 g: 2-3 mg/kg/day, until 12 months of age
  • 2000-2500 g: 1-2 mg/kg/day, until 6 months of age

*Start routine supplementation at 2-6 weeks of age if predominantly breastfeeding

27
Q

How much iron is needed to treat iron deficiency anemia?

A

3-6 mg/kg/day of elemental iron for at least 3 months

28
Q

What are the characteristics of Marasmus?

A

THIN and SKINNY

  • protein-energy malnutrition AND inadequate calories
  • characterized by severe wasting
  • most common form of protein-energy malnutrition
29
Q

What are the features of Kwashiorkor?

A

ROUND LIKE AN “O”

• insufficient protein consumption, characterized by peripheral pitting edema
• marked muscle atrophy, normal body fat
• dull reddish orange/rust coloured hair and skin
•

30
Q

What is the WHO framework for treatment of malnutrition?

A
  • Acute stabilization (treat hypoglycemia, hypothermia, dehydration)
  • Ongoing stabilization (correct electrolyte imbalance, prevent infection, correct micronutrient deficiencies and start cautious feeding)
  • Rehabilitation phase (achieve catch up growth)
  • Prevention (improve water, sanitation and hygiene)
31
Q

What are risk factors for obesity?

A
  • parents who are obese
  • type 2 diabetes
  • high preconceptual weight
  • maternal smoking
  • IUGR and catch up growth
  • ethnicity (Black > Hispanic > Native > White)
  • poor temperament
  • poor socioeconomic status
32
Q

How does the CPS define overweight/obese children (2-5, 5-18 years)?

A

BMI of:
At risk: >85th %ile, N/A
Overweight: >97th %ile, >85th %ile
Obese: >99.9th %ile, >97th %ile

33
Q

What are the CPS guidelines for oral fluid replacement in case of uncomplicated GI losses?

A
  • mild dehydration (<5%): replace with 50 mL/kg over the first 4 hours, as well as ongoing losses
  • moderate dehydration (<5-10%): replace with 100 mL/kg over the first 4 hours, as well as ongoing losses
  • severe dehydration (>10%): replace with IV fluids (20-40 mL/kg/hr)
34
Q

What screening test should be done for suspected protein-losing enteropathy?

A

• stool alpha-1-antitrypsin

35
Q

What diet should be recommended for a child with protein-losing enteropathy?

A

• diet high in protein with medium chain or short chain fatty acids

36
Q

What micronutrients are absorped in the various parts of the GI tract?

  • Duodenum and proximal jejunum
  • Throughout small intestine
  • Distal ileum
  • Colon
A
  • Duodenum and proximal jejunum: Ca, Mg, P, Fe, folic acid
  • Throughout small intestine: MCT and fatty acids
  • Distal ileum: Vitamin B12
  • Colon: water, electrolytes
37
Q

What nutritional considerations does CPS advise for paediatric atheletes?

A

• Athletes should consume proper amounts of calcium (1000-1300 mg/day), vitamin D (600 IU/day) and iron
(8-11/15 mg/day; more for females)
• Fluids
- Before activity: 400-600 mL of cold water 2-3 hours before their event
- During activities: 150-300 mL every 15-20 mins
- After activity: 1.5 L of fluid/kg of body weight lost
- Also eat sodium containing snacks to help stimulate thirst and increase water retention

For non-athletes, routine ingestions of carbohydrate-containing sports drinks can result in consumption of excessive calories, increasing the risk of obesity and dental caries

38
Q

What recommendations should be made regarding caffeine?

A
  • caffeinated drinks should not be marketed routinely to children
  • max daily allowance 400 mg/L (1/2 of cup of coffee)
39
Q

What are some preventative strategies that can be taken to reduce the risk of dental caries in Canada?

A
  • Prevention of inappropriate infant feeding practices (i.e. Prolonged or frequent bottle-feeding or juice consumption)
  • Water fluoridation
  • Evidence-based guidelines recommend a biannual varnish application regimen for high-risk populations
  • Regular use of fluoride mouth rinses have been shown to reduce tooth decay in older children
40
Q

What are the 3 main effects of fluoride on teeth?

A
  1. Inhibits plaque - may kill/inhibit bacteria and makes them less able to produce acid from carbohydrates
  2. Inhibits demineralization - fluoride is incorporated into crystals on the tooth surface, making the surface more resistant to acid
  3. Enhances speed of remineralization of enamel
41
Q

How much fluoride should be provided for dental health?

A

If living in a place with water fluoridated >0.3 ppm, none.

If water is not fluoridated, offer:

  • none if <6 months
  • 0.25 mg if 6 months to 3 years
  • 0.5 mg if 3-6 years
  • 1.0 mg if >6 years
42
Q

What are some potential complications of gastro/gastrojejunal feeding tubes?

A
  • obstruction
  • dislodgement
  • displacement/migration
  • advancement
  • granulation tissue
  • tenderness/pain
43
Q

What deficiencies are vegans/vegetarians at greater risk for?

A

Vitamin B12, iron, vitamin D, zinc and fatty acids

44
Q

What food sources should be suggested to vegans/vegetarians?

A
  • Vitamin B12: plants not a good source (almost exclusively obtained through animal foods), vegans will need fortified foods and supplements
  • Iron: cashews, kidney beans, black beans, lentils, oatmeal, raisins, soybeans, sunflower seeds, chickpeas, molasses, chocolate and tempeh
  • Fatty acids: walnuts, soy products, flaxseed and canola oils
  • Calcium and vitamin D: leafy greens (ideally with low oxalate like broccoli, kale or Chinese cabbage), soy milk, almond milk, fortified orange juice
  • Zinc: soy products, legumes, grains and nuts
45
Q

What are the characteristic signs of vitamin A deficiency?

