Pediatric Nutrition

Question 1

Typical Infant growth

Answer 1

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

Question 2

Preschool growth: age 2-6

Answer 2

growth starts to slow down but is still constant
adipose distribution begins after age 2

Question 3

Middle Childhood 7-10

Answer 3

Steady growth
female outgrow men in height and weight at this age

Question 4

Ages: 11-18

Answer 4

Begins before puberty and continues growth until complete
rate of weight increases

Question 5

Growth charts

Answer 5

WHO chart: for those younger than 2
CDC chart: for those 2-20
Different charts for boys and girls

Question 6

Nutrition requirements

Answer 6

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

Question 7

Malnutrition definition

Answer 7

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

Question 8

Z-score definition

Answer 8

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

Question 9

Failure to thrive

Answer 9

When someone falls 2 below the 50th percentile
weight is less than 3rd-5th percentile

Question 10

Causes of malnutrition

Answer 10

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

Question 11

Caloric requirements per age

Answer 11

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

Question 12

Breastfeeding and breast milk

Answer 12

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

Question 13

Advantages of breastfeeding

Answer 13

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

Question 14

Contraindications to breastfeeding

Answer 14

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

Question 15

Drugs to avoid while breast feedings

Answer 15

ones that reduce milk production: ergots, decongestants, antihistamines
Ones that can harm the infant: Immunosuppressants, chemotherapy, radioactivity agents

Question 16

Drug characteristics that increase absorption into breast milk

Answer 16

non-ionized
Low molecular weight
Low protein binding
high lipid solubility
Long half life
Low volume distribution

Question 17

Reasons to do formula feeding

Answer 17

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

Question 18

Formulas

Answer 18

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

Question 19

Typical feeding schedule

Answer 19

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

Question 20

Supplementation - Vitamin D3

Answer 20

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)

Question 21

Supplementation - Iron

Answer 21

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

Question 22

Example iron calculation
EX: 4kg patient requires 3mg/kg/day of iron supplementation
calculate dose, find mL needed, calculate mg dose of iron

Answer 22

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

Question 23

Supplementation zinc

Answer 23

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

Question 24

The Dos of complementary food

Answer 24

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

Question 25

The Donts of complementary food

Answer 25

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)

Question 26

Fluid requirement calculations
up to 10kg:
10-20kg:
>20kg:

Answer 26

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

Question 27

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

Answer 27

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)

Question 28

calculating feeding requirements for failure to thrive infants

Answer 28

If a baby is failure to thrive when calculating feeding requirements use 50th percentile weight for their calculation not real weight

Question 29

Short term non oral feeding routes

Answer 29

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

Question 30

Long term non oral feeding routes

Answer 30

PEG, PEJ, G-tubes
G-tubes are most common - a tube thats placed right at the gut