paeds - nutrition & growth Flashcards
growth definition
increase in size, composition and distribution of tissues
growth spurt definition
velocity: rate of change between measurements over time
Catch up growth definition
return to size attained if growth lag not occurred
correct age definition
adjustment for prematurity (1st yr)
Chronological age definition
years , months, days calculated
from the birth date
Bone age definition
osseous maturation level
Growth function of several factors
genetic, gender, nutritional, medical, psychosocial, endocrine
Standardized charts available to assess growth
- Weight for Age
- Height for Age
- Weight for Height
- BMI: body mass index
- MUAC: mid upper arm circumference
Other measurements: -Skull circumference -Triceps skinfold thickness
types of growth charts
- Z- scores
- Percentiles
- Height and weight have normal
(Gaussian) distribution curve (mean = median)
- Variation within normal range at a
given age
- Compares child’s measurement to standard z scores or centiles around the mean (z-score = 0 or 50th percentile)
growth charts - z scores
- Describe how far (in SD) a child’s weight is from the median weight of a child at the same age in the reference data.
- The Z-score scale is linear- a fixed interval of Z-scores has a fixed height difference in cm, or weight difference in kg, for that age
- Allows computation of statistics to classify population’s growth status
- Used for surveillance data
- BMI z-score charts: divide weight (kg) by height2 (m2) for 5 – 19 years
- below mean: <-2 (2.5%) ; <-1 (15%)
- above mean +1;2;3
wasting definition
- low weight for height
- Wasting or thinness indicates in most cases a recent and severe process of weight loss, which is often associated with acute starvation and/or severe disease. However, wasting may also be the result of a chronic condition.
stunting definition
- Low height-for-age
- Stunting growth reflects a process of failure to reach linear growth potential as a result of suboptimal health and/or nutritional conditions.
Absence of acute protein-energy malnutrition definition
- normal nutritional status
- defined as having a weight-for-height z- score of -2.0 or greater.
Moderate acute protein-energy malnutrition definition
a) weight-for-age between -3 and -2 z- scores and
b) can be due to a low weight-for-height (wasting) or a low height-for-age (stunting) or to a combination of both
Severe acute protein-energy malnutrition definition
a) weight-for-height z-score < -3.0 or severe wasting
b) and/or oedema
NB: Oedema: -automatically defined as severe PEM
Z score classification
+3 = BMI obese
+2 = BMI overweight
+1 = BMI risk of overweight
Lt/Ht for age:
-2 = mod stunted
-3 = severely stunted
Wt for age:
-2 = underweight
-3 = severely underweight
Wt for Lt/Ht
-2 = mod wasted
-3 = severely wasted
IMCI( Integrated Management of Childhood Illness) (with z score)
- WFA <-2 z-score: FU & referral after 1 mth
- WFA<-3 z-score: danger sign immediate referral
Nutrition: Breast Feeding
- Breast fed tend to grow more rapidly in first few months then slow down
- WHO& UNICEF
Exclusive brestfeeding for 6 mths
Complementary feeding from 6 mths with continued breast feeding up to 2 years : insufficient to meet nutritional requirements so other solids and liquids required
Promotion of BF
if not breastfed:
- 6-10x increased mortality in first months of life
- diarrhoea & pneumonia more common/ severe
artificially fed:
- immunological diseases: asthma, eczema, DM, IBD, coeliac
BF:
- HI meningitis, otitis media, UTI less common /severe
- Protection against obesity in later life
- Greater intelligence in late childhood
caloric intake
6-8 mths = 200kcal/day
9-11 mths = 300kcal/day
12-23 mths = 550kcal/day
Malnutrition definition
- Primary
Healthy individual’s need for protein, energy or both are
not met by an adequate diet - Secondary
Result of disease states that lead to suboptimal intake, inadequate nutrient absorption or use, and/or increased requirements because of nutrient losses or stress
failure to thrive (FTT)
Descriptive term, not a diagnosis
* Height or weight less than the third to fifth percentiles for age on more than one occasion
* Height or weight measurements falling 2 major percentile lines
Non Organic Causes of FTT
- Poor feeding or feeding-skills
- Difficult child or feeding disorders (eg, anorexia, bulimia)
- Child neglect; incompetent mother, ill mother, many children ; emotional deprivation syndrome
- Lack of support (e.g. no extended family) or lack of
preparation for parenting - Family dysfunction (e.g. divorce, spouse abuse, mother working, inadequate child minding, cultural beliefs and practices)
- Socioeconomic status: poverty, poor education, unemployment, migration, natural disasters, war, alcoholism, etc.
