Pediatric Nutrition and IV Fluids

Question 1

What is the recomendation for breastfeeding?

Answer 1

Exclusively feed baby with mother’s breastmilk for the first six months

Sustained for up to two years or longer with appropriate complementary feeding

Question 2

What are some contraindications for breastfeeding?

Answer 2

• HIV
• Infectious tuberculosis
• Infant has galactosemia

Question 3

What is the benefit of breastfeeding?

Answer 3

Important for the nutrition, immunologic protection, growth, and development of infants and toddlers

Question 4

What are some options if breastfeeding is not possible?

Answer 4

1. Expressed breastmilk from the mother
2. Pasteurized donor milk (from appropriate sources, currently limited to hospitalized infants)
3. Commercial infant formula

Question 5

Should mothers share breastmilk to feed each others children?

Answer 5

It is not recommended to share or use unprocessed or unscreened human milk

Question 6

What are some important tips for recommending infant formula?

Answer 6

1. Formula provides all nutrition
2. Cow-milk based formula recommended
3. Avoid low-iron formula (can cause iron-deficiency in babies after stores run out)
4. Lactose intolerance is extremely rare (so only provide lactose-free formula if baby has been diagnosed)
5. Cow’s milk allergies need to be diagnosed
6. Probiotics are safe, but evidence for benefit is weak

Question 7

What are some considerations for infant formula?

Answer 7

• Refer infants with medical conditions affecting formula choice
• Discourage the use of homemade formula or other milks
• Ensure caregivers can properly prepare and administer formula
• Never leave infants unattended during feeding due to choking hazards

Question 8

What does Vitamin D supplementation look like for infants?

Answer 8

All breastfed infants living anywhere in Canada should receive 400 units daily up to 1 year of life

Question 9

What does iron supplementation look like for infants?

Answer 9

Deficiencies in iron may have serious and irreversible adverse effects

Most infants have sufficient stores until about 6 months of life, then they need to be supplemented via food or iron-fortified food or drops

Question 10

What are the three common types of feeding tubes?

Answer 10

• Nasogastric/Orogastric
• Naso-jejunal
• Gastrostomy/Jejunostomy

Question 11

What are the characteristics of nasogastric/orogastric tubes?

Answer 11

• Inserted through the nasopharynx or mouth, ending in the stomach
• Short to medium term feeding (days to weeks)
• Prioritized for drug administration

Question 12

What are some characteristics of naso-jejunal tubes?

Answer 12

• Inserted through the nasopharynx, ending in the jejunum
• Require endoscopy or radiology to ensure the tube is in the correct position
• Short to medium term use
• Prone to blockage, evidence for using in drug administration is weaker
• Prioritized for nutrition

Question 13

What are some characteristics of gastrostomy/jejunostomy tubes?

Answer 13

• Surgical placement into the stomach via abdominal wall
• Long-term feeding (months to years)
• Patients may have cerebral palsy, seizures, and other metabolic disorders

Question 14

How can drug-food interactions be managed in pediatric patients receiving tube feed?

Answer 14

Work with dietitian to ensure maximal drug delivery (may need to hold feed) while maintaining nutrition requirements

Question 15

What is a good resource to reference for dosing drugs for administration via NJ, G, and J tubes?

Answer 15

Handbook of Drug Administration via Enteral Feeding Tubes (available in USask Library)

Question 16

What is tube occlusion?

Answer 16

• Blocked feeding tubes
• Significant problem for patients with feeding (23-35%)
• Caused by formula and/or medications or tube kinks
• If the tube cannot be unblocked, it needs to be replaced

Question 17

What is drug adhesion in the context of drug-tube compatibility?

Answer 17

• Drug interacts with the tube material and binds, and results in decreased absorption of medication
• Information about which drugs adhere is incomplete, may need to read through primary references or denteral feeding tube handbook

Question 18

How can issues with absorption of drugs delivered via tubes be resolved?

Answer 18

• Use alternate routes of admin (suppository, trandermal, IV, small amounts orally)
• Look into therapeutic alternatives (would a different drug be better)

Question 19

How can issues with tube occulusion be resolved?

Answer 19

• Solutions or soluble tablets are the formulation of choice (dissolve into water and administer into tube)
• Families should be educated on how to flush an occluded tube and when to seek care

Question 20

How can issues with drug adhesion in a feeding tube be resolved?

Answer 20

Consider alternate routes of therapy or other medications that could be used

Question 21

What is the 4-2-1 rule in the context of maintenance fluid regimens in children?

Answer 21

Review slides 22 to 25