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Paeds > obesity and poor growth > Flashcards

obesity and poor growth Flashcards

1
Q

how do you assess BMI

A 
in children >2yrs 
wt/ht2
children 2-18
overweight >85th 
obese >95th 
<2yrs 
obese >97th with rapid growth
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2
Q

what are the 3 main causes of obesity

A

nutritional
endocrine
syndromic

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3
Q

what are the clues to simple obesity

A

family hx
tall stature as well
normal bone age
early puberty

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4
Q

what are the endocrine causes of obesity

A

rare
hypothyroidism
cushings

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5
Q

what are the clues to endocrine cause of obesity

A

short stature

endocrine sx and signs

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6
Q

what syndromes are associated with obesity

A

Prada Willi

Downs

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7
Q

what are the clues to a syndromic cause of obesity

A 
short stature 
obese from birth 
dysmorphic features 
hypogonadism 
delayed puberty
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8
Q

what are the consequences of obesity

A 
psychological 
- poor self esteem 
- eating disorder 
- depression 
resp 
- asthma 
- OSA
CVS
- HTN 
- dyslipidemia 
- metabolic syndrome 
GIT 
- NAFLD
- cholelithiasis 
endocrine 
- diabetes
- PCOS
- IGT
MSK 
- SUFE
- OA
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9
Q

what ix should be undertaken for obesity

A 
not always if cause known e.g. simple 
consequences:
- FBC
- UEC
- LFT 
- urinalysis

cause:

  • TFT
  • urine free cortisol
  • chromosome analysis
  • MRI brain
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10
Q

management of obesity

A
  • monitor growth charts
  • increase physical activity 60min/day
  • decrease screen time <60min/day
  • healthy eating (2 fruit and 5 veg)
  • make it a whole family experience
  • focus on advantages of healthy lifestyle
  • aim for maintenance of wt not loss unless significant comorbidities
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11
Q

what is the definition of FTT

A
  1. <2nd centile for weight
  2. crosses 2 major centiles z
  3. <80th centile for ideal weight and <10th centile for wt/ht
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12
Q

what are the causes of poor growth/FTT

A
  1. inadequate intake/retention
    - poor provision of food
    - poor feeding e.g. structural (cleft palate) or difficulties (CP, turners, GDD
    - persistent vomiting (rumination, gord, pyloric stenosis, raised ICP)
  2. inadequate absorption
    - coeliac disease
    - CF
    - chronic diarrhoea
    - short bowel syndrome
  3. excessive caloric requirements
    - CF
    - CHD
    - chronic UTI
    - chronic illness
  4. psychosocial
    - attachment problems
    - substance abuse
    - parent MH
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13
Q

what are the red flags for poor wt gain

A
  • other signs of abuse/neglect
  • poor carer understanding -> disability
  • family vulnerability
  • poro attachment
  • MH issues
  • signs of dehydration/malnutrition
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14
Q

important hx points for FTT

A
  • nurtition (who feeds, diet settled after feeds, if formula how much and how often, what type, solids)
  • how much does the baby swallow with each feed
  • mealtime behaviours - are they a good experience or not. does the child sit down to eat
  • vomiting
  • BM
  • ROS
  • developmental hx
  • ob hx
  • pmhx
  • surghx
  • meds and allergies
  • famhx
  • psychological/social hx
  • other siblings - how is their growth
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15
Q

ex aspects that are important

A
  • happy active or unwell
  • hydration
  • muscle wasting
  • dysmorphism
  • pallor, jaundice
  • sx of child abuse
  • attachment
  • endocrine exam
  • observe feed
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16
Q

ix

A 
FBC
UEC
LFT
CMP 
iron studies 
TFT 
urine MCS
coeliac screen 
stool mcs + pcr
17
Q

when shoudl you admit a child with ftt

A

significant illness/dehydration
sx of child abuse or neglect
persistent poor growth despite intervention

18
Q

what amount of wt does a child lose post birth

A

5-10% at 1wk

19
Q

when will they be the same as BW

A

2-3wks

20
Q

when do they double wt

A

4mo

21
Q

when do they triple wt

A

girl 15mo

boy 13mo

22
Q

how much wt should a child gain

A

0-3mo 150-200g/wk
3-6mo 100-150g/wk
6-12mo 70-90g/wk

23
Q

how much milk should a child drink

A

6-8 feeds/day
breast 750-800mL/day 1-6mo

formula 150-200mL/kg/day until 3mo
120mL/kg/day until 6m0

Paeds (21 decks)

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