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Paediatrics > Nutrition > Flashcards

Nutrition Flashcards

1
Q

What is the continuum of inadequacy in nutrition in children ?

A

Weight loss
Growth failure (failure to thrive)
Malnutrition

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2
Q

What are the nutritional problems in children?

A 
Failure to thrive
Malnutrition
Vitamin D deficiency (Rickets)
Vitamin A deficiency
Obesity
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3
Q

What causes children to have nutritional vulnerability?

A

Low calorie reserves from protein and fat
High nutritional demand from rapid growth in infancy
Rapid neuronal development
Acute illness or surgery or trauma

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4
Q

What is the body composition of preterm, neonates and infants?

A

Preterm (90% water, 5% protein)
Term neonate (70% water, 10% protein, 20% fat)
Infant (60% water, 15% protein, 25% fat

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5
Q

What percentage of calorie expense is spent on growth in children?

A

Infants - up to 30%

Children - up to 5%

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6
Q

What percentage of BMR is spent on brain growth?

A

At birth - 66%

At one year 50%

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7
Q

What is the normal pattern of weight gain in newborns?

A

4 months - double BW

1 year - triple BW

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8
Q

What is the normal calorie need of children?

A

up to 6 months - 115 kcal/kg/day
up to 1 year - 95 kcal/kg/day
up to 10 years - 75 kcal/kg/day

Increase to 150-200 kcal/kg/day to get catch up growth

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9
Q

What is the Barker hypothesis?

A

FGR and LBW increases risk of CAD, CVD, T2DM, HT in later life

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10
Q

What are the advantages of exclusive breastfeeding?

A

FOR INFANT
Ideal nutrition concoction for frist 6 months
Improves survival by reducing GIT infections
Reduces necrotising enterocolitis in preterm babies
Increases mother-baby bonding
Reduces risk of NCD in later life
FOR MOTHER
Increases mother-baby bonding
Increases birth spacing
Mothers risk of BCA is reduced

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11
Q

What are the anti-infective properties of breastmilk?

A

IgA - mucosal protection
Bifidus factor - promotes Lactobacillus growth in GIT
Lysozyme - Bacteriolytic enzyme
Lactoferrin - iron binder and anti E coli
Interferon - antiviral
Macrophages
Lymphocytes

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12
Q

What are the nutritional properties of breast milk?

A

Protein quality - easily digestible 60/40 whey/casein
Lipid quality - oleic acid for easy digestion
Ca/PO4 = 2/1 - prevents hypocalcemic tetany
Iron - up to 50% bioavailability
PUFA - for retinal development
Low renal solute load (prevents hypernatremic dehydration)

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13
Q

What are the potential complications of breastfeeding?

A 
Difficulty in establishing
Cant measure feeds
Infection transmission - CMV, HIV, Hep B
Breast milk jaundice
Can't continue exclusively beyond 6 months
Vit K deficient - bleeding in newborn
Twins
Preterms can't suck
Cracked nipples
Mother's milk production rate
Mother's career restriction and financial implications
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14
Q

What is colostrum?

A

Feed high in Ig and protein

Produced for first few days

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15
Q

When should breastfeeding be established?

A

Within 1 hour from birth
Exclusively for 6 months
With solid food for 6 months
Can go up to 18 months age

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16
Q

What is the physiology of breastfeeding?

A

Rooting, suckling and swallowing
Nipple stimulation leads to PRL from AP and OTC from PP
(Let down reflex)

17
Q

Why is pure cows milk unsuitable as a formula feed?

A

Too much protein and electrolytes
Inadequate iron and vitamins A,C,D
Can give after 1 year age

18
Q

How does Cow’s milk and Infant formula differ from breastmilk?

A

Same energy
More protein (but Cow’s milk protein)
Cows milk has less carb, formula has more
Cows milk has 40/60 whey/casein
Cows milk has more fat, sodium, calcium, phosphorus
Cows milk has less iron, formula has more

19
Q

What is failure to thrive?

A

Suboptimal weight gain in infants and toddlers with weight crossing below 2nd centile that is not constitutional
(AKA growth faltering)
Mild = fall across 2 centile lines
Severe = fall across 3 centile lines

20
Q

What are the causes of failure to thrive?

A

ORGANIC 5%
-CP, cleft lip
-CD, CKD, CF, CLD (chronic illness)
-GORD and severe vomiting
-Malabsorption (Coeliac, CF, OJ, NEC, short gut)
-Metabolic (Down, Hypothyroid, storage disorders, TORCH)
-High BMR (thyrotoxicosis, malignancy, HIV, CHD, CKD)
NON ORGANIC 95%
-poverty
-psycho-socio-economic-behaviuoral
-abuse

21
Q

How is FTT managed?

