Pediatric First Aid: Nutrition Flashcards
What is the difference in caloric requirement between a newborn and 1 year old?
Newborn: 100-120 kcal/kg/day
1 yo: 75 kcal/kg/day
What is the growth rate of newborns in g/day?
30 g/day
When should solid foods be introduced into a child’s diet? (Mom is exclusively breast feeding)
at 4-6 months
Why is whole cow’s milk not suitable for infants?
has higher levels of sodium, potassium, and protein = increase renal solute load
When can cow’s milk be introduced into a child’s diet?
AFTER their 1st birthday (1 yo+)
What is the optimal protein requirement for term infants per day?
2.2 g/kg/day
Why should baby’s not be put to sleep with a bottle?
can increase the risk of dental caries
What is the predominant protein in breast milk?
Whey
Why is cow’s milk not recommended for children less than 1 year of age?
infants GI is not well-developed enough to digest and can lead to GI blood loss/iron deficiency due to allergy formation
What is the name for the first milk produced after birth?
What color is it?
Colostrum - deep lemon color
What is the importance of colostrum for the newborn?
helps clear bilirubin from the gut and help prevent jaundice
high in protein, minerals, immunologic factors, antimicrobial peptides
What 4 supplements do breast-fed infants require?
- Vitamin K - 1mg IM @ birth
- Vitamin D - 400 IU/day
- Fluoride - after 6 months
- Iron - 4-6 months
What are the 4 main benefits to breast-feeding for an infant?
- dec. infection risk
- inc. immunologic factors
- dec. exposure to enteropathogens
- dec. chronic disease
How do you break the suction of a breastfeeding infant that will not let go of mom’s nipple?
insert finger in corner of mouth; DON’T PULL
What 4 infections are absolute contraindications to breastfeeding?
- active, untreated Tuberculosis
- Cytomegalovirus (CMV)
- HIV
- Herpetic breast lesions
What is the difference between Breast-Feeding Jaundice and Breast Milk Jaundice?
BF = due to dec. milk production or poor milk intake
- dec. intake = minimal stooling
- INC. enterohepatic bilirubin circulation
BM = breast milk inhibits bilirubin conjugation
- prolonged unconjugated hyperbilirubinemia
- transient unless severe, no Tx necessary
What is the timing of Breast-Feeding Jaundice vs Breast Milk Jaundice?
Breast Feeding = DURING first week of life
Breast Milk = AFTER first week of life (peak weeks 2-3)
Are maternal hepatitis A/B/C transmitted through breast-feeding?
Not usually!
- infant should be immunized against Hep B though
How many wet diapers should a child have prior to one week of life and how many should they have after the first week?
Prior to 1st week: 1 wet diaper x age in days
- ex: 3 days old = 3 wet diapers
After 1st week: 6 wet diapers/day
What is the most common cause of Failure to Thrive?
inadequate caloric intake
What is the most common cause of mastitis and where does it typically come from?
Should breastfeeding continue if mother has active mastitis?
MCC = Staph Aureus, typically from oropharynx of asymptomatic INFANT
- continue feeding on affected breast
What kind of anemia would be seen in an infant receiving goat’s milk?
MEGALOBLASTIC anemia
Is it okay to give an infant < 6 months of age water or juice?
NO!
Water - fills them up
Juice - empty calories/excess sugar = diarrhea
How should new foods be introduced to the infant?
individually and about a week apart
- helps identify allergies and intolerances
What is the equation for manually measuring the percentage of dehydration a child has?
Pre-illness weight - illness weight / pre-illness weight x 100%
What is the PARCHED mnemonic for checking pediatric dehydration?
P - pee/pressure
A - anterior fontanelle
R - refill (capillary)
C - crying
H - heart rate
E - elasticity of skin
D - dryness of mucus membranes
How do you calculate maintenance intravenous fluids (IVF) using the Holliday-Segar method?
First 10 kg of weight = 100 mL/kg
Next 10 kg of weight = 50 mL/kg
Weight > 20 kg = 20mL/kg over 20 kg
Ex: 25kg patient = 1000 mL + 500 mL + 100 mL = 1600 mL/day or 65 mL/hr
How do you calculate maintenance IVF using the 4-2-1 rule for milliliters per hour?
First 10 kg of weight = 4 mL/kg
Next 10 kg of weight = 2 mL/kg
Weight > 20 kg = 1 mL/kg
Ex: 25kg patient = 40 mL + 20 mL + 5 mL = 65 mL/hr
What is the definition of hypotonic (hyponatremic) dehydration?
Serum Na < 130 mEq/L
Euvolemic Hyponatremia is commonly caused by what condition in pediatric patients?
SIADH - hospitalized children are at increased risk for nonphysiologic ADH secretion
How do you calculate the sodium deficit of a patient with hyponatremia?
(Na desired - Na observed) x body weight (kg) x 0.6
- do NOT exceed correction > 2 mEq/hr for chronic hyponatremia
How should sodium replacement be given and how can it be given if serum Na < 120 mEq/L?
give first half of deficit over 8 hours, then second half over the next 16 hours
- if serum Na < 120 + CNS symptoms, give 3% NaCl solution IV over 1 hour to raise serum Na above 120 mEq/L
What is the definition of hypertonic (hypernatremic) dehydration?
serum Na > 150 mEq/L
What is the rate of hypernatremia correction?
decrease by rate of 10-15 mEq/L/day
How are pH and serum potassium levels related?
for ever 0.1 reduction of serum pH there is an increase in serum potassium of 0.2-0.4 mEq/L
What are the definitions of hypokalemia, severe hypokalemia, mild/moderate hyperkalemia, and severe hyperkalemia?
Hypokalemia = < 3.5 mEq/L
Severe hypokalemia = < 2.5 mEq/L
Mild/Mod hyperkalemia = 6.0-7.0 mEq/L
Severe hyperkalemia = > 7.0 mEq/L
How is the cardiac membrane stabilized in a patient with severe or symptomatic hyperkalemia?
calcium chloride or calcium gluconate
How does Kayexalate work?
binds potassium in the gut
- is very slow
What does a fluoride deficiency lead to in children?
Dental caries
What is the recommended iron supplementation for infants and when should you start supplementing infants?
1 mg/kg/day beginning at 4-6 months
- infants iron stores are sufficient for 6 months in a term infant
What is the recommended iron supplementation for preterm infants and when should you start supplementing them?
2 mg/kg/day starting at 2 months of age
Does human breastmilk have sufficient levels of Vitamin K?
No - it is deficient in Vitamin K
What is the difference in iron between human breast milk and cow’s milk?
Cow’s milk has more iron than human, but human breast milk has more bioavailable forms of iron
What additional two supplements should be given to strict vegetarian mothers?
Thiamine and Vitamin B12
What is the #1 most common cause of blindness in children worldwide?
Vitamin A deficiency
What are the BMI-for-age %iles for overweight, obese, and severely obese children?
Overweight = BMI in 85th-94th %ile
Obese = BMI 95th-98th %ile
Severely Obese = > 99th %ile
What is the risk of obesity in children with one obese parents vs two obese parents?
One obese parent = 40% chance of obesity as an adult
Two obese parents = 80% chance of obesity as an adult
