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RC: CPS Woo Hoo > Nutrition and GI > Flashcards

Nutrition and GI Flashcards

1
Q

Thyroxine needs to be check in which infants on soy formula?

A

Congenital hypothyroidism.

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2
Q

Harm for soy-based formula in which 2 populations?

A
  1. Premature (not adequate for growth)
  2. Congenital hypothyroidism (can cause abN function)
    +/- non-IgE CMPA (due to high rate of coincident soy allergies)
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3
Q

Best choice for newborn baby feed?

A

Breast feed

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4
Q

T or F: soy based formula support normal growth + nutrition for 1st year of life

A

True UNLESS PREM

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5
Q

CMPA formula recommendation

A

Protein Hydrolysate

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6
Q

Types of Fats

A
  1. Saturated= double bone btw carbon replaced by H
  2. Unsaturated= min. 1 double bonds between two atoms of carbon
    - > Cis vs. Trans based on arrangement of carbon across double bones
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7
Q

T or F: there is a safe level of dietary trans level

A

FALSE.

Trans= negative health effects.

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8
Q

Infantile Colic Criteria (Rome 3)

A
  • infant < 4 mo.
  • paroxysmal irritable/ fussy/ crying w/out clear cause
  • episode last min. 3h + 3d/week x 1 wk
  • no FTT
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9
Q

Should you change diet if colic?

A
  • IF severe and CMPA concern empiric time limited (max 2 wk) hypoallergenic diet
  • otherwise small # infants actually reduce symptoms
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10
Q

T or F: soy based form should be used to reduce colic

A

False.

Soy only if galactossemia or can’t take dairy.

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11
Q

T or F: lactose-free helps colic

A

FALSE.

Congenital lactase deficiency are.

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12
Q

T or F: pro/pre biotics help colic.

A

FALSE. Insufficient evidence for conclusion.

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13
Q

DDX for FTT may include=

A
  1. Nutrition (intake, ED)
  2. Energy Loss (emesis, pancreatic dx, liver dx, RTA)
  3. Energy Needs up (chronic condition, CHF, tumour)
  4. Endo problem/Other (low thyroid, GH deficiency)
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14
Q

Basic W/U for FTT may include:

A 
CBC
ESR or CRP
lytes, gas, BG, BUN, Cr
protein, albumin
Fe, TIBC, sat, ferritin
Ca, P, alk-phos
AST, ALT, GGT
serum immunoglobulins
tTG, IgA
TSH
U/A

Step 2= sweat chloride, vitamin level, fecal elastase, bone age

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15
Q

Adequate Caloric Needs Calc=

A

calorie for age (cal/kg/day) x ideal wt for ht (kg) / actual wt (kg)

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16
Q

When do you use appetite stimulants in FTT

A

After expert R/A and refractory cases.

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17
Q

First steps in toddler FTT

A
  1. Verify accuracy
  2. Plot on growth curve
  3. Calc. mid-parental ht
  4. Hx + P/E
  5. Caloric intake using food diary
  6. Basic W/U
  7. Optimize oral caloric intake
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18
Q

How much wt and ht do you gain from 2-5 y.o.?

A

1-2 kg/year

6-8 cm/year

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19
Q

How do you manage unrealistic expectations for picky eaters

A
  1. Reassure (decreased appetite normal in this age)
  2. Parents choose nutritious food and structure and child decide how much
  3. Small portion to start
  4. Snacks best mid-day
  5. Enjoyable time
  6. Limit table 20 min
  7. Ensure not tired or overstimulated
  8. No distractions
  9. No discipline then
  10. Eat together
  11. No indication for IV, formula, stimulants.
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20
Q

What is the BFI (Baby Friendly Initiative)?

A

operational traget for hospital to get child-feeding ideal. get designation when follow all 1- steps x min. 80% of all F.

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21
Q

List any steps in BFI (Baby Friendly Initiative)?

A
  • written BF policy
  • all HCP have skills + info to implement policy
  • inform preg F and families about imp of BF
  • place babies in uninterrupted skin-to-skin contact after birth min. 1 hr or until first feed done
  • assist BF and lactation
  • support exclusive BF x 6 month
  • facilitate 24h rooming for all mother-infant
  • encourage baby-led or cue-based BF
  • support feed + care for BF without pacifiers
  • provide transition among host to community services
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22
Q

Dx Contraindications to BF

A
  1. HIV (+) mother (even if ART)
  2. Herpes lesion on both BF
  3. Untreated Infectious TB (within first 2 wk of tx)
  4. Cytotoxic chemo
  5. Radioactive isotopes or radiation therapy.
  6. Classic galactossemia

No contraindication if…. Hep B, Hep C

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23
Q

T or F: you should stop BF for physiologic or milk jaundice

A

FALSE

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24
Q

T or F: should not BF if PKU

A

FALSE. Now encourage BF w/ supplement low-phenyl formula w/ strict monitoring for phenylalanine levels.

