Nutrition and GI Flashcards
Thyroxine needs to be check in which infants on soy formula?
Congenital hypothyroidism.
Harm for soy-based formula in which 2 populations?
- Premature (not adequate for growth)
- Congenital hypothyroidism (can cause abN function)
+/- non-IgE CMPA (due to high rate of coincident soy allergies)
Best choice for newborn baby feed?
Breast feed
T or F: soy based formula support normal growth + nutrition for 1st year of life
True UNLESS PREM
CMPA formula recommendation
Protein Hydrolysate
Types of Fats
- Saturated= double bone btw carbon replaced by H
- Unsaturated= min. 1 double bonds between two atoms of carbon
- > Cis vs. Trans based on arrangement of carbon across double bones
T or F: there is a safe level of dietary trans level
FALSE.
Trans= negative health effects.
Infantile Colic Criteria (Rome 3)
- infant < 4 mo.
- paroxysmal irritable/ fussy/ crying w/out clear cause
- episode last min. 3h + 3d/week x 1 wk
- no FTT
Should you change diet if colic?
- IF severe and CMPA concern empiric time limited (max 2 wk) hypoallergenic diet
- otherwise small # infants actually reduce symptoms
T or F: soy based form should be used to reduce colic
False.
Soy only if galactossemia or can’t take dairy.
T or F: lactose-free helps colic
FALSE.
Congenital lactase deficiency are.
T or F: pro/pre biotics help colic.
FALSE. Insufficient evidence for conclusion.
DDX for FTT may include=
- Nutrition (intake, ED)
- Energy Loss (emesis, pancreatic dx, liver dx, RTA)
- Energy Needs up (chronic condition, CHF, tumour)
- Endo problem/Other (low thyroid, GH deficiency)
Basic W/U for FTT may include:
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
Adequate Caloric Needs Calc=
calorie for age (cal/kg/day) x ideal wt for ht (kg) / actual wt (kg)
When do you use appetite stimulants in FTT
After expert R/A and refractory cases.
First steps in toddler FTT
- Verify accuracy
- Plot on growth curve
- Calc. mid-parental ht
- Hx + P/E
- Caloric intake using food diary
- Basic W/U
- Optimize oral caloric intake
How much wt and ht do you gain from 2-5 y.o.?
1-2 kg/year
6-8 cm/year
How do you manage unrealistic expectations for picky eaters
- Reassure (decreased appetite normal in this age)
- Parents choose nutritious food and structure and child decide how much
- Small portion to start
- Snacks best mid-day
- Enjoyable time
- Limit table 20 min
- Ensure not tired or overstimulated
- No distractions
- No discipline then
- Eat together
- No indication for IV, formula, stimulants.
What is the BFI (Baby Friendly Initiative)?
operational traget for hospital to get child-feeding ideal. get designation when follow all 1- steps x min. 80% of all F.
List any steps in BFI (Baby Friendly Initiative)?
- 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
Dx Contraindications to BF
- HIV (+) mother (even if ART)
- Herpes lesion on both BF
- Untreated Infectious TB (within first 2 wk of tx)
- Cytotoxic chemo
- Radioactive isotopes or radiation therapy.
- Classic galactossemia
No contraindication if…. Hep B, Hep C
T or F: you should stop BF for physiologic or milk jaundice
FALSE
T or F: should not BF if PKU
FALSE. Now encourage BF w/ supplement low-phenyl formula w/ strict monitoring for phenylalanine levels.
Key to Birth-6 mon. Nutrition
- BF exclusive x 6 mo.
- All BF= Vit D 400 IU
- First complementary = Fe rich (meat, Fe cereals)
- Monitor growth
T or F: colic typically resolve by 4 mon.
TRUE
6-24 months Nutrition Recommendations
- Support BF up to 2 y.o. +
- If not, start 3.25% pasteurized homo milk 9-12 mon. (max 20 ounces)
- Skim milk after 2 y.o.
- Vit D 400 IU if BF
- Fe rich food few times/d
- Responsive feeding key
- 12 mon= reg snacks + meals
- Ensure food prep, cook, stored well
T or F: New fluids best via bottle if after 6 month age
FALSE.
Best through soppy cup.
Name things that support mothers BF after returning to work.
- Child care nearby
- Breast pump
- Flexible schedule
- Supportive fam
How often and frequent should you introduce new foods to BB?
- avoid > 1 new/d
- wait 2 d before another common allergen
If no egg or milk in infant diet, watch:
- Ca
- Zinc
- Fe
- Vit D
- Vit B12
True or False: Fluoride reduces dental caries
True
Fluoride decreases enamel solubility via
1) Inhibition of Plaque
2) Inhibition of De-mineralization
3) Enhanced Re-mineralizatio of enamel
What is dental fluorosis?
- abnormal enamel development from ++ ingested fluoride
- occurs ~0.7 ppm
- usually no symptoms
- if P/E (+)= pitting teeth, ‘snow capped case’, chalking teeth
How do cities know to add fluoride to natural water?
Natural Fluoride concentration < 0.3 ppm
how much toothpaste to use?
pea size portion
When do you give supplemental fluoride?
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)
How much fluoride do you supplement for kids 0-6 months?
NONE.
No matter what the fluoride concentration is in envirn’t
When you need topical fluoride?
Once teeth have erupted
What are sports drinks?
