Pediatric Growth and Nutrition Flashcards
Neonate
</=28 days old
Premature
</= 37 weeks
Full-term
38-41 weeks
Post-term
> /= 42 weeks
Infant
> 28 days-12 months
Child
1-12 years
Toddler
1-4 years
Early school age
5-7 years
Older school age
8-12 years
Adolescent
13-17 years
Adult
> /= 18 years
Extremely low birth weight
<1000 grams
Very low birth weight
1000-1499 grams
Low birth weight
1500-2499 grams
Normal birth weight
2500-3999 grams
High birth weight
> 4000 grams
Growth charts used for children
<2 years: WHO
>/= 2 years: CDC
Markers of growth & development
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)
Weight assessment
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
Weight gain in term infants
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
Growth in length for infants
Increases by 50% in first year of life
Failure to thrive
Weight-for-age < 5th percentile on multiple occasions
Causes of FTT
Inadequate caloric intake, inadequate caloric absorption, excessive caloric expenditure
Treatment of FTT
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
How many calories in breast milk?
20 kcal/oz
Breastfeeding recommendations
Exclusive breastfeeding for first 6 months of life, with support for continued breastfeeding for the first year and beyond
Benefits of breastfeeding
Decreased URI (AOM), UTI, necrotizing enterocolitis, meningitis, diarrhea, sepsis, SIDS, diabetes, cancer, asthma, and obesity
Vitamin D requirement
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
Fluoride requirement
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
Iron requirement
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
Diet for pediatric patients
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.
Indications for specialized nutrition support
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
Enteral feeding tubes and medication administration considerations
Formulations: Avoid enteric coated and modified release products, viscous products
Interactions: Avoid mixing medications with enteral feeding formulas
Safety considerations of specialized nutrition support
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