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25
Q

Key to Birth-6 mon. Nutrition

A
  1. BF exclusive x 6 mo.
  2. All BF= Vit D 400 IU
  3. First complementary = Fe rich (meat, Fe cereals)
  4. Monitor growth
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26
Q

T or F: colic typically resolve by 4 mon.

A

TRUE

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27
Q

6-24 months Nutrition Recommendations

A
  1. Support BF up to 2 y.o. +
  2. If not, start 3.25% pasteurized homo milk 9-12 mon. (max 20 ounces)
  3. Skim milk after 2 y.o.
  4. Vit D 400 IU if BF
  5. Fe rich food few times/d
  6. Responsive feeding key
  7. 12 mon= reg snacks + meals
  8. Ensure food prep, cook, stored well
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28
Q

T or F: New fluids best via bottle if after 6 month age

A

FALSE.

Best through soppy cup.

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29
Q

Name things that support mothers BF after returning to work.

A
  1. Child care nearby
  2. Breast pump
  3. Flexible schedule
  4. Supportive fam
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30
Q

How often and frequent should you introduce new foods to BB?

A
  • avoid > 1 new/d

- wait 2 d before another common allergen

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31
Q

If no egg or milk in infant diet, watch:

A
  1. Ca
  2. Zinc
  3. Fe
  4. Vit D
  5. Vit B12
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32
Q

True or False: Fluoride reduces dental caries

A

True

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33
Q

Fluoride decreases enamel solubility via

A

1) Inhibition of Plaque
2) Inhibition of De-mineralization
3) Enhanced Re-mineralizatio of enamel

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34
Q

What is dental fluorosis?

A
  • abnormal enamel development from ++ ingested fluoride
  • occurs ~0.7 ppm
  • usually no symptoms
  • if P/E (+)= pitting teeth, ‘snow capped case’, chalking teeth
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35
Q

How do cities know to add fluoride to natural water?

A

Natural Fluoride concentration < 0.3 ppm

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36
Q

how much toothpaste to use?

A

pea size portion

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37
Q

When do you give supplemental fluoride?

A

IF they are min. 6 mon AND…
drinking water < 0.3 ppm
+ child does NOT brush BID
+ and dentist/HCP say high risk for caries (community, geographic trends)

38
Q

How much fluoride do you supplement for kids 0-6 months?

A

NONE.

No matter what the fluoride concentration is in envirn’t

39
Q

When you need topical fluoride?

A

Once teeth have erupted

40
Q

What are sports drinks?

A
  1. Flavoured beverage w/ sugars + lytes + vitamins
41
Q

What proportion of high schools studies caffeinated energy drinks consume caffeinated energy drinks?

A

> 50%

42
Q

What are caffeine side effects

A
  • tachy HR
  • HTN
  • fast speech
  • increased motor activity
  • delayed gastric emptying
  • diuresis
  • hot
43
Q

T or F: People who mix energy drinks w/ alcohol drink less alcohol than general.

A

False.

44
Q

T or F: Health Canada prohibits the use of caffeinated energy drinks as ingredient in premixed alcohol beverages.

A

True.

45
Q

Caffeine Recommended Max Daily Intake for ages.

A
  • 4-6: 45 mg/d
  • 7-9: 62.5 mg/d
  • 10-12: 85 mg/d
  • 13 y.o. +: 2.5 mg/kg/day
46
Q

What should paediatricians do re: caffeinated energy drinks?

A
  • ask about consumption
  • ask about reason to consume and if they mix w/ EtOH
  • educate re: AE
  • counsel on sports drink replacement (water, sports beverage if long)
47
Q

Which population have higher risk of caffeinated energy drinks?

A
  • CVS
  • Renal
  • Liver dx
  • Sz
  • DM
  • Mood, ADHD dx
48
Q

What is oral rehydration therapy?

A

Glucose + electrolytes

49
Q

Recommended WHO osmolarity of ORT?

A

245 mosm/L

50
Q

What do you give if no dehydration present?

A

Regular age-appropriate diet.

51
Q

What % is mild dehydration?

A

<5%

52
Q

What % is moderate dehydration?

A

5-10%

53
Q

What % is severe dehydration?

A

> 10%

54
Q

How do you treat mild dehydration? (<5%)

A

Rehydrate w/ ORS (50mL/kg) over 4 hour
Replace ongoing losses
Age appropriate diet after rehydration.

55
Q

How do you treat mod-dehydration? (5-10%)

A

Rehydrate ORS 100mL/kg over 4 hour
Replace ongoing losses
age appropriate diet after dehydration

56
Q

How do you treat severe dehydration (>10%)

A 
IV resus with NS 20cc/kg 
R/A and repeat as needed
ORT when stable
Replace ongoing losses with ORS
Age appropriate diet once rehydrated.
57
Q

Which general clinical parameters do you look at for dehydration assessment?

