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PHRM 864 Module 3 > Pediatric Nutrition > Flashcards

Pediatric Nutrition Flashcards

1
Q

Infant nutrition basics

A

lack of caloric reserve
increased metabolic rate
growth rates higher in infancy
increased demands during illness
dependence/independence

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2
Q

Typical infant growth

A

normally 3-4kg at birth
infant weight doubles by 4-6 months
infant weight triples by 12 months
infant length increases 50% by 12 months

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3
Q

Preschool age growth: 2-6 years

A

growth slows, but is constant
adipose tissue distribution begins after age 2

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4
Q

Middle childhood age growth: 7-10 years

A

steady growth
females > males in height and weight

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5
Q

Ages 11-18 growth (adolescence)

A

begins before puberty and continues until growth is complete
rate of weight gain increases

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6
Q

Assessing growth

A

growth charts available length, weight, head circumference assessment
which growth chart:
WHO: < 2 yrs old
CDC: 2-20 yrs old
different charts for boys and girls

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7
Q

Nutrition requirements

A

growth is NOT a linear process
variations that affect the rate of growth: age, organ function, body composition

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8
Q

Ex of body composition/organ function requirements

A

adults: brain 2% ABW, 19% BEE (basal energy expenditure)
neonates: brain 10% ABW, 44% BEE
~50% of a neonate’s basal energy expenditure is used by their brain (keep infants with appropriate glucose source because large amount of metabolic demand is focused in the brain - supports neurologic development)

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9
Q

Pediatric malnutrition

A

malnutrition: deficiencies or excess in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization –> can result in wasting, stunting, underweight, obesity, and micronutrient deficiences

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10
Q

Antropometry

A

growth charts with z-scores, mid-upper arm circumference
Z-score –> statistical analysis that tells us the distance and direction of an observation from a population mean (# of standard deviations you are from the mean)
ex. z-score = -4.2, 4,2 lower than the 50th percentile

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11
Q

Failure to thrive (growth faltering)

A

fall of 2 major percentiles
weight < 3-5th percentile

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12
Q

Etiology of malnutrition

A

acute (injured, don’t eat a lot) vs chronic causes (ex: critical illness, heart failure, cystic fibrosis)
leads to morbidity and mortality –> linked to unfavorable outcomes

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13
Q

Malnutrition mechanism

A

imbalance of energy needs and intake
three causes: inadequate caloric intake, inadequate absorption (cystic fibrosis), or excessive energy expenditure (heart failure)

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14
Q

Caloric requirements

A

as kids get older, kcal/kilo per day requirements will decrease

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15
Q

Breastfeeding

A

if no contraindications, AAP recommends: exclusive breastfeeding for first 6 mo, optimally continue for at least 1 year, may extend beyond 1 year if desired
WHO suggests up to 2 years

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16
Q

Breastfeeding advantages for newborn

A

optimal nutrients
decreased risk of infection (can pass antibodies to neonate)
decreased risk of immune-mediated diseases
psychological and cognitive advantages (bonding - oxytocin based advantages)

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17
Q

Breastfeeding advantages for mother

A

decreased post-partum bleeding
faster time to attainment of pre-pregnancy weight (breastfeeding burns a lot of calories)
decreased risk of breast and ovarian cancer
increased child spacing
mother - infant bond

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18
Q

Breast milk

A

caloric density: 20 kcal/ounce
mostly composed of water; components: lipids - 50% of caloric content, long-chain fatty acids; proteins - 70% whey, 30% casein; carbs - lactose

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19
Q

Breastfeeding contraindications

A

active, untreated maternal tuberculosis
HIV positive
human T-cell lymphotropic virus (type I and II)
ebola infection
untreated brucellosis
use of illicit drugs
DRUGS

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20
Q

Drugs to avoid in breastfeeding

A

falls into 2 main categories:
drugs that can harm the infant directly - immunosuppressants, chemo, radioactive agents
drugs that reduce milk production - ergots, decongestants, antihistamines
people in recovery for opioid use disorder take case by case i.e. methadone

21
Q

Maternal meds: things to consider

A

risk-benefit of therapy
infant characteristics: prematurity/size/age
proportion of feedings that are breast milk
drug characteristics: high oral bioavailability = more likely to be absorbed by infant; PK characteristics

22
Q

Drug characteristics for absorption into breastmilk - increase in breastmilk

A

non-ionized
small molecular weight
low protein binding
high lipid solubility
long T1/2
low Vd (drugs stay in bloodstream, delivered directly to breastmilk via bloodstream)

23
Q

Drug characteristics for absorption into breastmilk - decrease in breastmilk

A

ionization
large molecular weight
high protein binding
low lipid solubility
short T1/2
high Vd (drugs stay in the tissue and do not have access to enter the breastmilk)

24
Q

Formula feeding indications

A

substitute or supplement feeds for mothers who do not or cannot breastfeed
infants with human milk intolerance
maternal infection transmittable through breastfeeding (HIV, HSV)
maternal chemo
infants failing to gain weight despite optimization of breastfeeding