A

Non-organic
-Primary care with correction of eating behaviour and nutrition
Organic or severe non-organic (early infancy)
-Admission with active refeeding
-Correct eating behaviour, feeding technique and nutrition

22
Q

How to clinically evaluate FTT?

A 
Hx
-diet with food diary
-feeding pattern and technique
-symptoms of organic causes
-birth and delivery, breastfeeding
-family patterns
-developmental domains
-social issues
Ex for organic causes and abuse, anthropometry
Ix
-FBC with S Ferritin
-SCr, BUN, E, ABG, Ca, Po4, S Albumin
-LFT, TFT, CRP, UFR, SFR
-Karyotype, CXR, sweat test for CF
23
Q

Which anthropometric measurement allows screening for malnutrition in the community?

A

MUAC

24
Q

What are the complications of malnutrition?

A

Delayed wound healing
Permanent intellectual delays
Worsens prognosis of intercurrent illnesses

25
Q

What are the methods of supplying nutrition?

A

Enteral (NG, PEG, FJ)

Parenteral (TPN)

26
Q

What are the strategies for increasing energy intake?

A 
Diet
-3 meals and 2 snacks per day
-increase variety
-increase energy density
-decrease fluid food
Behavioural
-Meal punctuality
-Praise and support good eating habits
-Never force feed
-Encourage eating
27
Q

What are the anthropometric measurements for assessing nutrition?

A

Weight for height - acute malnutrition -3SD
MUAC - <115 mm is severe
Height for age - chronic malnutrition

28
Q

What are the features of Marasmus?

A 
Severe protein energy malnutrition 
Weight for height -3SD
Wasted and wizened
Withdrawn and apathetic
No edema
29
Q

What are the features of Kwashiorkor?

A

Severe protein energy malnutrition
Late weaning followed by high starch low calorie diet
Triggered by infection
Severe wasting and generalized edema
Almost normal weight from edema
Flaky skin with hyperkeratosis and desquamation
Hepatomegaly
Angular stomatitis
Sparse depigmented hair
Diarhea, hypothermia, bradycardia, hypotension
Low albumin, potassium, glucose, magnesium

30
Q

How is SAM managed?

A 
Correct hypoglycemia
Prevent hypothermia
Correct dehydration cautiously
Correct electrolytes
Treat infections
Supply micronutrients
Refeeding with small frequent meals low in protein
Start with F75 until above -3SD
then F100 until above -2SD
then BP100 until normal
then thriposha
31
Q

What is the physiology of Vit D?

A 
Low serum calcium
PTH
Cholecalciferol in skin
25 hydroxy in liver
1,25 hydroxy in kidneys
Increases serum calcium (GIT absorbs, urine bone resorbs)
32
Q

What are the effects of vit D deficiency?

A

Rickets - failed mineralization of osteoid growing bone

Hypocalcemia (tetany, seizures, stridor)

33
Q

What are the causes of rickets?

A

Nutritional (No sunlight, exclusive BF, vegan diet)
Malabsorption (Coeliac, CF, OJ)
Metabolism (CKD, CLD)
Drugs (phenytoin, phenobarbital)

34
Q

What are the features of rickets?

A 
Craniotabes ping pong skull
Rachitic rosary at costochondral junctions
Wide wrists and ankles (metaphysis expansion)
Harrison sulcus
Bow legs
FTT short stature
Frontal bossing
Delayed teeth
Hypotonia
35
Q

How to manage rickets?

A

Ix - calcium, phosphorous, ALP high, PTH high
Wrist Xray
Mx
Diet change, treat cause, give daily vit D3
Monitor ALP fall

36
Q

What are the features of Vit A deficiency ?

A

Fat malabsorption
Night blindness, corneal ulceration, bitot spots, scarring
Risk of measles

37
Q

What is childhood obesity?

A

Overweight >91 centile
Obese >98 centile
>3SD
High in developed countries, less active kids
risk higher in low socioeconomic groups
Not relate to food intake compared to normal kids

38
Q

What are the effective options for maintaining weight?

A 
Diet, exercise, behaviour, drugs, surgery
Reduce screen time
Increase activity
Reduce fat
Increase fruits and veggies 
No sugar
Reduce portion size
Good food habits
Orlistat lipase inhibitor
Metformin
39
Q

What are the complications of obesity?

A 
MSK - SCFE, bow legs, pes planus
Neuro - idiopathic high ICP
OSA
PCOS
T2DM
HT
DL
Psychological

Paediatrics (12 decks)

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