A
  • VS: HR, BP (low= late), LOC, U/O
  • AF
  • sunken eyes
  • MM
  • Thirst
  • Skin turgor
58
Q

What level of dehydration is this: ++ HR, low or absent U/O, great thirst, very dry MM, decreased turgor?

A

Severe

59
Q

Describe mild dehydration?

A
  • Slight elevated HR
  • Slightly decreased U/O
  • slightly dry MM
  • slightly increased thirst
  • no skin turgor
60
Q

T or F: ORT is as effective as IV for mild-moderately dehydrated child?

A

TRUE

- as effective IF not better

61
Q

T or F: ORT is as effective as IV for severe dehydration?

A

FALSE

- want to use IV

62
Q

List the ORS contraindications

A
  • severe dehydration
  • impaired LOC
  • protracted vomiting despite small f feeds
  • paralytic ileus
  • monosaccharide malabsorption
63
Q

T or F: you should stop diet when sick?

A

False- continue age appropriate diet (including BF, no need for lactose-free formula etc.)

64
Q

T or F: it is safe to give plain water for acute gastro.

A

False

- low Na and low glucose

65
Q

What are probiotics?

A

live micro-organisms; non pathogenic

66
Q

what are probiotics?

A

non-viable food components

i.e. fructo-and galacto-oligosaccharides

67
Q

What does baby gut flora look like adults?

A

once solid food introduced

- colonization in general starts immediately after birth

68
Q

How do intestinal bacteria contribute to gut function?

A
  • compete with pathogenic bacteria
  • increase mucus secretion
  • decrease gut permeability
  • modulate immune function
69
Q

When should you consider recommending probiotics?

A
  1. Prevent NEC if > 1 kg
  2. Prevent Abx-associated diarrhea
  3. Shorten viral diarrhea
  4. Decrease symptoms of colic
  5. Decrease symptoms of IBS
70
Q

Do probiotics aid in prevention or tx of: atopic dx, allergic colitis, preventing infection?

A

No.

71
Q

What are risk of probiotics?

A
  • small risk of invasive infection if immunocompromised
72
Q

Which growth charts does CPS recommend?

A

WHO

73
Q

T or F: weight for length or % ideal body weight should be used for kids > 2 y.o.

A

False.

  • if < 2 y.o.
  • BMI may be more helpful screen if older
74
Q

Define obesity on growth charts?

A

If < 2 y.o.= wt for length > 99.9th % tile
If 2-5 y.o.= BMI > 99.9th % tile
If 5-19 y.o.= BMI > 97th percentile

75
Q

Define overweight on growth charts?

A

If < 2 y.o.= wt for length > 97th % tile
If 2-5 y.o.= BMI > 97th percentile
If 5-19 y.o.= BMI > 85th % tile

76
Q

Define severe stunting for growth charts?

A

Length for age (if < 2) < 0.1% tile
Ht for age if > 2

Versus stunting in general= < 3rd percentile

77
Q

Define severe underweight and underweight?

A

wt for age

Underweight: < 3rd % tile
Severe: < 0.1%

78
Q

List the benefits of BM in prem:

A
  • less severe infections
  • less NEC
  • reduced colonization with pathogenic organisms
  • decreased NICU length of stay
79
Q

What are barriers for a prem receiving mother’s own BF?

A
  • mother may not be able to supply (ill/stressed)

- baby transported away from mother’s hospital

80
Q

T or F: donor milk reduces motivation for mother to express own milk.

A

False

81
Q

What are the rules of donor milk banking?

A
  • adhere to Health Canada regulations
  • NO profit and supply NICU on cost-recovery basis
  • altruistic donations
  • rigorous screening (interview, serology, consent)
  • milk batched from different mother but Always pasteurized to inactivate bacterial and viral contaminants and then re-cultured to ensure safe
82
Q

T or F: Donor milk is excluded if meds, smoking, drinking.

A

True

83
Q

T or F: Donor milk is tested for Hep A, B, C, and HIV only.

A

False

  • Hep B
  • Hep C
  • HIV
  • Human T cell leukaemia virus
84
Q

What nutritional components are not altered via the donor milk process?

A
  • Carb
  • Fat
  • Salt
85
Q

What nutritional components are changed via donor milk process?

A
  • Protein (13% denatured)
  • Some vitamins denatured
  • Some immunologic decreased
86
Q

T or F: there is a higher risk of allergic reaction if used donor milk compared to formula?

A

False.

  • risk of allergic rxn not higher than formula
87
Q

T or F: Donor milk is preferred over own mother’s milk.

A

False.

  • Only offer when N/A or limited amount
88
Q

T or F: can give pasteurized human donor milk without consent.

A

False.

-Always need consent.

89
Q

T or F: milk banking is cost effective?

A

True.

  • reduce Dx severity, reduce resources
90
Q

T or F: CPS endorses sharing of unprocessed human milk?

A

False.

  • CPS does NOT endorse sharing of unprocessed milk

RC: CPS Woo Hoo (9 decks)

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