Pediatric Nutrition Flashcards
What are 2 normal types of slow growth?
a) constitutional growth delay (delayed bone age)
b) genetic short stature (appropriate bone age)
What is failure to thrive? What are two ways it might manifest in older children? What are 4 major categories? What are two other possibilities?
Usually applied to infants or toddlers < 3 years old not gaining adequately
Older children may be:
a) stunted ? low ht/age
b) wasted ? low wt/ht
- inadequate caloric or nutrient intake
- malabsorption of nutrients
- inefficient or inappropriate metabolism of nutrients
- inflammation
Psychological deprivation (non-organic failure to thrive)
- find lack of a nurturing environment
(but)
- watch for occult oral-motor disorders
What protein needs does an infant have? What purpose do they serve?
- Protein requirements
Structural function, not energy source
May be limiting nutrient
Best utilization requires adequate energy
intake
Essential amino acids: PTT Val, HILLM
Also essential for infants:
tyrosine, cysteine, taurine
What carb needs does an infant have? What purpose do they serve? What does deficiency lead to? Excess?
Function: energy source
Allows protein to serve a structural function
Deficiency: ketosis
Excess: malabsorption, diarrhea
What fat needs do infants have? What purose do they serve?
Allows for energy storage (unlimited space)
Vehicle for fat-soluble nutrient absorption
(A, D, E, K)
Provides essential fatty acids:
Cannot be synthesized in animals
Linoleic (18:2 n6)
Linolenic (18:3 n3)
Substrates for arachadonic acid (AA) and
docosahexaenoic acid (DHA)
Describe how breastmilk changes based on baby’s age?
a) colostrum: produced in the first several days, lower
in fat and energy, higher in protein
b) transition milk: produced 7-14 days postpartum, lower
in Ig?s and rising lactose, fat, calories
c)mature milk: produced from 2 weeks to 7-8 months
Aside from energy sources, what are some important components of breastmilk? What are some possible deleterious ones?
Immunoglobulins (sIgA)
Lactoferrin
Lysozyme, peroxidase
Bile-salt stimulated lipase
Other enzymes, growth
factors, nucleotides, and
cellular constituents
Drugs
Lithium
Chemotherapy
Others
Infectious Agents
HIV
HSV
What vitamins and minerals should be supplemented for infants and when should that start?
Vit K Neonate
Vit D Neonatal
Iron 4- 6 mos
Fluoride 6 mos
Why is vitamin D important? Where do we get it from? Why does it need to be supplemented?
A hormone (also considered a vitamin) required for calcium and phosphorus homeostasis.
Sources: diet or synthesized in skin from UV exposure
Breast milk is low in vitamin D.
Skin synthesis dependent on latitude, time of year, skin pigment.
Supplementation recommended since we are no long an ?outdoor
species.?
Why is iron important for infants? When should it be supplemented? Why? How should it be supplemented?
Healthy newborns born with 4-6 month supply
Fe deficiency is common in pediatrics
Fe is important for neurological and hematological development
Breast Milk
low in iron, high in bioavailability (lactoferrin)
Breast fed infants are in a negative iron balance.
Many recommend supplements of 7 mg/d beginning at 0-4months
Some authorities just want iron containing foods by 4-6mo.
Formula
No good reason to use ?low iron? formula
What does flouride do? When should it be supplemented?
Fluoride ? formerly classified as a micronutrient;
reclassified as ?beneficial element for humans?
Probably strengthens teeth by direct contact with erupted enamel
in the mouth; however, too much can harm developing teeth
(fluorosis).
Recommendations:
After tooth eruption
Varies with location and source of water for the family
What are the recommendations for fruit juice consumption? What is it associated with?
Avoid consumption of more than 12 oz per day
Associated with dental caries, chronic diarrhea, FTT
Limited amount may be useful for constipated infants
When and how do food allergies present? What are the 6 most common?
Usually presents in the first 4 months
Presents with vomiting, diarrhea, eczema or wheezing
Mimics GERD
Other common food allergens:
egg white wheat soy peanuts, nuts corn fish
Why should whole cow’s milk not be used to feed infants?
WCM not balanced for infant human consumption
Low in iron, and promotes GI blood loss
High renal solute load
Increased incidence of allergic reactions when used
under 1 year of age
What is the recommendation for using goat’s milk for infant nutrition? Why?
Unsupported belief that goat?s milk less allergenic than cow?s milk or cow milk-based formula or soy formula
Renal solute load is even greater than that of cow?s milk (340 mOsm/L vs 298 mOsm/L) ? risk of dehydration and acidosis
Very low in folate ? risk of megaloblastic anemia
Recommendation: Don?t use goat?s milk for infant nutritional support.
