Nutrition for Pediatrics Flashcards
When should peanuts be introduced to infants with severe eczema to help prevent food allergies?
A) At 2 months of age
B) At 4-6 months of age
C) At 6 months of age
D) After the first year of life
B) Correct: Infants with severe eczema should be introduced to peanuts between 4-6 months to reduce the risk of peanut allergies, as per guidelines from Food Allergy Canada.
A) Incorrect: Introducing peanuts at 2 months is too early and not supported by current research.
C) Incorrect: For infants with severe eczema, 6 months may be too late for optimal allergy prevention.
D) Incorrect: Delaying peanut introduction until after 1 year increases the risk of developing an allergy.
Difference between food allergy, food intolerance and food sensitivity
Which statement is true regarding the differences between allergy, intolerance, and sensitivity?
A) Allergy involves antibodies and causes severe or life-threatening reactions.
B) Intolerance involves an immune response to food and causes mild symptoms.
C) Sensitivity is unrelated to the immune system and only causes digestive issues.
D) Allergies and intolerances are interchangeable terms.
A) Correct: Allergies involve the immune system producing antibodies (e.g., in Celiac disease the body builds antibodies IgE to gliadin), which can cause severe or life-threatening reactions, anaphylaxis, swelling of lips, eyes, face, Vomitting, Widespread body hives.
- Breathing issues: repetitive cough, wheezing, any difficulty breathing.
- Change in skin colour: pale or blue
Sudden fatigue, lethargy and seeming limp
- Behavioural changes: crying, irritability, clingy
Timeframe of allergic reactions: can occur in minutes or hours after
B) Incorrect: Intolerance does not involve an immune response; it is usually due to an inability to digest certain foods. Which cause uncomfortable symptoms Ex: Lactose intolerance: diarrhea, flatulence etc
Timeframe of intolerance symptoms: Lactose intolerance: Symptoms such as bloating, gas, and diarrhea often occur within 30 minutes to 2 hours after consuming lactose-containing foods.
Other intolerances (e.g., gluten, food additives): Reactions can take longer and may appear the next day or even 48 hours later, depending on how the food is digested and metabolized.
C) Incorrect: Sensitivity involves an immune response but is less severe and more variable in symptoms than allergies.
- Gastrointestinal symptoms: Bloating, gas, diarrhea, constipation, nausea, or abdominal pain
- Skin symptoms: Eczema, rashes, or acne-like breakouts
- Neurological symptoms: Headaches or migraines, brain fog, fatigue
- Mood changes: Irritability, anxiety, or depression-like symptoms
- Respiratory symptoms: Congestion, sinus pressure, or postnasal drip
Redness around the mouth is a local sensitivity
D) Incorrect: Allergies and intolerances are distinct, with different mechanisms and symptoms.
Allergenic Foods and Early Exposure
Common Food Allergens in children
Peanuts and tree nuts
Severe eczema: peanut intro at 4-6 months
Less severe eczema: peanut intro at 6 months
Eggs
Shellfish
Cow’s Milk/Soy
Wheat
Sesame
Current research: Food Allergy Canada, ”Eat early, eat often”; to prevent sensitization and maintain tolerance
Giving allergenic foods is safe because a severe first reaction is rare.
Why can’t allergenic foods be introduced earlier?
There are two key reasons why allergenic foods should not be introduced before 4 months:
Developmental Readiness:
Before 4 months, most infants are not developmentally ready for solid foods. They lack the oral-motor skills to safely swallow solids, which increases the risk of choking.
The digestive system is still maturing, and introducing solid foods too early can stress the gut, leading to poor digestion or absorption of nutrients.
Immune System Maturity:
The infant immune system undergoes significant development in the first few months of life. Introducing allergenic foods too early, before the immune system is ready, may not effectively promote tolerance and could theoretically increase the risk of an adverse reaction.
Why are elimination and challenge diets not recommended in cases of severe allergic reactions?
A) They take too long to diagnose allergies.
