Pediatric Nutrition Flashcards
What are some unique aspect of infant nutrition?
lack of caloric reserve increased metabolic rate high growth rate icnreased demands from illness dependence/independence
What is used to determine pedatric malnutrition?
anthropometry: the scientific study of the measurements and proportions of the human body.
WHO charts for <2 yrs w z-scores, MUAC
How much does an infant’s weight change in the first 4-6 months of life?
doubles
How much does an infant weight change in the first year?
triples
How much does the infant’s length change in the first year?
increases 50%
Describe child growth for ages 2-6.
growth slows but is constant
adipose tissue distribution begins
Describe child growth for ages 7-10.
steady growth
females > males in ht and wt
Describe child growth for ages 11-18.
Begins before puberty and continues until growth is complete.
Rate of wt gain increases.
What is the best tool for assessing a child’s growth?
grwoth charts for
length
wt
head circumference
What is the goal for a child’s wt assessment?
stay at or above 50th percentile
What is failure to thrive?
in pediatrics when a child’s growth falls 2 major percentiles or weight is <3-5th percentile
How many kcal/kg/d are necessary for a pre-term infant?
100-120+
How many kcal/kg/d are needed for a 0-6 mo infant?
100-110
How many kcal/kg/d are needed for a infant 6-12 mos?
90-100
How many kcal/kg/d are needed for a 1-7 yo?
60-80
How many kcal/kg/d are needed for a 7-12 yo?
50-60
How many kcal/kg/d are needed for a 12-18 yo?
30-50
What are the AAP recommendations for breastfeeding?
exclusive for first 6 mos
optimal to continue for at least 1 yr
may extend beyond 1 yr if desired
What are the adv of breastfeeding for a newborn?
optimal nutrients
decr risk of infx
decr risk of immune-related diseases
psychological and cognitive adv
What are the adv of breastfeeding for a mother?
decr post partum bleeding fasting time to attinment of pre-pregnancy wt decr risk of breast and ovarian cancer incr child spacing mother-infant bond
Contraindiciation to breastfeeding.
material HIV pos-status
infectious TB
Human T-cell lymphotrophic virus type I or II
Untreated brucellosis
Certain drugs
What types of drugs are avoided in breastfeeding?
immunosuppressants, chemotherapy, lithium, amphetamines, radioacive agents, etc.
drugs that reduce milk production: ergots, decongestants
What drug characteristics make it less likely to be presnt in breast milk?
high MW low lipid solubility high protein binding high volume of distribution short t1/2
How many times will term, healthy infants feed a day?
6-9 ties
What is the caloric density of breast milk? **
20 kcal/oz
What are the components of breastmilk?
lipids are 50% of calories:long-chain FAs
protein: 70/30 whey/casein
carb: lactose
What supplements are necessary for premature neonates?
Vitamin D:
<1.5 kg: 200 U/d
>1.5 kg: 200-400 U/d
Iron: 2 mg/kg/day (elemental)
What supplements are necessary for term infants?
Vitamin D: partially or fully breastfed: 400 IU daily
iron: not indicated for breastfed, healthy infants
What is the additional calori content added to human milk by fortifiers?
24 kcal/oz for 1 pk per 25 mL
22 kcal/oz for 1 pk per 50 mL
What are indications for formula feeding?
- substitute or supplement feeds for mother who do not or cannot breastfeed
- human milk intolernace
- maternal infection transmittable
- maternal chemotherapy
- failing to gain wt despite optimization of breastfeeding
What are the nutrtional contents of term formulas?
20kcal/oz, 19 kcal/oz
carb: lactose
cow milk protein
Vit D supp not needed
–>all should get iron fortified
Describe pre-term formulas.
more calorie dense:
24 kcal/oz
available as ready-to-feed bottles
$$
Describe enriched formulas.
more calorie dense: 22kcal/oz
liq or pulv
What are examples of specialty formulas?
soy-based
lactose-free
hypoallergenic or non-allergenic
antireflex
How are transitional formulas used?
for premature infants being discharged home from the hopsital
- designed for initiation at 1800g or 34 weeks PCA
- d/c at 52-56 weeks PCA
- usually 22 kcal/oz
when and how should formula be concentrated?
pre-term already conc’d
for TERM formulas decr amt of water to incr caloric content–> families should not do this on their own
When are complementary foods initated for infants?
btw 4-6 mo
introduce single ingredient foods first
How should complementary foods be introduced to an infant?
introduce 1 new food q4-5 d
increase serving size gradually
emphasize all food groups
What should not be done when iniating complementary foods in infants?
never put anything but breast milk or formula in a bottle -don't give <1 yr: honey cow's milk choking hazards potential allergens
Describe the Holliday-Segar method of calculating child fluid requirements.
<10 kg: 100 mL/kg
10-20 kg: 1000mL + 50 ml/kg for kg>10
>20 kg: 1500 mL + 20 mL/kg for q kg >20
What would be the amt of maintenance fluids for a 14 kg child?
1200 mL/24 hrs
What would be 1.5x the mainteance fluids for a 25 kg child?
2400 mL/24hrs
How should feeding reqs in a failture to thrive child be calculated?
use catch-up grwoth plan
for caloric need use 50th percentile wt
multiply desired wt by kcal/kg/d for age to get the new daily req
Which ped pts are candidates for nutritional supplementation?
ability to eat but stunted growth/devo oral aversions/picky eaters -req specialized diet -delayed intro of oral feeding -unpleasant oral-tactile situations
Define pre-term.
<37 wks gestational age.
