Nutrition and Fluid/Electrolytes Flashcards
Human milk/breastfeeding
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
What does breastfeeding decrease the incidence of?
Diarrhea Resp illness OM Bacteremia Meningitis Necrotizing enterocolitis Also have higher IQ neurodevelopment
How do you know if breast feeding is supplying enough or adequately providing nutrients?
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
What may occur with infants who have insufficient milk intake and poor weight gain in the first week of life?
They may have an increase in unconjugated bilirubin
This is known as breast feeding jaundice
Common breastfeeding problems include…
Cracked nipples
Enlargement
Breast tenderness
Presentation of mastitis
Fever
Chills
Malaise
Complaints of poor breastfeeding and breast tenderness
Tx for mastitis
Typically frequent breast emptying and abx therapy aids in relief
Abscess formation may occur if left untreated
Formula feeding
Only use iron-fortified formula unless previous diagnosis would prevent otherwise
When should breastfeeding be accompanied by solid foods?
By approximately 6 mos
What should happen if infants have been solely breastfed up to the point of complement feeding?
Going to need protein, iron, and zinc
How to add juice
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
Infant diet once they have solid food
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
Child’s diet
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
Teen eating
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
Obesity
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
Underweight
Below 5th percentile
Healthy weight
5th percentile to <85th percentile
Overweight
85th percentile to <95th percentile
Obese
95th percentile or above
How should weight be addressed?
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
SMART goals
Specific Measurable Attainable Realistic Timely
When is bariatric surgery indicated?
Must weigh pros and cons of each case
May be cost effective however controversial
Ascorbic acid
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
Riboflavin
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
Thiamine
B1 related to carbohydrate metabolism
Aphoic crying- no sound but appear crying
Peripheral neuropathy and paresthesias
Typically presenting between 1-4 mos of age
Niacin
Pellagra: Weakness Lassitude Dermatitis Photosensitivity Inflammation of mucous membranes Diarrhea Vomiting Dysphagia Dementia
B6
Three naturally occurring forms: pyridoxine, pyridoxal, pyridoxamine
Dietary deprivation of B6
Results in: Hypochromic microcytic anemia Vomiting Diarrhea FTT Listlessness Hyperirritability Seizures
Folate
Used in DNA synthesis
Causes megaloblastic anemia and neural tube defects
Comes from greens, veggies, cereals, and cheeses
B12
DNA synthesis and coenzyme for 5-methyltetrahydrofolate
Megaloblastic anemia, peripheral neuropathy, vitiligo, posterior lateral spinal column disease
Vegan diets
Vit A
Deals with epithelial cell integrity and vision
Night blindness, immune defects, hyperkeratosis
Common with protein calorie malnutrition; malabsorption
Vit D
Helps maintain serum calcium, phosphorous levels
Deficients causes rickets, reduced bone mineralization
Prohormone of 25- and 1,25-vit D
Sunlight and foritified milk
Vit E
Antioxidant
Causes hemodialysis in preterm infants: areflexia, ataxia
May benefit pts with G6PD
Vit K
Post-translation carboxylation of clotting factors 2, 7, 9, 10 and proteins C and S
Deficiency causes prolonged PT, hemorrhage
Calcium
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
Iron
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
Zinc
Helps in wound healing
Poor growth, alopecia, infections, and sexual development delays
Fluid percentages throughout childhood
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%
IV replacement formulas for children
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
3 sources of nl losses of water
Urine (60%)
Skin/lungs (35%)- insensible losses
Stool (5%)
What is the MCC for dehydration in children?
Gastroenteritis
Rehydration fluid therapy
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
Hyponatremic dehydration
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