- Flavoured beverage w/ sugars + lytes + vitamins
What proportion of high schools studies caffeinated energy drinks consume caffeinated energy drinks?
> 50%
What are caffeine side effects
- tachy HR
- HTN
- fast speech
- increased motor activity
- delayed gastric emptying
- diuresis
- hot
T or F: People who mix energy drinks w/ alcohol drink less alcohol than general.
False.
T or F: Health Canada prohibits the use of caffeinated energy drinks as ingredient in premixed alcohol beverages.
True.
Caffeine Recommended Max Daily Intake for ages.
- 4-6: 45 mg/d
- 7-9: 62.5 mg/d
- 10-12: 85 mg/d
- 13 y.o. +: 2.5 mg/kg/day
What should paediatricians do re: caffeinated energy drinks?
- 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)
Which population have higher risk of caffeinated energy drinks?
- CVS
- Renal
- Liver dx
- Sz
- DM
- Mood, ADHD dx
What is oral rehydration therapy?
Glucose + electrolytes
Recommended WHO osmolarity of ORT?
245 mosm/L
What do you give if no dehydration present?
Regular age-appropriate diet.
What % is mild dehydration?
<5%
What % is moderate dehydration?
5-10%
What % is severe dehydration?
> 10%
How do you treat mild dehydration? (<5%)
Rehydrate w/ ORS (50mL/kg) over 4 hour
Replace ongoing losses
Age appropriate diet after rehydration.
How do you treat mod-dehydration? (5-10%)
Rehydrate ORS 100mL/kg over 4 hour
Replace ongoing losses
age appropriate diet after dehydration
How do you treat severe dehydration (>10%)
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.
Which general clinical parameters do you look at for dehydration assessment?
- VS: HR, BP (low= late), LOC, U/O
- AF
- sunken eyes
- MM
- Thirst
- Skin turgor
What level of dehydration is this: ++ HR, low or absent U/O, great thirst, very dry MM, decreased turgor?
Severe
Describe mild dehydration?
- Slight elevated HR
- Slightly decreased U/O
- slightly dry MM
- slightly increased thirst
- no skin turgor
T or F: ORT is as effective as IV for mild-moderately dehydrated child?
TRUE
- as effective IF not better
T or F: ORT is as effective as IV for severe dehydration?
FALSE
- want to use IV
List the ORS contraindications
- severe dehydration
- impaired LOC
- protracted vomiting despite small f feeds
- paralytic ileus
- monosaccharide malabsorption
T or F: you should stop diet when sick?
False- continue age appropriate diet (including BF, no need for lactose-free formula etc.)
T or F: it is safe to give plain water for acute gastro.
False
- low Na and low glucose
What are probiotics?
live micro-organisms; non pathogenic
what are probiotics?
non-viable food components
i.e. fructo-and galacto-oligosaccharides
What does baby gut flora look like adults?
once solid food introduced
- colonization in general starts immediately after birth
How do intestinal bacteria contribute to gut function?
- compete with pathogenic bacteria
- increase mucus secretion
- decrease gut permeability
- modulate immune function
When should you consider recommending probiotics?
- Prevent NEC if > 1 kg
- Prevent Abx-associated diarrhea
- Shorten viral diarrhea
- Decrease symptoms of colic
- Decrease symptoms of IBS
Do probiotics aid in prevention or tx of: atopic dx, allergic colitis, preventing infection?
No.
What are risk of probiotics?
- small risk of invasive infection if immunocompromised
Which growth charts does CPS recommend?
WHO
T or F: weight for length or % ideal body weight should be used for kids > 2 y.o.
False.
- if < 2 y.o.
- BMI may be more helpful screen if older
Define obesity on growth charts?
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
Define overweight on growth charts?
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
Define severe stunting for growth charts?
Length for age (if < 2) < 0.1% tile
Ht for age if > 2
Versus stunting in general= < 3rd percentile
Define severe underweight and underweight?
wt for age
Underweight: < 3rd % tile
Severe: < 0.1%
List the benefits of BM in prem:
- less severe infections
- less NEC
- reduced colonization with pathogenic organisms
- decreased NICU length of stay
What are barriers for a prem receiving mother’s own BF?
- mother may not be able to supply (ill/stressed)
- baby transported away from mother’s hospital
T or F: donor milk reduces motivation for mother to express own milk.
False
What are the rules of donor milk banking?
- 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
T or F: Donor milk is excluded if meds, smoking, drinking.
True
T or F: Donor milk is tested for Hep A, B, C, and HIV only.
False
- Hep B
- Hep C
- HIV
- Human T cell leukaemia virus
What nutritional components are not altered via the donor milk process?
- Carb
- Fat
- Salt
What nutritional components are changed via donor milk process?
- Protein (13% denatured)
- Some vitamins denatured
- Some immunologic decreased
T or F: there is a higher risk of allergic reaction if used donor milk compared to formula?
False.
- risk of allergic rxn not higher than formula
T or F: Donor milk is preferred over own mother’s milk.
False.
- Only offer when N/A or limited amount
T or F: can give pasteurized human donor milk without consent.
False.
-Always need consent.
T or F: milk banking is cost effective?
True.
- reduce Dx severity, reduce resources
T or F: CPS endorses sharing of unprocessed human milk?
False.
- CPS does NOT endorse sharing of unprocessed milk
