Pediatric Nutrition

Question 1

*When can kids have solids?

Answer 1

Starting around 6 months if there are no developmental delays…start slow

Question 2

Infant digestive process (first 6 months)

Answer 2

• system very immature
• poorly coordinated swallowing until 3-4 months
• no saliva until 3M
• at risk of developing food allergies if solids introduced too early

Question 3

Infants nutritional requirements—first 6 months

Answer 3

• 110-120 k/cal/kg/day
• 140 cc/kg/day of fluids
• no solids until 4-6M

Question 4

Infants growth—first 6 months

Answer 4

If growing well, their healthy is pretty good—about an ounce/day; lose 10% births eight in first 10-14 days but back to birth weight at 2 weeks age

Question 5

Feeding

Answer 5

• breast milk/formula—20oz at 1M
• breast milk/formula—30oz by 6M
• water not needed even when hot bc dilution is easy to do—give milk if thirsty
• don’t give cow’s milk, honey or corn syrup for first year
• can start an iron fortified cereal (first solid food) with water or milk at 6 months
• Easy to overfeed bc tiny stomach

Question 6

Formula prep

Answer 6

• 1 scoop to 2 oz of water = 20 cal/ounce of most formula
• to warm bottle place in warm or hot water NOT microwave
• throw formula/BM away after 4h of being warmed

Question 7

Know baby is ready for solids at 6 months when…

Answer 7

• Can sit with little support and have good head control
• drink 30-32 oz of formula/day and want more
• drink 8 oz of formula and is hungry in <4 hours
• doubled birth weight

Question 8

Infants digestive process (second 6 months)

Answer 8

• amylase to digest complex carbs
• dispose available for fat absorption
• tongue thrust gone
• tooth eruption begins

Question 9

Infant nutrition—second 6 months

Answer 9

• 105 k/cal per kg/day
• limit formula to 24-30 oz/day when added to foods
• iron, fluoride add at 4-6M when supplementing
• need adequate source of vit 6 after 4-6M (in fruit—baby food, or fruit juice but can lead to excess sugar—needs to be watered down)

Question 10

Infant growth—second 6 months

Answer 10

• Weight gain of 3-5 oz/weekly
• 1/2 inch monthly

Question 11

Second 6 months feeding

Answer 11

• introduce solids
• offer juice from a cup, mix with juice from cereal to improve absorption of iron
• start with strained foods and introduce one food at a time, try for 3-5 days before adding something else
• meat is last
• start with finger foods around 6-7M—very soluble
• chopped foods by 9-12M—they can start chewing now

Question 12

Foods to avoid in first year of life

Answer 12

Nuts, strawberries, wheat, shellfish, egg whites, citrus

Question 13

Choking hazard foods and foods to avoid

Answer 13

Grapes, hard candy, popcorn, hotdogs, raw mini carrots, smooth/hard foods, fried food, high concentrated sugary food and drink

Question 14

Toddler digestive process

Answer 14

Inc in gastric activity, digestive process more mature and complex, physiologic anorexia—not very hungry

Question 15

Toddlers nutritional requirements

Answer 15

• off bottle by 1 year
• vitamin and mineral needs increase

Question 16

Toddlers feeding

Answer 16

• wean from bottle
• 2-3 cups of milk/day
• after 2Y of age can get skim milk or low-fat
• frequent nutritious snacks
• grazing ok
• breast milk is ok but not too nutritious at this point
• one T of solid food per Y of age
• eating habits established during toddler years are critical to establish eating patterns
• consistency and rituals are important

Question 17

Preschooler digestive process

Answer 17

Mature

Question 18

Preschool feeding

Answer 18

• may be picky eaters
• table manners can be taught around age 4-5
• may have food jags—only want to eat one food, food fad
• five a day fruit and veg encouraged

Question 19

School age nutritional requirements

Answer 19

• need more protein
• girls over 10 need 2200 cal, boys 2500
• need independence in meals
• formation of habits that influence the future
• choose health over junk food

Question 20

School age feeding concerns

Answer 20

• junk food popular
• school food programs
• threat of childhood obesity
• influence by media, family, school food programs, outside food influences

Question 21

Adolescent nutrition requirements

Answer 21

• Females—more iron and calcium
• Growth spurt—iron, calcium, zinc
• Varied based on puberty
• inc risk of poor nutrition, obesity from sedentary, eating disorders, cholesterol

Question 22

Subjective data for nutritional assessments

Answer 22

Talk to child alone—nutritional status during pregnancy, infant feeding, 24 hour recall, 3 day food diary is better, supplements—iron, fluoride, feeding patterns of child and family, feeding capabilities of child, activity pattern/play, wound healing

Question 23

Objective data for nutritional assessment

Answer 23

Fontanelles, muscle tone, bowels, mucous membranes, knock-knee past 2-7, bowlegged past toddler, hair, skin folds, albumin, nitrogen balance, mineral, HIB, Hct, iron/ferritin levels, cholesterol

Question 24

Criteria for referral for nutritional assessment

Answer 24

• markedly over or under weight
• feeding skills below developmental level
• unusual food habits
• inadequate dietary intake
• nutritional tx central to medical management
• physical signs of nutritional deficiency
• emotional disturbances associated with habits
• high risk for compromised nutrition