Pediatric Nutrition - Van Hoorn & Crouse Flashcards
What distribution of macronutrients (% CHO, % protein, & % fat) is recommended for a pregnant woman as opposed to a non-pregnant woman?
What about straight caloric intake between pregnant and non-pregnant women?
Macronutrient distribution is essentially the same between pregnant and non-pregnant women:
- 50-60% CHO
- 15-20% protein
- 25-30% fat
However, pregnant women are advised to increase their calorie level overall.
How many calories should a pregnant woman eat per day if she weighs:
- Ideal (normal) Body Weight
- >120% IBW
- <90% IBW
- 30 kcal/kg
- 24 kcal/kg
- 36-40 kcal/kg
Recall: One dietary calorie (_C_alorie) = one kcal.
When are prenatal vitamins recommended for a pregnant woman?
Always!
Why is sufficient iron intake important for a pregnant woman?
- Prevents anemia
- Supports fetal growth
- Allows production of additional blood
What sources of iron are recommended for a pregnant woman?
- Lean beef / pork
- Whole grains
- Dark leafy greens
Name two notable micronutrients that influence iron absorption.
- Vitamin C improves absorption
- Calcium can block absorption
[OJ seems like a double-edged sword…]
Why is folic acid important for a pregnant woman?
What are recommended sources of folic acid for a pregnant woman?
Decreased risk of birth defects
Sources:
- Fortified grains
- Beans
- Dark leafy greens
Why is calcium important for a pregnant woman?
- Prevents bone loss (in mother)
- Improves fetal bone growth
What are recommended sources of calcium for pregnant women?
- Dairy products
- Fortified orange juice
- Fish with bones
What is the recommended weight gain for a mother with a baseline BMI of:
- <18.5
- 18.5-24.9
- 25-29.9
- >30
- 28-40 lb
- 25-35 lb
- 15-25 lb
- 15 lb
What are three complications related to overweight or obesity during pregnancy?
- Gestational diabetes
- Macrosomia (excessive birth weight of the newborn)
- Eclampsia
What is a notable eating disorder seen in some pregnant women?
Pica
An eating disorder characterized by an appettie for non-food materials, such as dirt, paper, clay, sand, glass [yikes], etc.
Why are pregnant women recommended to limit fish consumption?
Which fish as especially cautioned against?
Want to limit mercury ingestion - teratogenic
Especially avoid **large, predatory **fish (biomagnification of mercury levels in the higher levels of the food chain)
- Shark
- Swordfish
- King mackerel
- Tilefish
- Albacore tuna
Which foods should be avoided by pregnant women to reduce the risk of listeriosis?
- Soft cheeses
- Raw fish (sushi)
- Deli meats
- Unpasteurized milk
- Smoked seafood
Name some benefits of breastfeeding over formula.
- Abs in milk aid the baby’s immune system
- Better digested, less gas & constipation
- Linked to decreased risk for ovarian & breast cancer
- (In the mother, I assume?)
- Less expensive
- Improves mother/child bonding
- Burns calories
What macronutrient recommendations are given to a woman who is breastfeeding?
- Breastfeeding burns 200-500 kcal/day
- Keep in mind for daily caloric intake
- Eat wide variety of foods
- Focus on protein sources
- Additional fluids are necessary - dehydration risk
What micronutrient recommendations are given to breastfeeding women?
Continue taking a prenatal vitamin!
- Calcium: 1,000 mg/day
- Folic acid: 500 µg/day
What growth chart should be used for premature infants?
Fenton 2003
What growth chart should be used from birth to 24 months for a generally healthy infant?
WHO growth charts
What growth chart should be used from 2-20 years old for generally healthy children?
CDC growth charts
What specific metric is followed using the CDC growth chart?
What percentile is defined as overweight?
Obese?
Metric: BMI
Overweight: 85-95%ile BMI-for-age
Obese: >95%ile BMI-for-age
When is the Down Syndrome growth chart recommended?
Apparantly, this growth chart has fallen out of favor.
It is no longer recommended for use.
When should the Brooks specialty growth charts be used?
