Pediatric Nutrition Flashcards
Infant Nutrition Basics
- Lack of caloric ___
- ___ metabolic rate
- Growth rates ___ in infancy
- ___ demands during illness
- Dependence/independence
- reserve
- increased
- higher
- increased
Typical Infant Growth
- Infant weight doubles by ___ - ___
months - Infant weight triples by ___ months
- Infant length increases 50% by ___
months
4-6
12
12
Childhood and Adolescent Growth
Preschool: Ages 2-6
* Growth ___ , but is constant
* ___ tissue distribution begins after age 2
Middle Childhood: 7-10
* Steady growth
* Females ___ males in height and weight
Ages 11-18 (adolescence)
* Begins before puberty and continues until growth is complete
* Rate of weight gain ___
- slows
- adipose
- >
- increases
Assessing Growth
Growth charts available for length, weight, head circumference assessment
Which growth chart?
* ___ < 2 years old
* ___ : 2-20 years old
* Different charts for boys and girls
- WHO
- CDC
Nutrition Requirements
Growth is NOT a ___ process
Variations include
* Age
* Organ function
* Body composition
Example of body composition/organ function requirements:
* Adults: Brain 2% ABW; 19% BEE
* Neonates: Brain 10% ABW; 44% BEE
BEE = basal energy expenditure
linear
Pediatric Malnutrition
___ : deficiencies or excesses in nutrient intake, imbalance of
essential nutrients or impaired nutrient utilization
- Can result in wasting, stunting, underweight, obesity, and micronutrient deficiencies
Anthropometry
- Growth charts with z-scores, mid-upper arm circumference (MUAC)
- Z-score -> statistical analysis that tells us the distance and direction of an observation from a population mean
Failure to ___ (growth faltering)
- Fall of ___ major percentiles
- Weight < ___ - ___ th percentile
Malnutrition
thrive
2
3-5
Etiology and Causes of Malnutrition
Etiology
* Acute vs chronic causes
* Ex: critical illness, heart failure, cystic fibrosis
Mechanism
* Imbalance of energy needs and intake
* Three causes: inadequate ___ intake, inadequate ___ or excessive ___ expenditure
Why does it matter?
* Morbidity and mortality -> linked to unfavorable outcomes
- caloric, absorption, energy
Caloric Requirements
- preterm infant:
- < 6 mo: ___ - ___ + kcal/kg/day
- 6-12 mo: ___ - ___ kcal/kg/day
- 1-7 y: ___ - ___ kcal/kg/day
- 7-12 y: ___ - ___ kcal/kg/day
- 12-18 y: ___ - ___ kcal/kg/day
- 100-120
- 85-105
- 80-100
- 75-90
- 50-75
- 30-50
Protein Requirements
- low birth weight/preterm: __ - ___ g/kg per day
- infant (1-12 mo): ___ - ___ g/kg per day
- children (>10 kg or 1-10 y): ___ - ___ g/kg per day
- adolescents (11-17 y): ___ - ___ g/kg per day
- 3-4
- 2-3
- 1-2
- 0.8-1.5
Breastfeeding
If no contraindications, AAP recommends:
- Exclusive breastfeeding for first ___ months
- Optimally continue for at least 1 year
- May extend beyond 1 year if desired
WHO suggests up to __ years
6
2
Breastfeeding Advantages
Newborn
- Optimal nutrients
- __ risk of infection
- ___ risk of immune-mediated diseases
- Psychological & ___ advantages
Mother
- ↓ post-partum ___
- Faster time to attainment of pre-
pregnancy ___
- ↓ risk of ___ & ___ cancer
- ↑ child ___
- Mother – infant bond
- decreased
- decreased
- cognitive
- bleeding
- weight
- breast, ovarian
- spacing
Breast Milk
Caloric density: ___ kcal/ounce
lipids: ___ % of caloric content
- long chain fatty acids
proteins
- ___ % whey
- ___ % casein
carbohydrates
- lactose
- 20
- 50
- 70
- 30
Breastfeeding Contraindications
- Active, untreated maternal ___
- ___ positive*
- Human T-cell lymphotropic virus (Type I & II)
- ___ infection (suspected or confirmed)
- Untreated brucellosis
- Use of illicit drugs
- ___
- TB
- HIV
- Ebola
- DRUGS
Maternal Medications in Breastfeeding
Drugs to avoid” fall into two main categories
1) Drugs that can harm the ___ directly (Ex: Immunosuppressants, chemotherapy, radioactive agents, etc_
2) Drugs that reduce ___ ___ (Ex: Ergots, decongestants, etc)
Drug characteristics
- ___ oral bioavailability = more likely to be absorbed by infant
- infant
- milk production
- high
Drug characteristics for absorption into
breastmilk
increase in breast milk
- non- ___
- ___ molecular wt
- ___protein binding
- ___ lipid solubility
- ___ t1/2
- ___ Vd
- non-ionized
- small
- low
- high
- long
- low
Human Milk Fortifiers
Breast milk does not adequately meet nutritional needs of ___ infants
