NUTRITION Flashcards
The most practical and pertinent guide in evaluating nutritional status in children is:
Regular or periodic follow up of weight and height
Colostrum is produced over the first 2 days of lactation. The secretion has higher protein and lower fat and lactose than mature human milk. Likewise, it is especially rich in:
IgA
The whey-to-casein ratio in mature human milk is about
3:2
Foremilk
released at the start of feeding; watery; HIGH LACTOSE AND PROTEIN
Hindmilk
released as feeding progresses until towards the end of feeding; creamy; HIGH FAT (5X MORE THAN FOREMILK)
FIRST 0-7 DAYS
- 37-84 mL/day; D1-2 of life
- Watery (>80% water)
- protein-rich
- High in Ig/protective factors: lactoferrin, lysozyme
- Na, vit A/K & growth factors
- Low levels: fat & carbohydrates
COLOSTRUM
- Between colostrum & mature milk
- Rising levels of macronutrients
TRANSITIONAL MILK
- D 10-14 of life
- Colostrum content + high fat & lactose
MATURE MILK
o produced when breastfeeding frequency decreases
o reverts to being more like colostrum
INVOLUTIONARY MILK
BREAST MILK COMPOSITION
- casein to whey ratio - low
- 10:90 in early milk
- 40:60 in mature milk
- 50:50 in late lactation
- fat globules bound by membranes rich in:
- phospholipids – cell growth & brain development
- cholesterol – facilitates myelination of the CNS
Breast milk has MORE compared to Formula milk except
§ Iron
§ Vit D
§ Vit K
Definitive test for GERD
esophageal pH probe
•
management for intractable GERD, refractory esophagitis & strictures, with morbidities from chronic pulmonary disease (recurrence rate of 14%)
Fundoplication
Which of the following is an absolute contraindication to breastfeeding?
nfant with galactosemia
CONTRAINDICATIONS TO BREASTFEEDING
- Galactosemia
- Septicemia
- Active TB
- Breast Cancer
- Malaria
- Substance Abuse
- Severe neurosis or Psychosis
- HIV
Micronutrient deficiency that presents with Vesiculobullous, eczematous, dry scaly or psoriasiform lesions symmetric perioral, sacral, and perianal areas; Chronic diarrhea, Stomatitis, Glossitis, Irritability, superinfection
Zinc
Generalized scaly dermatitis; Alopecia, Thrombocytopenia, Failure to thrive
Essential Fatty Acids deficiency
Edema, erythema and burning of sun exposed skin on the face neck hands on butterfly distribution dermatitis around the neck; Diarrhea, dementia
Niacin (Pellagra) / Vit B3
Alopecia with neurological symptoms
Biotin / Vit B7
This is seen in what condition?
Vitamin A deficiency
“BItot SPot”
Disease of growing bone which occurs in children only before fusion of the epiphyses
Rickets
“rachitic rosary” and “Harrison groove” are seen in what disorder?
Rickets
* Widening of the costochondral junctions leads to “rachitic rosary”
* “Harrison groove” is a horizontal depression along the lower anterior chest due to pulling of the softened ribs by the diaphragm during inspiration
This is seen in what disease?
Rickets
* Windswept deformity (valgus deformity of 1 leg with varus deformity of the other leg)
Treatment of Rickets
Vitamin D 300,000-600,000 IU orally or IM as 2-4 doses over 1 day (Stoss therapy)
- Either strategy should be followed by daily Vit D intake of 400 IU/day as a multivitamin
- Adequate dietary calcium & phosphorus
Angular cheilosis (perleche) and Glossitis (magenta tongue) are associated with?
Vit B2, Scurvy and Zinc deficiency
This is seen in what deficiency state?
Vit B3 deficiency
” Casal Necklace “
Mothers who have been long term users of high estrogencontaining contraceptives may have lower levels of _____ and need supplements of 20mg/day
Vit B6
Microcytic anemia, cheilosis, glossitis, dermatitis
Vit B6 deficiency
This is seen in what deficiency state?
Vitamin C deficiency (Scurvy)
- “scorbutic rosary” at the costochondral junction & depression of the sternum
- Angulation of the scorbutic beads is sharper than the rachitic rosary
- Bluish, purple spongy swellings of the mucous membranes esp. over the upper incisors
- Other symptoms: swollen joints, purpura and ecchymoses, poor wound & fracture healing
- perifollicular hemorrhages, hyperkeratosis of hair follicles, “corkscrew hair”
- X ray changes: distal ends of long bones with a ground-glass appearance
Scurvy
Most micronutrients in breastmilk are not affected by maternal diet/status. _____ and _____ are affected by maternal status.
Vitamin D and Iodine
full-term neonates are born with sufficient stores of ____ and ____ that are enough for the first 6 months of life.
Iron and Zinc
Bowlegs or knock knees Caput quadratum, Periosteal osteoid Craniotabes Ping pong ball sensation Rachitic rosary, Pigeon chest Harrison groove
Vit D Deficiency
“White line” on end of shafts, Scorbutic rosary/beads
Vit C deficiency
Pellagra, Casal necklace, Pellagrous glove and boots, Glove and boots lesion
Niacin (Vit B3) deficiency
Perleche
Vir B2 deficiency
Bitot spots, Xerosis conjunctivae, Xerosis cornea
Vit A Deficiency
Hyperostosis, Absence of metaphyseal changes
Vit A Intoxication
A deficiency of this trace element is associated with skin ulcers, reduced immune response and hypogonadal dwarfism:
Zinc
Irritability, pruritus, painful extremities, with brawny swelling, coarse hair, dry skin, seborrhea and increased intracranial pressure is seen in
Hypervitaminosis A
In a Southwestern town in Mindanao, children are fed mostly with corn as staple. The most common vitamin deficiency encountered in these children is:
Niacin
In children with malnutrition, the most seriously compromised immunologic function is:
Antibody production
* One of the macronutrients severely affected in malnutrition are proteins (think Kwashiorkor). Therefore, problem in proteins → problem in antibodies.
anthropometrics useful to assess Wasting and Acute malnutrition
Weight for height
§ Measures linear growth
§ Represents cumulative impact of adverse events
Height for age (length for age if <2)
For malnutrition, the term we are looking for is WASTING. Only three parameters can be used depending on age of patient:
Weight for length/height, MUAC, BMI
Differentiate kwashiorkor and marasmus
Severe wasting is extreme thinness diagnosed by
weight-forlength (or height) below −3 SD of the WHO Child Growth Standards
children ages 6-59 mos, a mid-upper arm circumference ____ also denotes extreme thinness
<115mm
Hallmark of REFEEDING SYNDROME
severe hypophosphatemia
BMI PERCENTILE FOR AGE
- Rare complication of extreme exogenous obesity in which patients have severe cardiorespiratory distress with alveolar hypoventilation & a decrease in pulmonary, tidal & expiratory reserve volumes
- Polycythemia, hypoxemia, cyanosis, cardiac enlargement, CHF, somnolence
- Weight reduction as rapidly as possible
PICKWICKIAN SYNDROME
Treatment goal for obesity
Weight maintenance
