Nutrition/Malnutrition

Question 1

Adequacy of milk intake assessed how?

Answer 1

• voiding and stool
• voiding should be 6-8 X/d
• stools should be 4-5X/d by day 5 of life- yellow
• rate of weight gain- most accurate

Question 2

Higher bilirubinemia in newborn why? Relates to breastfeeding how?

Answer 2

• normal higher bili in newborn period
• more often in breast fed
• BUT higher feeding freq: lower bili conc. (stimulated meconium and excretion of bilirubin)
• 1st week of life: if milk frequency is enough- meconium passage and stimulation of GI tract, if milk frequency isn’t enough and there is poor weight gain- increased enterohepatic circ. because of glucoronidase in milk unconjugated bilirubin to be reabsorbed = breastfeeding jaundice
• 2nd-3rd week of life: factor in milk causes jaundice (incr. absorption) = breast milk jaundice … diagnosis of exclusion, exclude everything else first

Question 3

Formulas that exist and for what reasons?

Answer 3

• mother absent
• allergic to cow’s milk
• allergic cow/soy milk

Question 4

What kind of nutrition does milk provide (fat/calories/carbs)

Answer 4

High fat, carb and calorie dense

Question 5

Water intake should be daily?

Answer 5

<10kg 100ml per each 1kg of the b.w.

10kg-20kg 1000ml + 50ml per each 1kg of b.w. over 10kg

20kg-30kg 1500ml + 20ml per each 1kg of the b.w. over 20kg

Question 6

Other food introduction @ what age? What/when?

Answer 6

@around 6 months- add unsweetened juice, single grain non gluten like rice,barley,corn, 2-3 servings of veg, certain meats

@8months- eggs
@10months- gluten without restriction
11-12 months- dairy and honey

HYPERALLERGENIC babies- avoid nuts, eggs, fish,…

Question 7

Iron deficiency risk factors in toddlers/young children?

Answer 7

High milk consumption

Low leafy greens/meat consumption

Question 8

Undernutrition/malnutrition differential reasons in infant vs child/ado?

what is seen on examination, what type of growth problem?

Answer 8

Baby: IUGR, prematurity, perinatal stress are RF
Infant: breastfeeding problem, GERD, caregiver ineff., allergy, pyloric stenosis, inborn error metabolism, thyroid disease, CHD, malignancy,….

Child/Ado: mood/eating disorder, IBD/IBS, GERD, allergy, celiac, Inborn error of metabolism, thryoid, CHD, malignancy,….

Growth failure/ failure to gain weight
Linear growth/HC (severe)

Question 9

TYpes of malnutrition/FTT

Answer 9

Marasmus- not enough calories: patients have loss of muscle mass and SC fat, dry skin, thin hair, apathetic,lethargic, bradycardic and hypotensive

Kwashiorkor- not enough protein/normal caloric intake. Patients have pitting edema starting in LL and ascends + atrophy muscle mass, flag sign in hair (discoloration after normal nutrition), pellagroid (rash on trunk and extremities).

Question 10

Diagnosis of FTT? multiple ways..name 2

1 for babies 0-12m

Answer 10

• weight below 2nd%ile for gestation corrected age on more than one occasion
• a ratio of weight that decreases by 2 percentiles lines over time

-A rate of daily weight gain less than that expected for age (30g/d for 0-3m vs 8g/d for 1-3 yo)

Question 11

TT of malnutrition?

Refeeding syndrome?

If TT fails?

Answer 11

If severe, child at risk, deleterious patient/parent relationship, severe dehydration,…. hospitalise

Catch up intake- 50% greater than DIR(daily recommended - powedered sugar,peanut,vitamins,…
Infants- add formula/ increase concentration formula

Catch up-children- increase cereals, high caloric milk drinks, limit juice and psychosocial environment around eating is important!

Refeeding syndrome- sweatiness, hypokalemia, hepatomegaly, cardiac dysfunction,… MONITOR!!

TT fails- can do nasogastric feedings AND CONSIDER OTHER CAUSES LIKE MALABSORPTION, MALIGNANCY,…