A

• Most characteristic and specific signs:
○ Delayed dark adaptation, night blindness, photophobia
○ Corneal and conjunctival epithelial tissues keratinize and become opaque, forming dry, scaly layers of cells (xerophthalmia) forming plaques
○ Bitot spots –> triangular pearly white or yellowish foamy spots on bulbar conjunctiva

  • General: FTT, diarrhea, repeat infections, apathy, mental retardation, wide separation of cranial bones at the sutures
  • Hyperkeratotic patches on the arms, legs, shoulders and buttocks
  • Pyuria and hematuria
46
Q

What are the signs of hypervitamosis A?

A
  • Fatigue
  • Hair loss
  • Arthralgia
  • Increased intracranial pressure
  • Carotenemia (reversible orange colour of the skin)
47
Q

What deficiency mimicks that of Beriberi?

A

Thiamine (vitamin B1)

48
Q

What are the signs of thiamine deficiency?

A
  • Fatigue, apathy, irritability
  • Depression
  • Drowsiness
  • Poor mental concentration
  • Anorexia, nausea and abdominal discomfort
  • Peripheral neuritis (tingling, burning, paresthesias of the toes and feet, decreased DTR, loss of vibration sense, tenderness and cramping of the leg muscles)
  • Heart failure, prolonged QT interval, inverted T waves, low voltage
  • Ptosis of the eyelids and atrophy of the optic nerve
  • Paralysis of the laryngeal nerve –> aphonia, hoarse voice
  • Muscle atrophy, ataxia
  • Wernicke encephalopathy (rare)
49
Q

What are the signs of riboflavin deficiency?

A

Pellegra
- Dermatitis
□ May be initiated by irritants, i.e. intense sunlight
□ Symmetric, sharply demarcated areas of erythema on exposed surfaces, resembling sunburn i.e. caudal necklace
□ May have glove and stocking appearance (distribution changes)
- Diarrhea
- Dementia: other CNS symptoms - depression, disorientation, insomnia, delirium

50
Q

What foodstuffs are rich in riboflavin?

A

Anything with tryptophan!

Meat, fish, poultry, cereals, legumes, green leafy vegetables, milk and eggs

51
Q

Which vitamin deficiency can lead to listlessness, irritability, seizures, vomiting, FTT?

A

Vitamin B6 (pyridoxine)

52
Q

Children taking which medications should also consider supplementing their vitamin B6 intake?

A

Isoniazid, penicillamine, corticosteroids, phenytoin, carbamazepine

53
Q

What children are at greater risk of developing vitamin B12 deficiency?

A
  • Those with illnesses affecting absorption at the terminal ileum i.e. Crohn’s disease, short gut syndrome, Celiac disease, any resection
  • Pernicious anemia
  • Vegans/vegetarians
  • those with tapeworms
54
Q

What are the signs/symptoms of vitamin B12 deficiency?

A
  • Neurologic: parasthesias, impaired vibration sense, ataxia, developmental regression, neurophyschiatric changes, weakness, fatigue
  • Hematologic: megaloblastic anemia, pallor
  • GI: diarrhea/vomiting
55
Q

What are the clinical characteristics of vitamin C deficiency (scruvy)?

A

Think issues with collage synthesis and iron transport

  • bleeding and swelling of mucous membranes
  • MSK pain
  • swelling at knees and ankles
  • pseudoparalysis
  • subperiosteal hemorrhages
  • petechiae and ecchymoses
  • General: irritability, fatigue, loss of appetite, low-grade fever
56
Q

What are the classic signs of Vitamin D deficiency (rickets)?

A
  • craniotabes (“ping pong” skull)
  • windswept deformity (valgus/varus deformity)
  • flaring of epiphyses
  • rachetic “rosary bead” appearance to ribs
  • frontal bossing
  • signs of hypocalcemia i.e. seizures
57
Q

What investigations should be ordered for a child with suspected rickets?

A
  • serum Ca (ionized and non-ionized)
  • serum phosphate
  • PTH
  • vitamin D (1,25 hydroxy and 25-hydroxy forms)
  • alkaline phosphotase
  • creatinine
  • standard electrolytes
58
Q

Which deficiency presents with limb and truncal ataxia, absence/loss of DTR, dysarthria, nystagmus, positive Romberg, poor proprioception/vibratory sense and blindness?

A

Vitamin E deficiency

59
Q

Why are preterm infants at greater risk for vitamin E deficiency?

A

Transfer and stores occur primarily during the last trimester of development

60
Q

Why are newborns predisposed to vitamin K deficiency?

A

○ Minimal transplacental passage
○ Limited hepatic storage in the newborn period
○ Low concentration of vitamin K in the breast milk
○ Absence of bacterial intestinal flora to synthesize K2

61
Q

What is the recommended dose of vitamin K?

A

Within first 6 hours post-natally

  • IM injection x 1
    • 0.5 mg if <1500 g
    • 1.0 mg if >1500 g
  • if family declines, advise re: risks
  • if still declines offer 2 mg PO, and repeat at 2-4 weeks and at 6-8 weeks
62
Q

What are the characteristic features of zinc deficiency?

A
  • symmetrical perioral, perianal and acral rash
  • failure to thrive
  • reddish/brown hair
  • chronic diarrhea
  • poor wound healing with yeast superinfection
  • conjunctivitis and corneal dystrophy

Pediatrics (27 decks)

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