Organic Causes of FTT
- Inadequate intake
* Lack of appetite (eg, iron deficiency anemia, CNS pathology, chronic infection)
* Inability to suck or swallow: CNS or muscular
* Vomiting (eg, CNS, metabolic, obstruction, renal)
* Gastroesophageal reflux and esophagitis - Poor absorption and/or use of nutrients
* GI disorder (eg, CF, celiac disease, chronic diarrhoea)
* Renal: renal failure, renal tubular acidosis
* Endocrine: hypothyroidism, diabetes mellitus,
growth hormone deficiency
* Inborn error of metabolism
* Chronic infection (eg, HIV, tuberculosis, parasites) - Increased metabolic demand
* Hyperthyroidism
* Chronic disease (eg, heart failure, BPD)
* Chronic inflammatory conditions (eg, inflammatory bowel disease,
lupus erythematosus)
* Renal failure
* Malignancy - Prenatal causes
* Prematurity with complications
Maternal malnutrition/chronic illness
Toxic exposure in utero- alcohol, smoking, medications, infections
Chromosomal abnormalities
protein energy malnutrition types
- kwashiorkor (oedema)
- marasmus
kwashiorkor definition
- Insufficient intake of protein that is of inadequate biological value, and is often associated with deficient energy intake.
- Main dietary stable is CHB source e.g. maize, rice
- Age: 9 – 24 mths: “the disease of the deposed baby when the next one
is born”-weaning and post-weaning phases
kwashiorkor clinical features
HIS GOMME
- Growth failure, muscle wasting, oedema
- Skin lesions: hyper/hypopigmentation, ulceration, weeping dermatosis
- Hair changes: sparse, thin, red/grey discolouration
- Mouth : stomatitis, cheilosis
- Eyes : corneal ulcers
- Mental changes: apathy, irritability
- Other : anaemia, bleeding diathesis, hepatomegaly, purpura
- Infections: AGE, pneumonia / TB, UTI, sepsis
marasmus clinical features
hIs gUM
- Age: first year of life
- Loss of subcutaneous fat, dry, wrinkled skin
- Muscle wasting
- May present with infections:AGE, TB, UTI, sepsis
- NO oedema, hair, skin, or mental changes
- underweight:
- Underweight and undersize, while have normal weight for height ratios
- No specific physical stigmata
- Susceptible to infections e.g. GE, measles, TB
protein energy malnutrition prevention
clinical level:
G- growth monitoring
O- oral rehydration
B- breast feeding
I- immunizations
F- female education
F- fertility control
F- food supplementation
local authority/ national level:
- Promotion of adequate wage structures
- Production of food e.g. eggs.
- Food subsidies
- Health education
road to health booklet (RHB)
Tool for recording assessments, activities and interventions
- Personal health record of every child < 5yrs
- Recording and communication of a child’s health
- Issued at birth, freely, by the health service concerned
RHB benefits
- Main function: allow the sharing of accurate information, facilitating continuity of care
- Contains screening and diagnostic tools - Communication between health workers and
caregivers - Shares key health promotion messages with
caregivers - Data source for community based research
- Utilised by government departments e.g. home
affairs, to assist with delivery of services.
RHB additional factors
- Good nutrition to grow and be healthy = health promotion & counselling
- Love play and talk for healthy development
- Protection from preventable childhood diseases
- Health care for sick children
- Special care for children with other conditions (HIV, TB, disability, grants)
RHB additional factors - Good nutrition to grow and be healthy
- promote exclusive breastfeeding for the first 6 months of life
- Promote appropriate complementary feeding and adequate nutritional status
- Stimulation, play and communication advice for different age groups
- How to prepare Sugar-Salt Solution (SSS) – prevent dehydration in management of diarrhoea
