Paediatrics Flashcards
How often should you do anthropometric measures on a baby?
Weight:
- Once a month before 6 months
- Every 2 months 6-12 month
- Every 3 months >1 year
OFC:
- At birth and 8 weeks
- < 2 years
If concerns about growth then measure more frequently
What is STAMP?
Malnutrition screening tool for paediatrics.
Step 1:
Does the child have a diagnosis that has any nutritional implications?
Step 2:
What is the child’s nutritional intake?
Step 3:
Use a growth chart or the gentile quick reference tables to determine the child’s measurements.
Step 4:
Overall risk of malnutrition
Add scores together
Care plan:
- High risk –> take action, refer to dietitian, nutritional support team or consultant, monitor as per care plan.
- Medium risk –> monitor nutritional intake for 3 days and repeat STAMP
- Low risk –> continue routine clinical care, repeating STAMP screening weekly while patient is an inpatient.
What dietary observations would you make?
If breast fed
- How long for?
- How many feeds?
- Emptying?
- Wet nappies?
If bottle fed
- Bottle volume?
- How many feeds?
- Tolerating?
- Prepared correctly?
Weaning
- Age
- Foods, textures, timings, portions, quantity eating
- Child led?
- Messy play
- Fussiness?
General
- Diet recall
What clinical observations would you make?
Medical history
Current presenting complaint
Medication - any drug nutrient interactions
Physical examination/ sign of nutritional deficiency
GI symptoms - vomiting, diarrhoea, constipation?
Allergies
Bowels
Increased requirements - malabsorption, infection, requiring catch up growth
How should fluids be weaned?
Prior to 6 months
- Breastfed babies do not need any additional drinks
- Formula feeding aim for 500-600ml/day
From 6 months
- Continue to offer breast milk or formula
- Tap water can be introduced
From 12 months
- Cow’s milk can be introduced
- Fortified plant milks
- Fruit juice, squash
What are the fluid requirements children?
Premature –> 150-200ml/kg
0-6 months –> 150ml/kg
7-12 months –> 120ml/kg
12 months + (11-20kg) –> 100ml/kg for the first 10kg
+ 50ml/kg for the next 10
20kg + –> 100ml/kg for the first 10kg
+ 50ml/kg for the next 10
+ 25ml/kg thereafter
Max 2500ml/ day
What are some causes of faltering growth?
Organic
- Increased requirements
- Reduced absorption
- Reduced intake
- Increased losses
- Inability to use nutrients
- Cognitive anomalies
Non-organic
- Poverty
- Poor parenting
- Disrupted maternal-child relationship
- Inappropriate feeding
- Behavioural problems
How do you identify faltering growth?
- A fall across 1 or more weight gentiles if birth weight <9th
- A fall across 2 or more weight gentiles if birthweight 9-91st
- A fall across 3 or more weight gentiles if birthweight >91st
- When current weight is below the 2nd gentile for age, whatever the birthweight
What is the dietetic management of faltering growth?
- Breast milk fortifier
- Increase formula concentration
- Consider weaning
- Food fortification
- Consider high calorie formula
How should food refusal be managed?
- Eliminate organic cause e.g. reflux, constipation
- Consider sensory issues e.g. oral hypersensitivity, autism, dislike of messy hands
- Allow child autonomy with self-feeding
- No forcing, restraint or coercion
- Avoid attention for not eating
- Offer appropriate portions
- Introduce small bits of new food without coercion
What is the feeding advice for 1-5 year olds?
Deficiency risks?
Base meals on the eat well place
- regular meals, 1-3 snacks depending on age
- 5 portions of fruit and vegetables
- 3 portions of dairy products (reduce milk intake to 3 x 120ml/day) –> can prevent iron absorption and fill them up.
- offer variety, shape, texture and colour
- use age appropriate utensils
- encourage messiness –> food exploration
At risk deficiencies:
- Iron, vitamin D, calcium, zinc
What supplements should be recommended to children?
From birth
- Abidec multivitamin
From 3 years
- Multivitamin
All children should be on a supplement from birth however formula fed babies (400ml/day) will not require one. Minimum a vitamin D supplement. Mother should be also away of vet d and calcium, may need a supplement if breastfeeding.
What is the dietary advice for constipation?
- 6-8 drinks per day –> more in hot whether or if taking laxative)
- Encourage regular meals and snacks
- Increase soluble fibre (vegetables, fruit, oats) & insoluble fibre (skins of fibre and vegetables, wholegrain).
- Encourage physical activity
- Consistent routine for developing regular toilet habits
- Give praise and encouragement
- Educate on importance of fibre, however too much can make the stool harder and more difficult to pass.
Laxatives such as movacol and laid does not count towards fluid intake.
What is the dietetic management of toddler diarrhoea?
Definition?
- Reduce refined sugars, sweeteners and fruit juice in the diet (especially pure apple juice due to fermentation process).
- Reduce fibre intake if child having lots of wholegrain, fruit and veg.
- Reduce fluid 5-8 cups per day
- Increasing fat to healthy level through dairy if very low fat diet.
Two or more watery loose bowel movements per day, paler, smellier stools with sometimes undigested vegetables.
Usually caused by an imbalance of fluid, fibre and undigested sugar –> excessive fluid passed out in loose stools.
What are some reasons why a child may be enteral fed?
Inability to suck/ swallow:
- Neurological/ degenerative disorders
- Developmental delay
- Trauma
- Critically ill child - ventilated
Increased requirements:
- Cystic fibrosis
- Severe burns
- Malabsorption syndromes
- Congenital heart disease
Anorexia associated with chronic disease:
- Cystic fibrosis
- IBD
- Malignancy
- CKD
- Liver disease
- Metabolic disorders
Congenital abnormalities:
- Tracheo-oesophageal fistula
- Orofacial malformations
Primary disease management:
- Crohn’s disease
- Short bowel syndrome
- Glycogen storage disease
- Severe gastro-oesophageal reflux
- Very long chain fatty acid disorders
Refusal to eat:
- Anorexia nervosa
- ARFID