- increase calories, minerals, vitamins, and protein
- increase calorie content to ___ - ___ kcal/oz
- Available as a liquid and powder
- preterm
- 22-28
Term Formulas
Modeled after breast milk
- Provide __ - __ kcal/ounce
- Carbohydrate source is ___
- Contain ___ milk protein
- All infants should receive ___ -fortified formula
- usually not concentrated
- 19-20
- lactose
- cow’s
- iron
Specialty Formulas
- Preterm/enriched formulas
- Higher kcal/ounce ( ___ - ___ kcal/oz)
- May be hospital only vs transitional
- ___ -based
- ___ -free
- Hypo ___ or non- ___
- Anti- ___
- 22-30
- soy
- lactose
- allergenic
- reflux
Typical Feeding
Term, healthy infants will feed an average of __ - __ times per day
* Improve infant ___
* ___ milk production
* Breastfeeding parents often encouraged to breastfeed __ - __ times per day initially
- 6-9
- coordination
- stimulate
- 8-12
Feeding schedule for first year of life
As infants grow older:
* ___ amount of feedings per day
* ___ ounces (oz) per feeding
- decreased
- increasesd
Cholecalciferol
- vitamin ___
- 400 IU = __ mcg
- use caution with drops vs mLs
premature neonates
- < 1.5 kg: ___ IU daily ( ___ mcg)
- > 1.5 kg: ___ - ___ IU daily ( __ - __ mcg)
term infants
- Partially or fully breastfed: ___ IU ( __ mcg) daily
- Formula fed: ___ - ___ IU ( __ mcg) daily until receiving 1000
mL/formula/day (approx. ___ ounces/day)
- D3
- 10
- 200, 5
- 200-400, 5-10
- 400, 10
- 200-400, 10, 30
Iron Supplementation
Premature neonates
- __ mg/kg/day (elemental)
Term infants
- Not routinely indicated for breastfed, healthy infants
- Deficiency: __ mg/kg/day (elemental)
Use caution when selecting products
- Many different concentrations and formulations available
- Ferrous sulfate contains ~ ___ % elemental iron
- 2
- 3
- 20
Iron Calculation
Dosing based on elemental iron, but often ordered in mg of ferrous sulfate
- Common ferrous sulfate concentration is 75 mg/mL ( __ mg elemental
iron/mL)
15
Zinc
Essential trace element absorbed in the
small intestine
- Deficiency: dermatitis, diarrhea,
infections, altered wound healing
- Normal concentration: ___ - ___ mcg/dL
Supplementation/replacement
- Oral or IV
Dosing based on elemental zinc
- Zinc sulfate __ mg = __ mg of elemental zinc
- 70-150
- 44, 10
Initiation of Complementary Foods
- Typically begins at __ months
- Introduce ___ ingredient foods first
- Introduce 1 new food every __ - __days
- Increase serving size gradually
- Emphasize all food groups
- 6
- single
- 4-5
Calculating Fluid Requirements
Holliday-Segar Method
- Up to 10 kg: ___ mL/kg
- 10-20 kg: ___ mL + ___ mL/kg for every kg greater >10
- >20 kg: ___ mL + ___ mL/kg for every kg greater >20
- 100
- 1000, 50
- 1500, 20
T or F: IV fluids used in pediatric patients may be different than adults
T
Fluid selection may be impacted by:
* Patient age (need for glucose)
* Underlying disease states (heart failure)
* Special nutritional requirements (ketogenic diet, metabolic diseases)
Calculating Feeding Requirements
Information needed:
* Age (postconceptional age if patient was preterm)
* Underlying medical conditions
* Current weight
* Number of feedings a day
Calculating Feeding Requirements
When formula requirements exceed fluid requirements, always calculate
based on ___ needs
Special exceptions
* Fluid restricted patients
* Use ___ formulas in these patients
- caloric
- calorie-dense
Calculating Feeding Requirements
Failure to thrive (growth faltering)
* Use “ ___ ” growth plan
* To calculate caloric need, use weight that corresponds with ___ th percentile on growth chart
* Multiply the desired weight by the kcal/kg/day value for age to get the new daily requirement
* Use this new daily requirement to decide how much breast milk or formula to use per feeding
- catch-up
- 50th
Non-Oral Nutrition
Exclusively oral nutrition may not be possible due to:
- Consumption issues
- Digestion issues (short gut)
- High energy needs (CF, burns, CHF, infection, etc)
- Poor growth
- Specialty nutrition needs (metabolic, ketogenicO
- Inability to safety take oral
- Malnutrition
Alternative Routes of Administration
Short term
* ___ , ___ , ___ , ___ tube
Long term
* ___ , ___ , surgical ___ or
___ (G-tube)
Parenteral nutrition
NOTE: Don’t assume meds can go
every route!
- NG, ND, NJ, orogastric
- PEG, PEJ, jejunostomy, gastrostomy
