paeds - nutrition & growth

Question 1

growth definition

Answer 1

increase in size, composition and distribution of tissues

Question 2

growth spurt definition

Answer 2

velocity: rate of change between measurements over time

Question 3

Catch up growth definition

Answer 3

return to size attained if growth lag not occurred

Question 4

correct age definition

Answer 4

adjustment for prematurity (1st yr)

Question 5

Chronological age definition

Answer 5

years , months, days calculated
from the birth date

Question 6

Bone age definition

Answer 6

osseous maturation level

Question 7

Growth function of several factors

Answer 7

genetic, gender, nutritional, medical, psychosocial, endocrine

Question 8

Standardized charts available to assess growth

Answer 8

• 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

Question 9

types of growth charts

Answer 9

1. Z- scores
2. 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)

Question 10

growth charts - z scores

Answer 10

• 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

Question 11

wasting definition

Answer 11

• 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.

Question 12

stunting definition

Answer 12

• 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.

Question 13

Absence of acute protein-energy malnutrition definition

Answer 13

• normal nutritional status
• defined as having a weight-for-height z- score of -2.0 or greater.

Question 13

Moderate acute protein-energy malnutrition definition

Answer 13

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

Question 14

Severe acute protein-energy malnutrition definition

Answer 14

a) weight-for-height z-score < -3.0 or severe wasting
b) and/or oedema
NB: Oedema: -automatically defined as severe PEM

Question 15

Z score classification

Answer 15

+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

Question 16

IMCI( Integrated Management of Childhood Illness) (with z score)

Answer 16

• WFA <-2 z-score: FU & referral after 1 mth
• WFA<-3 z-score: danger sign immediate referral

Question 17

Nutrition: Breast Feeding

Answer 17

• 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

Question 18

Promotion of BF

Answer 18

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

Question 19

caloric intake

Answer 19

6-8 mths = 200kcal/day
9-11 mths = 300kcal/day
12-23 mths = 550kcal/day

Question 20

Malnutrition definition

Answer 20

• 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

Question 21

failure to thrive (FTT)

Answer 21

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

Question 22

Non Organic Causes of FTT

Answer 22

• 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.

Question 23

Organic Causes of FTT

Answer 23

1. 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
2. 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)
3. Increased metabolic demand
   * Hyperthyroidism
   * Chronic disease (eg, heart failure, BPD)
   * Chronic inflammatory conditions (eg, inflammatory bowel disease,
   lupus erythematosus)
   * Renal failure
   * Malignancy
4. Prenatal causes
   * Prematurity with complications
   Maternal malnutrition/chronic illness
   Toxic exposure in utero- alcohol, smoking, medications, infections
   Chromosomal abnormalities

Question 24

protein energy malnutrition types

Answer 24

• kwashiorkor (oedema)
• marasmus

Question 25

kwashiorkor definition

Answer 25

• 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

Question 26

kwashiorkor clinical features

Answer 26

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

Question 27

marasmus clinical features

Answer 27

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

Question 28

protein energy malnutrition prevention

Answer 28

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

Question 28

road to health booklet (RHB)

Answer 28

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

Question 29

RHB benefits

Answer 29

• 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.

Question 30

RHB additional factors

Answer 30

• 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)

Question 31

RHB additional factors - Good nutrition to grow and be healthy

Answer 31

• 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