Nutrition and Gastro

Question 1

weight gain

Answer 1

newborns should gain 1oz/day

nursing on demand is recommended

Question 2

solids

Answer 2

introduce at 4-6 months; breast milk still primary nutrition
teach parents about tongue thrust
iron-rich foods, esp if premie
can blend breast milk into foods (!)

Question 3

supplements during introduction

Answer 3

vitamin D
probiotics

that’s it

Question 4

foods at 9 months

Answer 4

let them have a variety, teach their immune sys

*new belief: give kids everything they might eat in their lives within first year

Question 5

1-3 years

Answer 5

20-25g protein daily

GOOD FATS

Question 6

2-3 years

Answer 6

gauge kids on weekly intake (can vary a lot day to day)

Question 7

Infant formulas

Answer 7

most are cow-milk based, organic have rice syrup instead of corn
breast milk has more whey, less casein than cow

Question 8

Colic

Answer 8

excessive, inconsolable crying in infants younger than 3 months
-due to gas, milk protein allergy, immature nervous sys?
Homeopathy: chamomilla, pulsatilla, colocynthis, dioscorea, nux vomica
craniosacral, gripe water

Question 9

Reflux

Answer 9

physiologic- just milk, babies growing well
esophageal- milk and acid, irritates the esophagus, poor weight gain

management: upright positioning after eating, small feedings, drugs, antacids, herbs, food allergies

Question 10

Malrotation of bowel

Answer 10

Dx: barium esophagram

Question 11

Pyloric stenosis

Answer 11

hypertrophy of pylorus–> obstruction of gastric outlet
onset 2-8 weeks; PROJECTILE vomiting
Dx: US and barium study

Question 12

Grunting baby syndrome

Answer 12

not constipation, self limiting

Question 13

Hirschprung disease

Answer 13

80% present with failure to pass mec at 48 hours

Tx: surgery

Question 14

Nausea and Vomiting

Answer 14

DDX

• viral gastroenteritis, watery diarrhea following vomiting
• bacterial gastro, pain, fever, anorexia, bloody diarrhea
• intussusception, periodic cramping, tx by barium enema

Question 15

Acute Diarrhea causes

Answer 15

viral/ bacterial gastroenteritis

UTIs, OM, irritable bowel,

Question 16

Functional diarrhea

Answer 16

painless recurrent passage of 3 or more unformed stools daily for more than 4 weeks i

-ong-term mucosal injury secondary to viral gastroenteritis, carbohydrate malabsorption, mucosal damage (celiac), fat malabsorption, low fiber diet

TX: avoid dairy, decrease fruit juice/sugar, increase fat in diet, increase fiber in diet. probiotics, digestive enzymes, slippery elm, l-glutamine.

Question 17

Constipation

Answer 17

in breastfed babies, up to 1 week WNL

intentional/unintentional holding around potty training

Question 18

Intussusception

Answer 18

usually invagination of the ileum through the ileocecal valve into the colon
3-24 months of age.
Sudden crampy abdominal pain, vomiting, and most notably, lethargy and paradoxical irritability
Diagnosis and treatment is usually barium enema study. or surgery

Question 19

Appendicitis

Answer 19

N/V and an acute abdomen, anorexia, fever, constipation, pain at McBurney’s point.
do not want to move, are irritable.
Rare before age 3.
Surgery

Question 20

Chronic abdominal pain

Answer 20

? Food allergies, celiac, anatomic issues (especially musculoskeletal), parasitic infections, h. pylori, UTIs, colitis or Crohn’s, maldigestion, drug reactions (NSAIDS, steroids, erythromycin), lead poisoning.
abdominal exam and (UA, CBC, O&P, stool culture, stool guaiac, celiac testing)