B) The symptoms may not improve during elimination.
C) Severe allergic reactions can be life-threatening upon reintroduction of the food.
D) They are only effective for intolerances, not allergies.
C) Correct: Severe allergies can lead to life-threatening reactions (e.g., anaphylaxis) upon food reintroduction, making elimination and challenge diets unsafe in these cases.
A) Incorrect: Elimination and challenge diets can still be used to diagnose milder reactions but are not suitable for severe allergies.
B) Incorrect: While symptoms may not always improve immediately, this is not the primary reason for avoiding these diets in severe allergies.
D) Incorrect: Elimination diets can help diagnose allergies, sensitivities, or intolerances, but severe allergies require other diagnostic methods (e.g., skin prick testing).
Why introducing foods between 4–6 months decreases sensitivity:
Immune system training: At 4–6 months, the immune system is still developing and more likely to learn that certain proteins (e.g., peanuts, eggs) are harmless. Early exposure trains the immune system to tolerate these foods, reducing the risk of an overreaction in the future.
Gut maturation: By this age, the gut is maturing and better able to process allergenic proteins without triggering an immune response. The “leakiness” of the immature gut lining decreases, which lowers the risk of sensitization to food particles.
Practical evidence: Infants introduced to allergenic foods during this window (e.g., peanuts, eggs, or cow’s milk) are less likely to develop allergies, as demonstrated in multiple studies, including LEAP and EAT (Enquiring About Tolerance).
What if foods are introduced earlier (before 4 months)?
Not recommended: Introducing allergenic foods too early (e.g., before 4 months) is not advised because:
The infant is not developmentally ready for solids (risk of choking).
The immune and digestive systems may still be too immature to properly process allergenic proteins, potentially leading to adverse reactions or sensitization instead of tolerance.
In summary:
4–6 months: Optimal window for introducing allergenic foods to promote tolerance and reduce allergy risk.
After 6 months: Increased risk of sensitization and allergy development, particularly for high-risk infants.
Before 4 months: Not safe or effective due to developmental and physiological immaturity.
Why is Vitamin K administered to newborns shortly after birth?
a) To boost the immune system.
b) To prevent bleeding disorders caused by Vitamin K deficiency.
c) To enhance brain development.
d) To support lung maturation.
✅ Correct answer: b) To prevent bleeding disorders caused by Vitamin K deficiency.
Newborns have low levels of Vitamin K, which is needed for blood clotting. Prophylaxis prevents Vitamin K Deficiency Bleeding (VKDB).
❌ Wrong choices:
a) Vitamin K is not an immune booster.
c) Brain development relies on nutrition, oxygenation, and genetics, not Vitamin K.
d) Lung maturation is supported by surfactant, not Vitamin K.
When should Vitamin K be administered to newborns?
a) Within 6 hours of birth.
b) Within the first week of life.
c) Only if the newborn shows signs of bleeding.
d) At the 2-week check-up.
✅ Correct answer: a) Within 6 hours of birth.
Vitamin K prophylaxis is most effective when given early to prevent early-onset VKDB.
❌ Wrong choices:
b) Waiting a full week increases the risk of VKDB.
c) VKDB is best prevented, not treated after bleeding begins.
d) Delayed administration is ineffective against early and classic VKDB.
Rationale for Vitamin K Prophylaxis
* Vitamin K is essential for blood clotting.
* Newborns are born with low levels of Vitamin K.
* Prophylaxis significantly reduces the incidence of VKDB.
* Vitamin K Deficiency Bleeding (VKDB) can have severe consequences.
Administer within 6 hours post-birth.
What is the most dangerous type of Vitamin K Deficiency Bleeding (VKDB)?
a) Early VKDB (0-24 hours)
b) Classic VKDB (1-7 days)
c) Late VKDB (2-12 weeks)
d) None—VKDB is not a serious condition.
✅ Correct answer: c) Late VKDB (2-12 weeks)
Late VKDB is the most dangerous form, as it often causes severe internal bleeding, particularly in the brain.
