Pediatric nutrition Flashcards
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
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
Preschool age 2-6
growth slows, but is constant
adipose tissue begins after age 2
Middle school age 7-10
steady growth
females>males
Adolescence age 11-18
before puberty and continues until growth is complete
rate of weight gain increases
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
Pediatric malnutrition
deficiencies or excess in nutrient intake and imbalance of essential nutrients or impaired nutrient utilization
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
Mechanism of malnutrition
imbalance of energy needs and intake that can be acute or chronic
Causes of malnutrition
Inadequate caloric intake
Inadequate absorption
Excessive energy expenditure
AS YOUR AGE INCREASES, YOUR CALORIE REQUIREMENTS DECREASE
AS YOUR AGE INCREASES, YOUR CALORIE REQUIREMENTS DECREASE
AS YOUR AGE INCREASED, DECREASE IN # OF FEEDINGS AND INCREASE IN OZ PER FEEDING
AS YOUR AGE INCREASED, DECREASE IN # OF FEEDINGS AND INCREASE IN OZ PER FEEDING
IF FAILURE TO THRIVE, USE WEIGHT OF 50TH PERCENTILE FOR FEEDING REQUIREMENTS
IF FAILURE TO THRIVE, USE WEIGHT OF 50TH PERCENTILE FOR FEEDING REQUIREMENTS
Breastmilk
20 kcal/oz
Formula
1oz= 30 mL
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
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
