Pediatric nutrition Flashcards by Hannah Walters

Overview of infant nutrition

Lack of caloric reserve–>need constant source of calories

Increased metabolic rate

Increased demands during illness

Growth rates higher in infancy

Dependence/independence

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Infant body weight

Normal: 2-4 kg

Infant weight doubles by 4-6 months

Infant weight triples by 12 months

infant length increases by 50% by 12 months

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Preschool age 2-6

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

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Middle school age 7-10

steady growth

females>males

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Adolescence age 11-18

before puberty and continues until growth is complete

rate of weight gain increases

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Growth is NOT linear

Variations include: age, organ function, body composition

Brain is 10% of body weight in infant

50% of neonates basal energy expenditure is by the brain

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Pediatric malnutrition

deficiencies or excess in nutrient intake and imbalance of essential nutrients or impaired nutrient utilization

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How to assess

Anthropometry

Z scores showing the number of standard deviations away from the mean

MAJOR ISSUE IS FAILURE TO THRIVE

Fall of 2 major percentiles OR weight < 3-5th percentile

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Mechanism of malnutrition

imbalance of energy needs and intake that can be acute or chronic

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Causes of malnutrition

Inadequate caloric intake
Inadequate absorption
Excessive energy expenditure

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AS YOUR AGE INCREASES, YOUR CALORIE REQUIREMENTS DECREASE

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AS YOUR AGE INCREASED, DECREASE IN # OF FEEDINGS AND INCREASE IN OZ PER FEEDING

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IF FAILURE TO THRIVE, USE WEIGHT OF 50TH PERCENTILE FOR FEEDING REQUIREMENTS

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Breastmilk

20 kcal/oz

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Formula

1oz= 30 mL

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Breastfeeding if no contraindications

Exclusive breastfeeding for first 6 months

Optimally continue for at least 1 year

WHO suggests up to 2 years

DRUGS that can harm breastmilk directly

Immunosuppressants

Chemo

Radioactive agents

Drugs that can reduce milk production

Ergots

Decongestants

Antihistamines

Opioid use disorder is not an absolute contraindication specifically with methadone

Other contraindications to breastfeeding

Active, untreated maternal TB

Untreated brucellosis

HIV

Ebola

Human T-cell Lymphotropic Virus

Newborn advantages to breastfeeding

optimal nutrients

decreased risk of infection

decreased risk of immune-mediated diseases

psychological and cognitive advantages

Mother advantages to breastfeeding

Decreased post-partum bleeding

Decreased risk of beast and ovarian cancer

Increased time to attainment of pre pregnancy weight

increased child spacing

Mother-infant bonding

Components of beastmilk

Lipids, proteins, carbs

Maternal medications

Risk-benefit of therapy–>how important to mother to continue medications

Infant size, age, premature?

Proportion of feeding that are breast milk–>once or twice daily compared to exclusively breastmilk

Consider drug characteristics

Increase drug in breastmilk Non-ionized Small molecular weight Low protein binding High lipid solubility Long t1/2 life Low Vd

Formula feeding indications

Mothers who do not or cannot breastfeed Infants with human milk intolerance Infants failing to gain weight with breastfeeding Breastfeeding contraindication

Human milk fortifiers

Increase calories, minerals, and protein when breast milk does not meet 22-30 kcal/oz

Term formulas

Modeled after breastmilk 19-20 kcal/oz All infants should receive iron-fortified formula Usually not concentrated

Speciality formulas

Preterm/enriched--> 22-30 kcal/oz Soy-based Lactose-free Hypoallergenic Anti-reflex

Vitamin D3 (Cholecalciferol)

ALL BREASTFED BABIES MUST RECEIVE 400 IU=10 mcg Premature: < 1.5 kg: 200 IU daily (5 mcg) > 1.5 kg: 200-400 IU daily (5-10 mcg) Term: Breastfed: 400 IU daily (10 mcg) Formula: 200-400 IU daily (5-10 mcg) until receiving 1000 mL/formula/day

Iron

NOT INDICATED FOR ALL BABIES Premature: 2 mg/kg/day (elemental) Term: Not routinely indicated for breastfed, healthy infants Deficiency: 3 mg/kg/day (elemental) Dosage form: Ferrous sulfate 75 mg/mL (15 mg of elemental iron/mL) KNOW HOW TO CALCULATE

Zinc

NOT INDICATED FOR ALL BABIES--> only when deficient Premature infants, prolonged exclusive breastfeeding after > 6 months, PN, IBD, vegan/vegetarian, malnutrition Dosing: zinc sulfate 44 mg=10 mg of elemental zinc Based on elemental zinc

Complementary Foods "Do"

Begins at 6 months Introduce 1 new food every 4-5 days Increase serving size gradually Emphasize all food groups

Complementary Foods "Don't"

Do not put anything but breastmilk or formula in bottle Never give the follow to children < 1 year: honey, cow's milk, choking hazards, allergens

Fluids

Type: always have dextrose Dosing: Up to 10 kg: 100 mL/kg 10-20 kg: 1000 mL + 50 mL/kg for every kg greater then >10 > 20 kg: 1500 mL + 20 mL/kg for every kg greater than >20