Pediatric Growth and Nutrition

Question 1

Neonate

Answer 1

</=28 days old

Question 2

Premature

Answer 2

</= 37 weeks

Question 3

Full-term

Answer 3

38-41 weeks

Question 4

Post-term

Answer 4

> /= 42 weeks

Question 5

Infant

Answer 5

> 28 days-12 months

Question 6

Child

Answer 6

1-12 years

Question 7

Toddler

Answer 7

1-4 years

Question 8

Early school age

Answer 8

5-7 years

Question 9

Older school age

Answer 9

8-12 years

Question 10

Adolescent

Answer 10

13-17 years

Question 11

Adult

Answer 11

> /= 18 years

Question 12

Extremely low birth weight

Answer 12

<1000 grams

Question 13

Very low birth weight

Answer 13

1000-1499 grams

Question 14

Low birth weight

Answer 14

1500-2499 grams

Question 15

Normal birth weight

Answer 15

2500-3999 grams

Question 16

High birth weight

Answer 16

> 4000 grams

Question 17

Growth charts used for children

Answer 17

<2 years: WHO
>/= 2 years: CDC

Question 18

Markers of growth & development

Answer 18

Weight, length/height, head circumference, weight-for-length, BMI
Growth charts
Motor skills (gross and fine, assessment recommended at every well-check)
Cognitive development (assessment recommended at every well-check)

Question 19

Weight assessment

Answer 19

Underweight:
<3: Weight for length < 5th percentile
>/=2: BMI for age < 5th percentile

Risk of overweight:
>2: BMI for age 85th-95th percentile

Overweight:
<3: Weight for length > 95th percentile
>/=2: BMI for age > 95th percentile

Obese:
2-18 years: BMI >/= 30 kg/m2 or BMI for age >/= 95th percentile

Question 20

Weight gain in term infants

Answer 20

20-30 g/day
Double birth weight by 4 months of age
Triple birth weight by end of 1st year of life
Neonates may lose weight in first days of life, but should regain it within the first to second week of life

Question 21

Growth in length for infants

Answer 21

Increases by 50% in first year of life

Question 22

Failure to thrive

Answer 22

Weight-for-age < 5th percentile on multiple occasions

Question 23

Causes of FTT

Answer 23

Inadequate caloric intake, inadequate caloric absorption, excessive caloric expenditure

Question 24

Treatment of FTT

Answer 24

Breastfed infants: breastfeeding more often, lactation support, formula supplementation
Formula-fed infants: concentrated formulas
Avoid juice or cow milk consumption, add rice cereal to foods

Question 25

How many calories in breast milk?

Answer 25

20 kcal/oz

Question 26

Breastfeeding recommendations

Answer 26

Exclusive breastfeeding for first 6 months of life, with support for continued breastfeeding for the first year and beyond

Question 27

Benefits of breastfeeding

Answer 27

Decreased URI (AOM), UTI, necrotizing enterocolitis, meningitis, diarrhea, sepsis, SIDS, diabetes, cancer, asthma, and obesity

Question 28

Vitamin D requirement

Answer 28

400IU per day, starting first few days of life Breastfed/partially breastfed infants taking < 1000 mL/day of Vitamin D-fortified milk (human milk offers < 25 IU/L of Vitamin D) All non-breastfed infants and older children ingesting < 1000mL/day of Vitamin D-fortified formula, food or milk Adolescents not obtaining 600 IU for Vitamin D through fortified milk

Question 29

Fluoride requirement

Answer 29

0.5 mg/day in infants > 6 months Supplementation not needed in first few months of life Only needed for exclusively breastfed infants Children should not use fluorinated toothpaste until 2 years old

Question 30

Iron requirement

Answer 30

Breastfed: Full term = 1 mg/kg/day from 4-12 months, pre-term = 2 mg/kg/day from 1-12 months Formula fed: Full term = fortified formula containing Fe 4-12 mg/L until 12 months, pre-term = additional 1 mg/kg/day to bring total daily dose to 2 mg/kg/day

Question 31

Diet for pediatric patients

Answer 31

Solids start ~ 4-6 months of age Single ingredient, started 1 week apart Cereals: rice, barley, oatmeal Veggies, fruits, meats start at 8-9 months Toddlers Regular diet + whole milk until 2 years of age Watch fruit juice: Limit to 4-6 ounces per day or avoid entirely. Make a part of a meal/snack, not for diarrhea management.

Question 32

Indications for specialized nutrition support

Answer 32

Enteral: Premature neonates under 32-34 weeks gestational age Infants too sick to breastfeed or bottle feed Patients who are mechanically ventilated Pediatric patients whose needs cannot be met by the oral route Parenteral: Nutritional needs cannot be met by EN or when the GI tract is not functioning (e.g. short bowel syndrome

Question 33

Enteral feeding tubes and medication administration considerations

Answer 33

Formulations: Avoid enteric coated and modified release products, viscous products Interactions: Avoid mixing medications with enteral feeding formulas

Question 34

Safety considerations of specialized nutrition support

Answer 34

Enteral: Contamination of EN formulations and enteral feeding misconnections Parenteral: Calcium phosphate precipitation, contamination of PN formulation, over or under dosing of dextrose, omission of dextrose, iron overload, trace element overdoses, overdose of electrolytes, and heparin overdose