Pediatric Nutrition Flashcards
Infant weight double by _______
4 -6 months
Infant weight triples by ______
12 months
Infant length increase 50% by _______
12 months
Do babies store a lot of calories?
NO - therefore they need to be given more calories - they are mainly water
Do babies have higher or lower metabolic rates
higher
Ways to define pediatric malnutrition
- Anthropometry (WHO charts /z-scores if less than 2 years old, MUAC)
- Etiology/Chronicity
- Mechanism
- Imbalance of nutrients
- outcomes
At Preschool Age (4 - 6 yo):
______ tissue distribution begins after age 2
ADIPOSE
At Preschool Age (4 - 6 yo):
Growth ______ but is ______
slows, constant
At Middle Childhood: ( 7 - 10 yo)
- Steady growth
- Females _(> or
> (females are bigger than males at this age normally)
Assessing growth:
Goal = child to be AT or ABOVE the ____ percentile
50th
2 signs that there is “failure to thrive”
- fall of 2 major percentiles
- weight < 3 - 5th percentile
If no contraindications: Breastfeeding is recommended…
- Exclusively for the first ________
- optimal to continue for at least _______
- May go beyond _______ if desired
6 months; 1 year; 1 year
Breastfeeding Advantages:
For newborn and For mother
Newborn: OPTIMAL NUTRIENTS; decrease risk of infection and decrease risk of immune mediated diseases; psychological and cognitive advantages
Mother: Lose “baby” weight faster; decrease post partum bleeding; decrease risk of breast and ovarian cancer; increases “child spacing”; mother-infant bond
Contraindications for breastfeeding
Infections (Maternal HIV positive status; Infectious TB; Human T-Cell lymphotrophic virus, bruecllosis)
OR
Certain drugs
2 main drug categories for breastfeeding mothers to avoid
- drugs that will DIRECTLY harm the baby (immunosuppresants, chemotherpay, lithium, amphetamines, radioactive agents)
- drugs that will decrease milk production (Antihistamines, decongestants, Ergots)
Examples of drugs that will directly harm baby (important for breastfeeding mothers to avoid these drugs)
immunosuppresants, chemotherpay, lithium, amphetamines, radioactive agents
Examples of drugs that will decrease milk production (important for breastfeeding mothers to avoid these drugs)
Antihistamines, decongestants, Ergots
“Pharmacokinetics” of breastfeeding - will it get into the breast milk?
- if the drug has a high molecular weight
less will be in breast milk
“Pharmacokinetics” of breastfeeding - will it get into the breast milk?
- if the drug has high lipid solubility
lots in breastmilk then (bc breastmilk is very lipophilic)
“Pharmacokinetics” of breastfeeding - will it get into the breast milk?
- if the drug has high protein binding
less can get into breastmilk
“Pharmacokinetics” of breastfeeding - will it get into the breast milk?
- if the drug has a high volume of distribution
less will be in milk
“Pharmacokinetics” of breastfeeding - will it get into the breast milk?
- if the drug has short half life
less will be in milk
Caloric density of breast milk
20 kcal/oz = 20 kcal/ 30 ml
Lipid components of breast milk: notable factors
lipids are 50% of breast milk; breast milk has long chain fatty acids in it which are important for neural/retinal development
Protein components of breast milk: notable factors
70% whey; 30% casein
whey vs casein:
which one helps with gastric emptying and which one is easier to digest
whey - easier to digest;
casein - helps with gastric emptying
Carbohydrate components of breast milk: notable factors
lactose - helps baby grow “good bacteria” in its gut!
What 2 things are typically supplement to babies (newborns or term infants)
Vitamin D and Iron
What to supplement a term infant
vitamin D (not iron though)
what is a human milk fortifier
it is added to breast milk when breast milk is not adequately meeting the nutritional needs of a preterm infant - it will calories/vitamins and protein
How does a human milk fortifier comes in what form
liquid or powder
Indications for formula feeding
- substitute/supplement feeds for mothers who do not/cannot breastfeed
- infants that cant tolerate human milk
- mother chemotherapy
- maternal infection that can be transferred
- infants failing to gain weight despite optimization of breastfeeding
Characteristics of formula for Term babies
- modeled after breast milk ~ 20 kcal/oz - lactose is carb source - has COWS MILK PROTEIN - Vit. D supplementation NOT needed - get iron-fortified formula
Downsides of using formula
- will not have the long chain fatty acids
- no immune benefits
Types of speciality formulas
- soy based
- lactose free
- hypoallergenic/ non-allergenic
- antireflux
When to start introducing foods
4 - 6 months
How to introduce new foods to an infant
- start with SINGLE ingredient foods
- do new food q4 - 5 days
- emphasize all food groups
- gradually increase serving size
The “Dont’s” of introducing new foods to a baby
- dont put anything other than formula/breast milk in a bottle
- If under a year do NOT give them honey, cow’s milk (not exclusively); choking hazard foods, potential allergens (strawberries, egg yolk)
Calculating fluid requirements for a infant:
If up to 10 kg:
100 mL/kg
Calculating fluid requirements for a infant:
If 10 - 20 kg
1000 mL + (50 mL/kg for every kg greater than 10 kg)
Calculating fluid requirements for a infant:
> 20 kg
1500 mL + (20 mL/kg for every kg greater than 20 kg)
What information is needed for calculating feeding requirements
age; IF preterm or not; underlying medical conditions; current weight; number of feedings a day
Steps to calculating feeding requirement
- get weight (in kg)
- Calculate kcal needs
- Calculate total fluid requirements
- Use the formula conversion (20 kcal/30 mL) to calculate how much formula is needed (fluid amount can be over calculate fluid requirement)
How to calculate feeding requirement for a “failure to thrive” infant
- use the 50th percentile WEIGHT you WANT them to be at
- use that weight to find calories per day
When/why do we use Enteral and Parenteral nutrition for infants
- consumption issues (no coordination)
- digestion issues
- high energy needs
- poor growth
- malnutrition