❌ Wrong choices:
a, b) Early and classic VKDB are serious but less deadly than late VKDB.
d) VKDB can cause neurological damage or death.
Risks of Vitamin K Deficiency Bleeding (VKDB)
* Types of VKDB:
* Early VKDB: 0-24 hours after birth.
* Classic VKDB: 1-7 days after birth.
* Late VKDB: 2-12 weeks after birth (most dangerous).
* Complications:
* Severe internal bleeding (brain, intestines, skin).
* Can cause long-term neurological damage or death.
Incidence of Late VKDB in Canada
* Key Statistics:
* The incidence of late VKDB after oral or IM vitamin K administration in Canada remains unknown.
* Estimated incidence: 1 per 140,000 to 170,000 births (CPSP).
* Newborns without prophylaxis are 81 times more likely to
develop late-onset VKDB.
Why are these dates what they are?
Early VKDB (0-24 hours)
Occurs very soon after birth and is usually seen in infants whose mothers took medications that interfere with vitamin K (e.g., anticonvulsants, antibiotics, warfarin).
This happens because maternal vitamin K does not cross the placenta efficiently, and newborns are born with low stores.
Classic VKDB (1-7 days)
Peaks at days 2-3, when newborns’ natural vitamin K levels are lowest.
Affects breastfed infants more since breast milk contains low vitamin K compared to formula.
Bleeding usually occurs in the gastrointestinal tract, skin, or surgical sites (e.g., after circumcision).
Late VKDB (2-12 weeks) – The most dangerous
This form is most severe and unpredictable because:
It often causes brain bleeds (intracranial hemorrhage), leading to death or permanent disability.
It occurs suddenly in seemingly healthy infants.
Seen almost exclusively in breastfed infants who did not receive vitamin K prophylaxis.
The liver’s ability to make vitamin K-dependent clotting factors (II, VII, IX, X) is still immature in this period.
Newborn gut bacteria, which eventually help synthesize vitamin K, are not well-established yet—so the baby relies entirely on external vitamin K sources.
Why is Late VKDB the most dangerous?
Location of bleeding: Late VKDB is most likely to cause brain bleeds, which can lead to:
Seizures
Permanent brain damage
Coma or death
Higher mortality rate: Late VKDB has a worse prognosis than early or classic VKDB.
Difficult to detect early: Symptoms may not be obvious until severe bleeding has already occurred.
Poor response to treatment: Once brain bleeding starts, treatment may not fully reverse the damage.
What is the preferred method of Vitamin K administration in newborns?
a) Intramuscular (IM) injection.
b) Oral Vitamin K1.
c) IV administration.
d) No routine administration is needed.
✅ Correct answer: a) Intramuscular (IM) injection.
IM Vitamin K is the most effective at preventing all types of VKDB.
❌ Wrong choices:
b) Oral Vitamin K requires multiple doses and is less effective against late VKDB.
c) IV administration is not routinely used.
d) Not giving Vitamin K increases VKDB risk by 81 times.
Why is oral Vitamin K less effective than IM Vitamin K?
a) It is not absorbed as well.
b) It requires multiple doses.
c) It does not prevent late VKDB as effectively.
d) All of the above.
✅ Correct answer: d) All of the above.
Oral Vitamin K requires multiple doses, has lower absorption, and is less effective at preventing late VKDB.
❌ Wrong choices:
a, b, c) Each statement is true but only part of the full explanation.
What is the estimated incidence of late VKDB in newborns without Vitamin K prophylaxis?
a) 1 in 100,000 births.
b) 1 in 140,000 to 170,000 births.
c) 1 in 10,000 births.
d) 1 in 1,000 births.
✅ Correct answer: b) 1 in 140,000 to 170,000 births.
This is the estimated incidence in Canada when prophylaxis is used.
❌ Wrong choices:
a, c, d) These numbers do not match the estimated Canadian incidence.
