Pediatric Nutrition-Israel Flashcards
T/F: Infants have a caloric reserve
False; NEED a constant calorie source
T/F: It is okay for an infant to be NPO
F; must give dextrose IV
Typical infant weight at birth (term)
2-4 kg
Weight _____ by month 6
Doubles
Weight _____ by month 12
Triples
Length of an infant will increase by ____% by month 12
50
Growth for a preschooler (2-6 y/o)
Growth slows, but still increases at a constant rate. Fat stores increase around 2 years old
Growth for a pt that is in middle childhood (7-10 y/o)
Steady growth
Girls > Boys
Growth for a pt in adolescence (11-18 y/o)
Begins before puberty and continues until growth is complete. Rate of weight gain increases
Boys > Girls
T/F: During a growth spurt, the growth matches the growth change in infancy
F; way more growth change in infancy
Which growth charts are used for which ages?
WHO for < 2 y/o
CDC for 2-20 y/o
T/F: Growth is NOT linear
True
Where do neonates expend most of their energy?
In the brain
What is malnutrition?
Excess OR deficiency in nutrient intake
What are we most concerned about for a patient that is chronically undernourished?
Refeeding syndrome
What is a Z-score?
Statistical analysis giving the NUMBER OF STANDARD DEVIATIONS away from the MEAN a value is
What does a Z-score of -4.2 indicate?
The patient is 4.2 standard deviations below the 50th percentile
Requirements to be considered failure to thrive (growth faltering)
- Weight crosses 2 major percentile lines
- Weight is below the 3-5th percentile
Acute causes of malnutrition
Child seriously injured, in ICU and needs TPN
Chronic causes of malnutrition
-Disorders (CF-cannot produce pancreatic enzymes)
-HF (using so much energy just to live life)
What are the 3 underlying causes leading to malnutrition?
- Inadequate caloric intake
- Inadequate absorption
- Excessive energy expenditure
As infants and children age, their calorie/kg requirement will ______.
Decrease
If there are no contraindications, how long should a mother exclusively breastfeed?
First 6 months
*WHO suggests up to 2 y/o
Advantages of breastfeeding for newborn
- Optimal nutrients
- Decreased risk of infection/immune-mediated diseases
- Psychologic/cognitive advantages (oxytocin production/bonding)
Advantages of breastfeeding for mother
- Decreased post-partum bleeding
- Return to pre-pregnancy weight more quickly
- Decreased risk of breast/ovarian cancer
How many kcal per oz are in breast milk?
20 kcal/oz
Breastfeeding contraindications
TB
HIV
T cell lymphotropic virus
Ebola
Illicit drugs
DRUGS THAT MOM IS TAKING
2 main categories for maternal medications to avoid during breastfeeding
- Directly harm the infant (chemo; immunosuppressant)
- Reduce the milk supply (antihistamine bc dries things out)
Characteristics of drugs that increase absorption into breast milk
-Non-ionized
-Small MW
-Low protein binding
-High lipid solubility
-Long half-life (sticking around more, so more likely to get into milk)
-Low Vd (doesn’t have many tissues to go to in mom. so it will go into breast milk)
Indications for formula feeding
-Mothers who do not/cannot breast feed
-Infants with intolerance
-Maternal infection (HIV)
-Maternal chemo
-Infants failing to gain weight
What is added to milk when we fortify it?
-Calories
-Minerals
-Vitamins
-Proteins
How many kcal/oz when milk is fortified?
22-28 kcal/oz
Term formulas contain ____ kcal/oz
19-20
Similar to human milk
T/F: all formulas are the same
False; for example, some are thickened to help prevent GERD
Typical feeding for term, healthy babies
6-9 times/day
Typical feeding for baby breastfeeding
8-12 times/day
Typical feeding for neonates
Q1-2H
With time, frequency will go _____, but volume will go _____
down; up
Which vitamin is cholecalciferol?
Vitamin D3
How is cholecalciferol dosed?
In mcg or IU
What is the conversion for IU to mcg for cholecalciferol?
400 IU = 10 mcg
How much cholecalciferol should a premature neonate receive?
200 IU QD (5 mcg)
How much cholecalciferol should a term infant who is fully/partially breastfed get?
400 IU QD (10 mcg)
How much cholecalciferol should a term infant that is formula fed get?
200-400 IU QD up to 1000 ml/formula/day
Should all infants get iron supplementation?
NO
How much iron should a premature neonate get?
2 mg/kg/day elemental iron
How much iron supplementation should a term infant with an iron deficiency get?
3 mg/kg/day elemental iron
What is the common ferrous sulfate concentration?
75 mg/ml
What is the common concentration of elemental iron?
15 mg/ml
Steps for calculating iron
- Calculate dose based on pt weight and their requirement
- Determine the product (we use 75 mg/ml ferrous sulfate)
- Determine the ml needed of elemental iron (use the 15 mg/ml)
- Convert the elemental form back to salt form using the 75 mg/ml concentration
Is supplementation of zinc routine?
No
Initiating complementary foods
-Start ~6 months
-Try 1 new food Q4-5d
-Increase serving size gradually
-Emphasize all food groups
-NEVER put anything but breast milk/formula in bottle
What should you never give to children < 1 y/o?
-Honey (may cause botulism)
-Cow’s milk
-Choking hazards
-Potential allergen (ex: if family member has PB allergy, give PB in clinic)
Fluid requirements for pts up to 10 kg
100 ml/kg
Fluid requirements for pts 10-20 kg
1000 ml + 50 ml/kg for every kg over 10 kg
Fluid requirements for pts >20 kg
1500 ml + 20 ml/kg for every kg over 20 kg
Required information to calculate feeding
-Age
-Preconceptual age if preterm
-Medical conditions
-Current weight
-# of feedings per day
How many ml are in 1 ounce?
30 ml
Steps to calculate feeding requirement
- Convert weight to kg
- Calculate caloric needs based on chart
- Calculate volume of formula (given in situation)
- Calculate total fluid requirements (minimum fluid goal is 100 ml/kg)
Calculating feeding requirements for pts who are failure to thrive (growth faltering)
Follow the same steps as for a term patient, but use the 50th percentile weight, NOT the patient’s current weight
Short-term routes for non-oral nutrition
NG, ND, NJ, orogastric tube
Long-term routes for non-oral nutrition
PEG, PEJ, surgical jejunostomy, G-tube
