Nutrition and Fluid/Electrolytes

Question 1

Human milk/breastfeeding

Answer 1

Ideal standards for infant feeding
At least for the first 6 mos of life
Infants are likely to breastfeed better if started within 2 days and even better 1 hr after delivery

Question 2

What does breastfeeding decrease the incidence of?

Answer 2

Diarrhea
Resp illness
OM
Bacteremia
Meningitis
Necrotizing enterocolitis
Also have higher IQ neurodevelopment

Question 3

How do you know if breast feeding is supplying enough or adequately providing nutrients?

Answer 3

This can be assessed by the voiding and stool patterns of the infant
A well hydrated infants voids about 6-8 times a day (soaking).
Loose yellow stools are also to be noted at least 4 times a day

Question 4

What may occur with infants who have insufficient milk intake and poor weight gain in the first week of life?

Answer 4

They may have an increase in unconjugated bilirubin

This is known as breast feeding jaundice

Question 5

Common breastfeeding problems include…

Answer 5

Cracked nipples
Enlargement
Breast tenderness

Question 6

Presentation of mastitis

Answer 6

Fever
Chills
Malaise
Complaints of poor breastfeeding and breast tenderness

Question 7

Tx for mastitis

Answer 7

Typically frequent breast emptying and abx therapy aids in relief
Abscess formation may occur if left untreated

Question 8

Formula feeding

Answer 8

Only use iron-fortified formula unless previous diagnosis would prevent otherwise

Question 9

When should breastfeeding be accompanied by solid foods?

Answer 9

By approximately 6 mos

Question 10

What should happen if infants have been solely breastfed up to the point of complement feeding?

Answer 10

Going to need protein, iron, and zinc

Question 11

How to add juice

Answer 11

Only do so after 1 year and with a cup- not a bottle
-Limit this to ONLY 4 oz/day and it must be unsweet
Do not let child fall asleep with a bottle or drink
-Leads to higher incidence of dental caries

Question 12

Infant diet once they have solid food

Answer 12

All foods with the potential to obstruct the airway should be avoided until 4 yoa
To avoid the potential of botulinism, don’t give a child under the age of 1 honey

Question 13

Child’s diet

Answer 13

First 1000 days of life- about 3 yrs
-Promotes healthy habits that stick for life
The consumption of cows’ milk is not ideal until after 1 year of age
-Limit large intakes
-Low fat or fat free/NOT whole milk
Juice should be limited to 4 oz a day
-If they are 7-18 then 8 oz of juice a day

Question 14

Teen eating

Answer 14

Poor eating habits tend to develop during the teenage years

Eating disorders also start to develop here, such as binge eating, anorexia, and body dysmorphia

Question 15

Obesity

Answer 15

New studies report that 17% of kids 2-20 are obese now
Obesity runs in the family however is rarely genetic in nature
Children born to obese mothers are 3-5x more likely to become obese

Question 16

Underweight

Answer 16

Below 5th percentile

Question 17

Healthy weight

Answer 17

5th percentile to <85th percentile

Question 18

Overweight

Answer 18

85th percentile to <95th percentile

Question 19

Obese

Answer 19

95th percentile or above

Question 20

How should weight be addressed?

Answer 20

Complete a BMI at every encounter
Talk/ask about physical activity and diet at every encounter
Then, complete labs routinely if indicated! Typically if they are over 95th percentile

Question 21

SMART goals

Answer 21

Specific
Measurable
Attainable
Realistic
Timely

Question 22

When is bariatric surgery indicated?

