Pediatric nutrition

Question 1

Overview of infant nutrition

Answer 1

Lack of caloric reserve–>need constant source of calories

Increased metabolic rate

Increased demands during illness

Growth rates higher in infancy

Dependence/independence

Question 2

Infant body weight

Answer 2

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

Question 3

Preschool age 2-6

Answer 3

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

Question 4

Middle school age 7-10

Answer 4

steady growth

females>males

Question 5

Adolescence age 11-18

Answer 5

before puberty and continues until growth is complete

rate of weight gain increases

Question 6

Growth is NOT linear

Answer 6

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

Question 7

Pediatric malnutrition

Answer 7

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

Question 8

How to assess

Answer 8

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

Question 9

Mechanism of malnutrition

Answer 9

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

Question 10

Causes of malnutrition

Answer 10

Inadequate caloric intake
Inadequate absorption
Excessive energy expenditure

Question 11

AS YOUR AGE INCREASES, YOUR CALORIE REQUIREMENTS DECREASE

Answer 11

AS YOUR AGE INCREASES, YOUR CALORIE REQUIREMENTS DECREASE

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

Breastmilk

Answer 14

20 kcal/oz

Question 15

Formula

Answer 15

1oz= 30 mL

Question 16

Breastfeeding if no contraindications

Answer 16

Exclusive breastfeeding for first 6 months

Optimally continue for at least 1 year

WHO suggests up to 2 years

Question 17

DRUGS that can harm breastmilk directly

Answer 17

Immunosuppressants

Chemo

Radioactive agents

Question 18

Drugs that can reduce milk production

Answer 18

Ergots

Decongestants

Antihistamines

Question 19

Opioid use disorder is not an absolute contraindication specifically with methadone

Answer 19

Opioid use disorder is not an absolute contraindication specifically with methadone

Question 20

Other contraindications to breastfeeding

Answer 20

Active, untreated maternal TB

Untreated brucellosis

HIV

Ebola

Human T-cell Lymphotropic Virus

Question 21

Newborn advantages to breastfeeding

Answer 21

optimal nutrients

decreased risk of infection

decreased risk of immune-mediated diseases

psychological and cognitive advantages

Question 22

Mother advantages to breastfeeding

Answer 22

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

Question 23

Components of beastmilk

Answer 23

Lipids, proteins, carbs

Question 24

Maternal medications

Answer 24

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

Question 25

Consider drug characteristics

Answer 25

Increase drug in breastmilk

Non-ionized

Small molecular weight

Low protein binding

High lipid solubility

Long t1/2 life

Low Vd

Question 26

Formula feeding indications

Answer 26

Mothers who do not or cannot breastfeed

Infants with human milk intolerance

Infants failing to gain weight with breastfeeding

Breastfeeding contraindication

Question 27

Human milk fortifiers

Answer 27

Increase calories, minerals, and protein when breast milk does not meet

22-30 kcal/oz

Question 28

Term formulas

Answer 28

Modeled after breastmilk

19-20 kcal/oz

All infants should receive iron-fortified formula

Usually not concentrated

Question 29

Speciality formulas

Answer 29

Preterm/enriched–> 22-30 kcal/oz

Soy-based

Lactose-free

Hypoallergenic

Anti-reflex

Question 30

Vitamin D3 (Cholecalciferol)

Answer 30

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

Question 31

Iron

Answer 31

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

Question 32

Zinc

Answer 32

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

Question 33

Complementary Foods “Do”

Answer 33

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

Question 34

Complementary Foods “Don’t”

Answer 34

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

Question 35

Fluids

Answer 35

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