What should healthcare providers emphasize when educating parents about Vitamin K prophylaxis?
a) The importance of preventing VKDB.
b) The differences between IM and oral Vitamin K.
c) The risks of refusing Vitamin K.
d) All of the above.
✅ Correct answer: d) All of the above.
Parents must understand why Vitamin K is crucial, how IM is more effective than oral, and the severe risks of VKDB.
❌ Wrong choices:
a, b, c) These are correct but incomplete answers.
Vitamin K Administration Options
* Intramuscular (IM) Injection (Preferred Method)
* Single dose at birth.
* Highly effective in preventing all forms of VKDB.
* Oral Vitamin K1 (Alternative)
* Less effective, particularly for late VKDB.
* Requires multiple doses for efficacy:
* Initial dose at birth.
* Follow-up doses at 1 week and 4-6 weeks.
Which newborn requires 800 IU/day of vitamin D supplementation?
a. A formula-fed infant living in a tropical climate.
b. A breastfed infant living in a region above 55° latitude during winter months.
c. A term infant who is bottle-fed in a southern region.
d. A newborn exclusively breastfed in a warm climate.
Correct Answer: (b) A breastfed infant living in a region above 55° latitude during winter months.
✅ Explanation: Infants in northern regions (above 55° latitude) require 800 IU/day from October to April due to low sun exposure.
❌ (a) Incorrect: Formula-fed infants receive vitamin D through formula and need only 400 IU/day.
❌ (c) Incorrect: Bottle-fed infants typically require less supplementation.
❌ (d) Incorrect: Warm climates provide more sun exposure, reducing the need for 800 IU/day.
Which of the following indicates a newborn is feeding effectively?
a. The baby is alert and satisfied after feeding.
b. The baby feeds only 3-4 times per day.
c. The baby has fewer than 3 wet diapers per day.
d. The baby is losing weight consistently after the first week.
Which of the following requires intervention in a newborn’s weight pattern?
a. A 5% weight loss in the first 4 days.
b. Regaining birth weight by 12 days.
c. A 12% weight loss in the first week.
d. Gaining 20g/day after the first week.
Correct Answer: (c) A 12% weight loss in the first week.
✅ Explanation: Weight loss >10% in the first week requires a feeding assessment to prevent dehydration or inadequate nutrition.
❌ (a) Incorrect: A 5% weight loss is normal in the first few days.
❌ (b) Incorrect: Birth weight should be regained by 10-14 days, so 12 days is acceptable.
❌ (d) Incorrect: 20g/day weight gain is normal after the first week.
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Normal weight loss (≤10%): Newborns naturally lose fluid after birth due to the transition from placental nutrition to independent feeding.
Excessive weight loss (>10%):
Inadequate breastfeeding: Poor latch, low milk supply, or infrequent feeds lead to insufficient calorie intake.
Dehydration: Not getting enough fluids results in reduced urine output and weight loss.
Medical conditions: Jaundice, infection, or metabolic issues can impair feeding and weight gain.
Feeding frequency:
Breastfed infants: 8-12 feeds per day (every 2-3 hours)
Formula-fed infants: May feed slightly less frequently (every 3-4 hours)
Wet diapers (hydration indicator):
First few days: At least 1 wet diaper per day per day of life (e.g., Day 1 = 1 wet diaper, Day 2 = 2 wet diapers, etc.).
After Day 4: 6-8 wet diapers per day indicates good hydration.
Weight gain:
Initial weight loss: Up to 10% loss in the first 4-5 days is normal.
Regaining birth weight: Should happen by 10-14 days.
Post-first week weight gain: ~20-30g/day is expected.
