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
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
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
Calculating Feeding Requirements
Information needed:
* Age (postconceptional age if patient was preterm)
* Underlying medical conditions
* Current weight
* Number of feedings a day
