Pediatric Nutrition Flashcards
Typical Infant growth
usually start 2-4 kg
by 4-6 months their weight should double from their starting weight
by 12 months their weight should triple from their starting weight
Infant length increases 50% by 12 months
Preschool growth: age 2-6
growth starts to slow down but is still constant
adipose distribution begins after age 2
Middle Childhood 7-10
Steady growth
female outgrow men in height and weight at this age
Ages: 11-18
Begins before puberty and continues growth until complete
rate of weight increases
Growth charts
WHO chart: for those younger than 2
CDC chart: for those 2-20
Different charts for boys and girls
Nutrition requirements
growth is NOT a linear process
age, organ function, and body composition can affect the rate of growth
50% of neonates basal energy expenditure is used by their brain
Malnutrition definition
Deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization which can result in wasting, stunting, underweight, obesity, and micronutrient deficiencies
Z-score definition
Zscore is the amount of standard deveations away from the mean
example would be if a patient had a Z-score of -4.2 that means they are 4.2 standard deviations below the mean
Failure to thrive
When someone falls 2 below the 50th percentile
weight is less than 3rd-5th percentile
Causes of malnutrition
acute: child is seriously injured and cant eat normally
Chronic: critical illness, heart failure, cystic fibrosis
mechanism: inadequate caloric intake, inadequate absorption, or excessive energy expenditures
Caloric requirements per age
ALL IN Kcal/kg per day
preterm infant: 100-120+
<6M: 85-105
6-12M: 80-100
1-7 Y: 75-90
7-12 Y: 50-75
12-18 Y: 30-50
Breastfeeding and breast milk
Breast milk is mostly water with lipids, proteins, and carbohydrates
20Kcal/oz
1oz/30ml
breastfeeding for the first 6 months
optimally continue for at least 1 year
may extend beyond 1 year if needed
WHO suggests up to 2 years
Advantages of breastfeeding
For the newborn:
optimal nutrient, decreased risk of infection, decreased risk of immune-mediated disease both due to antibodies provided thru breast milk, psychological and cognitive advantages
For the mother:
decreased post partum bleeding, faster time to attainment of pre-pregnancy weight, decreased risk of breast and ovarian cancer, strengthens mother infant bond
Contraindications to breastfeeding
HIV positive, Human T-cell Lymphotropic virus (type I and Type II), Ebola infection (suspected or confirmed), Untreated brucellosis (infection spread from animals to humans), Use of illicit drugs, Drug therapy
Drugs to avoid while breast feedings
ones that reduce milk production: ergots, decongestants, antihistamines
Ones that can harm the infant: Immunosuppressants, chemotherapy, radioactivity agents
Drug characteristics that increase absorption into breast milk
non-ionized
Low molecular weight
Low protein binding
high lipid solubility
Long half life
Low volume distribution
Reasons to do formula feeding
Substitute or supplement feeds for mothers who do not or cannot breastfeed
infants with human milk intolerance
maternal infection transmittable through breastfeeding
maternal chemotherapy
infants failing to gain weight despite optimization of breast feeding
Formulas
There is a variety of options and not one options is the same as the next
some are lactose free, soy based, non-allergenic, and anti-reflux
they provide around the same amount of calories as regular breast milk but some options do provide higher calories
Typical feeding schedule
usually 6-9 times a day
if 6 times a day that would be every 4 hours or 9 times would be every 2.5 hours ish
As the baby grows the frequency of breastfeeding decreases but the volume of milk provided increases
Supplementation - Vitamin D3
Required that all babyies get 400IU or 10mCg of Cholecalciferol which is supplementation for Vitamin D3
For premature less than 1.5kg: 200 IU daily (5mCg) or those greater than 1.5kg 200-400IU daily (5-10 mCg)
Supplementation - Iron
Not for all kids usually for those with iron deficiencies
premature should get 2mg/kg/day and term babies should get 3mg/kg/day
Iron calculation is based on elemental iron but script is writen in ferrous sulfate
Example iron calculation
EX: 4kg patient requires 3mg/kg/day of iron supplementation
calculate dose, find mL needed, calculate mg dose of iron
4kg x 3mg/kg/d = 12mg iron supplementation
find ml : 12mg x 1ml/15mg = 0.8ml elemental iron
dose of iron salt: 0.8mL x 75mg/1mL = 60mg of salt
ferrous sulfact concentration is 75mg/ml - used to find mg of Iron salt (ferrous sulfate)
15mg elemental iron/ml - used to find ml of elemental iron
REMEMBER: dosed based on elemental iron but ordered in ferrous sulfate
Supplementation zinc
not routinly given and usually only for those with specific needs/ deficiency. it is dosed based on elemental zinc
reasons why people would be on zinc include: vegan or vegetarian diets, generalized malnutrition, Inflammatory bowel disease, premature infants
Normal concentration 70-150mCg/dL
Dosed based on elemental zinc: Zinc sulfate 44mg = 10mg of elemental zinc
The Dos of complementary food
Typically can start trying foods around 6 months
introduce single ingredient foods first
introduce 1 new food every 4-5 days
increase serving size gradually and emphasize all food groups
The Donts of complementary food
ONLY put breast milk and forumla in the bottle and before the age of 1 do not give baby any of the following: honey, cows milk, choking hazards, and any potential allergies (ex. If family history of peanut allergy might want to wait to test out peanutbutter for the baby)
Fluid requirement calculations
up to 10kg:
10-20kg:
>20kg:
up to 10kg: 100ml/kg
10-20kg: 1000ml + 50ml/ kg for every kg greater than 10
>20kg: 1500ml + 20ml / kg for every kg greater than 20
Calculating feeding requirements
AH is a 5-month-old female born at 39 weeks gestation. her current weight is 14lbs. she has no underlying medication conditions. she will be fed with standard infant formula (20kcal/oz) Caloric need for child is 110kcal/kg/day
14lbs x 1kg/2.2lbs = 6.4 kg
calculate caloric need(will be given on exam) : 110kcal/kg/day x 6.4kg = around 700 kcal/day
calculate volume of formula: 700kcal x 30ml/20kcal = 1050mL/ day or 35oz
Calculate total fluid requirements (a double check): 100mL/Kg x 6.4 kg = 640mL/day (this can be a double check to make sure that the volume of formula is always above the required fluid total)
calculating feeding requirements for failure to thrive infants
If a baby is failure to thrive when calculating feeding requirements use 50th percentile weight for their calculation not real weight
Short term non oral feeding routes
NG: nasogastric tube which goes from the nose to the gut and most commonly seen
NJ: must need a procedure to have this and cannot be placed and changed at home
Long term non oral feeding routes
PEG, PEJ, G-tubes
G-tubes are most common - a tube thats placed right at the gut