Answer 22

Must weigh pros and cons of each case

May be cost effective however controversial

Question 23

Ascorbic acid

Answer 23

Water soluble vitamin
A principal form of vitamin C
Deficiency results in scurvy
Irritability, bone tenderness with swelling, pseudoparalysis of the legs
Occurs with infants fed unsupplemented cows milk in the first year of life and if diet is void of fruits and veggies

Question 24

Riboflavin

Answer 24

B2
Affects glucose, fatty acid and amino acid metabolism
Ariboflavinosis- angular stomatitis, glossitis, cheilosis
Subclinical deficiency noted in diabetic pts, chronic cardiac dz, and infants undergoing phototherapy for hyperbilirubinemia

Question 25

Thiamine

Answer 25

B1 related to carbohydrate metabolism
Aphoic crying- no sound but appear crying
Peripheral neuropathy and paresthesias
Typically presenting between 1-4 mos of age

Question 26

Niacin

Answer 26

Pellagra:
Weakness
Lassitude
Dermatitis
Photosensitivity
Inflammation of mucous membranes
Diarrhea
Vomiting
Dysphagia
Dementia

Question 27

B6

Answer 27

Three naturally occurring forms: pyridoxine, pyridoxal, pyridoxamine

Question 28

Dietary deprivation of B6

Answer 28

Results in:
Hypochromic microcytic anemia
Vomiting
Diarrhea
FTT
Listlessness
Hyperirritability
Seizures

Question 29

Folate

Answer 29

Used in DNA synthesis
Causes megaloblastic anemia and neural tube defects
Comes from greens, veggies, cereals, and cheeses

Question 30

B12

Answer 30

DNA synthesis and coenzyme for 5-methyltetrahydrofolate
Megaloblastic anemia, peripheral neuropathy, vitiligo, posterior lateral spinal column disease
Vegan diets

Question 31

Vit A

Answer 31

Deals with epithelial cell integrity and vision
Night blindness, immune defects, hyperkeratosis
Common with protein calorie malnutrition; malabsorption

Question 32

Vit D

Answer 32

Helps maintain serum calcium, phosphorous levels
Deficients causes rickets, reduced bone mineralization
Prohormone of 25- and 1,25-vit D
Sunlight and foritified milk

Question 33

Vit E

Answer 33

Antioxidant
Causes hemodialysis in preterm infants: areflexia, ataxia
May benefit pts with G6PD

Question 34

Vit K

Answer 34

Post-translation carboxylation of clotting factors 2, 7, 9, 10 and proteins C and S
Deficiency causes prolonged PT, hemorrhage

Question 35

Calcium

Answer 35

The most abundant major mineral
99% is in the bone and the 1% left is in the extracellular fluid
Nonskeletal calcium has a role in nerve conduction, muscle contraction, blood clotting and membrane permeability
There is no classic deficiency syndrome because blood and cell levels are closely regulated

Question 36

Iron

Answer 36

Heme-containing macromolecule
Deficiency causes anemia, spoon nails, reduced muscle and mental performance
Ask about hx of Pica, use of cows milk, or GI bleeding

Question 37

Zinc

Answer 37

Helps in wound healing

Poor growth, alopecia, infections, and sexual development delays

Question 38

Fluid percentages throughout childhood

Answer 38

Fetus has a high total body water percentage which gradually decreases to 75% of birth weight for a term infant
At the first year of life it decreases to 60% of body weight and remains there until puberty
-Females then develop more fatty cells which have less water content and will decrease to 50%
-Males who develop more muscle mass will stay around 60%

Question 39

IV replacement formulas for children

Answer 39

0-10 kg: 100 mL/kg per day
11-20 kg: 1,000 mL + 50 mL/kg for each 1 kg >10 kg
>20 kg: 1500 mL + 20 mL/kg for each 1 kg >20 kg

Question 40

3 sources of nl losses of water

Answer 40

Urine (60%)
Skin/lungs (35%)- insensible losses
Stool (5%)

Question 41

What is the MCC for dehydration in children?

Answer 41

Gastroenteritis

Question 42

Rehydration fluid therapy

Answer 42

Fluid bolus, usually 20 mL/kg of the isotonic solution, over about 20 mins
Rehydration is completed when signs of intravascular volume depletion resolve
-More alert, better profusion, normal BP, lower HR

Question 43

Hyponatremic dehydration

Answer 43

Occurs in children who have diarrhea and consume a hypotonic fluid (like water or diluted formula)

• Don’t rapidly correct or you may cause complications!
• Usually these kids are lethargic and irritable