Which nutrient is most likely to require supplementation in a breastfed infant following a vegan diet?
a) Iron
b) Vitamin B12
c) Vitamin C
d) Omega-6 fatty acids
b) Vitamin B12 ✅ – Vitamin B12 is almost exclusively found in animal products, making supplementation essential for vegan infants.
a) Iron ❌ – While iron from plant sources has lower bioavailability, iron deficiency can often be managed through dietary sources like fortified cereals.
c) Vitamin C ❌ – Vitamin C is widely available in plant foods and is not a common deficiency in vegan diets.
d) Omega-6 fatty acids ❌ – Omega-6 fatty acids are readily available in plant-based diets from sources like nuts, seeds, and vegetable oils.
Why might plant-based iron sources be less effective than animal-based sources for a breastfed infant?
a) Plant-based iron is only absorbed when paired with dairy products
b) Non-heme iron from plants has lower bioavailability
c) Babies cannot digest plant-based iron until 6 months
d) Breast milk contains enough iron to last through infancy
b) Non-heme iron from plants has lower bioavailability ✅ – Non-heme iron (found in plant foods) is less efficiently absorbed than heme iron (from animal products).
a) Plant-based iron is only absorbed when paired with dairy products ❌ – Dairy products can actually inhibit iron absorption due to calcium interference.
c) Babies cannot digest plant-based iron until 6 months ❌ – Infants can absorb plant-based iron, but absorption efficiency is lower than heme iron.
d) Breast milk contains enough iron to last through infancy ❌ – Breast milk has limited iron, and infants need additional dietary sources after 4-6 months.
Which of the following nipple types is considered ideal for breastfeeding?
A) Inverted
B) Flat
C) Everted
D) Cracked
Answer: C) Everted
Correct: Everted nipples protrude outward, making it easier for the baby to latch properly.
Incorrect:
A) Inverted nipples may pose challenges for latching and require interventions.
B) Flat nipples may need stimulation or tools like nipple shields to facilitate breastfeeding.
D) Cracked nipples indicate trauma, which can be painful and hinder breastfeeding.
A mother presents with a history of breast augmentation. What should the provider assess for regarding breastfeeding success?
A) Risk of decreased milk production
B) Higher likelihood of exclusive breastfeeding
C) Presence of mastitis
D) Increased production of foremilk
Answer: A) Risk of decreased milk production
Correct: Breast surgery (augmentation or reduction) may affect milk ducts and glandular tissue, impacting milk supply.
Incorrect:
B) Surgery does not increase the likelihood of exclusive breastfeeding.
C) While mastitis can occur, it is not specifically related to breast augmentation.
D) Foremilk production is not directly affected by breast surgery.
Which of the following is a sign of successful breastfeeding?
A) Audible swallowing
B) Nipple pain throughout the feed
C) Rapid shallow sucking without swallowing
D) Frequent crying immediately after feeding
Correct Answer: A) Audible swallowing
Explanation:
A) Audible swallowing → Correct. This indicates effective milk transfer.
B) Nipple pain throughout the feed → Incorrect. Persistent nipple pain suggests a poor latch.
C) Rapid shallow sucking without swallowing → Incorrect. This suggests ineffective feeding.
D) Frequent crying immediately after feeding → Incorrect. This suggests inadequate milk intake.
Which of the following is not a standard nutritional intervention for preterm infants?
A) Fortified breast milk
B) Iron supplementation
C) High-fat formula
D) Delayed feeding until 1 month of age
Answer: D) Delayed feeding until 1 month of age ✅ (Correct—Delayed feeding increases risk of NEC and is not recommended).
A) Incorrect: Fortified breast milk is standard to meet higher nutrient needs.
B) Incorrect: Iron supplementation prevents anemia.
C) Incorrect: Preterm formulas contain medium-chain triglycerides for extra energy.
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Long-Term Nutritional Management
* Breast Milk + Fortification: Increases protein, caloric density, and
minerals.
* Preterm Formula: Higher protein, medium-chain triglycerides,
increased calcium/phosphorus.
* Transition to 22 kcal/oz Formula at term until 6-9 months.
* Iron Supplementation: 2-4 mg/kg/day from 2 weeks to 2 months.
* Erythropoietin Therapy (EPO): Requires higher iron dosing (4-6
mg/kg/day).