25
Q

Human milk fortifiers

A

breast milk does not adequately meet nutritional needs of preterm infants
human milk fortifiers increase calories, minerals, vitamins, and protein
available as a liquid and powder
when added to human milk provide: increase calorie content to 22-28 kcal/oz

26
Q

Term formulas

A

modeled after breast milk: provide 19-20 kcal/oz
carbohydrate source is lactose
contain cow’s milk protein
all infants should receive iron-fortified formula
usually not concentrated: decrease water content to increase caloric content

27
Q

Specialty formulas

A

preterm/enriched formulas: higher kcal/oz (22-30kcal/oz), may be hospital only vs transitional
soy-based
lactose-free
hypoallergenic or non-allergenic
anti-reflux (thickened formula)

28
Q

Typical feeding

A

term, healthy infants will feed an average of 6-9 times per day
some infants require more frequent feedings: improve infant coordination, stimulate milk production
breastfeeding parents often encouraged to breastfeed 8-12 times per day initially

29
Q

Feeding schedule for 1st year of life

A

as infants grow older: decrease amount of feedings per day, increase ounces per feeding
feeding less frequently, but taking in more volume

30
Q

Cholecalciferol

A

vitamin D3 = cholecalciferol
dosed in mCg or international units (IU): cholecalciferol 400 IU = 10 mCg
use caution when selecting products: drops vs mL
if you are breastfed baby, get vit D supplement

31
Q

Cholecalciferol indications - premature neonates

A

<1.5 kg: 200 IU daily (5mCg)
> 1.5 kg: 200-400 IU daily (5-10 mCg)

32
Q

Cholecalciferol indications - term infants

A

partially or fully breastfed: 400 IU (10 mCg) daily
formula fed: 200-400 IU (10 mCg) daily until receiving 1000 mL/formula/day (approx. 30 oz/day)

33
Q

Iron supplementation - premature neonates

A

2mg/kg/day (elemental)

34
Q

Iron supplementation - term infants

A

not routinely indicated for breastfed, healthy infants
deficiency: 3 mg/kg/day (elemental)
use caution when selecting products: many different concentrations/formulations available; ferrous sulfate contains ~20% elemental iron; need to talk same “language” as prescriber

35
Q

Iron dosing

A

based on elemental iron, but often ordered in mg of ferrous sulfate
common ferrous sulfate concentration is 75 mg/mL (15 mg elemental iron/mL)

36
Q

Zinc

A

supplementation is not routine, done based on known zinc deficiency
essential trace element absorbed in small intestine
deficiency –> dermatitis, diarrhea, infections, altered wound healing; normal concentration 70-150 mCg/dL
supplementation/replacement: oral or IV; dosing based on elemental zinc, zinc sulfate 44 mg = 10 mg of elemental zinc

37
Q

Patients who may require zinc supplementation/replacement

A

premature infants, prolonged exclusive breastfeeding after > 6 mo of age, parental nutrition, inflammatory bowel disease/intestinal failure, vegan/vegetarian diets, generalized malnutrition

38
Q

Initiation of complementary foods

A

typically begins at 6 mo
introduce single ingredient foods first

39
Q

Do’s of initiating complementary foods

A

introduce 1 new food every 4-5 days
increase serving size gradually
emphasize all food groups

40
Q

Don’ts of initiating complementary foods

A

never put anything but breast milk or formula in a bottle
never give the following to children < 1yr: honey (botulism), cow’s milk, choking hazards, potential allergens

41
Q

Calculating fluid requirements

A

holliday-segar method:
up to 10 kg: 100 mL/kg
10-20 kg: 1000 mL + 50 mL/kg for every kg > 10
>20 kg: 1500 mL + 20 mL/kg for every kg > 20

42
Q

Fluid selection

A

IV fluids used in pediatric pts may be different than adults
fluid selection may be impacted by: patient age (need for glucose), underlying disease states (heart failure), special nutritional requirements (ketogenic diet, metabolic diseases)

43
Q

Calculating feeding requirements - information needed

A

age, postconceptional age if pt was preterm, underlying medical conditions, current weight, number of feedings in a day, fluid/caloric needs
when formula requirements exceed fluid requirements, always calculate based on caloric needs; special exceptions: fluid restricted pts, use calorie-dense formulas

44
Q

Calculating feeding requirements - failure to thrive

A

use “catch-up” growth plan
to calculate caloric need, use weight that corresponds with 50th 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

45
Q

Non-oral nutrition

A

exclusively oral nutrition may not be possible due to: consumption issues, digestion issues (short gut), high energy needs (CF, burns, CHF, infection), poor growth, specialty nutrition needs (metabolic, ketogenic), inability to safely take oral, malnutrition

46
Q

Alternative routes of administration - short term

A

NG, ND, NJ, orogastric tube

47
Q

Alternative routes of administration - long term

A

PEG, PEJ, surgical jejunostomy or gastrostomy (G-tube)

48
Q

More alternative routes of administration

A

parenteral nutrition
various considerations must be taken into account
DON’T assume meds can go every route

PHRM 864 Module 3 (9 decks)

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