For a child with cerebral palsy.
What are the macronutrient requirements of infants?
(% CHO, % protein, % fat)
Needs are reflected in the composition of breastmilk:
- 40-50% CHO
- 40-50% fat
- 10% protein
N.B. Formula is made to mimic the components of breastmilk.
What supplementary micronutrients are given **directly **to infants, and when?
-
Vitamin K
- Single prophylactic dose given shortly after birth (intramuscular)
-
Iron
- For breastfed infants, give a supplement by 6mo of age (can be in the form of iron-rich food)
-
Vitamin D
- For breastfed infants, start a supplement shortly after birth
Compare the cause and the general pathology of Kwashiorkor with that of Marasmus.
Kwashiorkor
- Muscle wasting masked by edema
- Caused by lack of adaquate protein in the diet
Marasmus:
- Wasted appearance and diminished subQ fat stores
- Caused by overal lack of adaquate energy intake
How long should breast milk and/or formula be the sole source of nutrition for an infant?
For the first 6 months of life
What is the most common cause of dental caries (cavities / tooth decay) in infants?
- Cavities:
- Use of a bottle or sippy cup while sleeping
- Unchecked intake while awake with liquids other than water (esp. juice!)
What condition is:
- Common in newborns
- Usually resolves with lower volume/more frequent feedings, position changes, and maturation of infant’s GI tract
- Painless and does not affect the infant’s growth?
When is this condition actually considered harmful?
GER (Gastroesophageal reflux)
Only considered GERD (Disease) if the reflux is accompanied by symptoms and complications (i.e., inadequate growth).
How should an infant’s first food be chosen?
- Foods that help to meet both energy and micronutrient needs
- Iron-fortified cereals
- Pureed meats
How quickly should foods be introduced?
Introduce new, single-ingredient foods no sooner than 2-3 days apart to watch for possible allergic reactions.
(Remember: Introduce first foods around 6mo of age)
What recommendations are given for drinking juice in infants?
- Only after 6 months of age!
- Limit to 4oz or less per day
- Only in an open cup
- Helps to limit drinking - bottle or sippy cup is too easy to drink from
What recommendations are given for milk drinking in infants?
- Not before 12 months of age
- Only whole cow’s milk should be offered
What stooling pattern is typical for breastfed infants?
For formula-fed infants?
- Breastfed:
- 3-4 per day
- Soft
- Medium-sized
- Yellow
- Formula fed:
- Less frequent
- Firmer
- Tan-colored
How does stooling pattern change with age?
As the infant ages, the volume of stools increases as the frequency decreases.
What are some red flags to watch for in terms of infant feeding problems?
- Consume too little or too much
- Feeding too quickly or too long
- Feeding not on a typical schedule
- Having difficulty successfully transitioning to new / appropriate textures for age
What macronutrient distribution is recommended for toddlers through adolescence?
(% CHO, % fat, % protein)
- 50-60% CHO
- 10-15% protein
- 25-30% fat
Similar to adult distribution, with ~5% more fat & ~5% less protein.
In terms of children and adolescents, which four populations are at the most risk of protein deficiency?
- Dieters
- Athletes who restrict intake
- Vegetarians
- Those with food allergies
- What are two benefits of adequate dietary fiber?
- How much dietary fiber is needed for a 6-12mo old?
- How much is needed for children older than 2 years?
- Benefits:
- Prevents constipation
- Protects against heart disease
- 6-12 months: gradually increase to 5g/day by 1st birthday
- >2 years: (child’s age + 5g) per day
Calcium is critical during adolescence to achieve peak bone mass. Name three eating habits in adolescents that present a risk for inadequate calcium intake.
- Low milk intake
- High soda intake
- Low vitamin D
What are benefits of adequate Vitamin D intake?
- Bone health
- Disease prevention
- Cancer
- Autoimmune
- Infectious
How much Vitamin D is required early in life? After that?
At what point does the amount switch?
-
400 IU/day for first 12 months of life
- Remember: Starts with the first day of life
- 600 IU/day after 12 months
What eating habits in childhood / adolescence present a risk for iron deficiency?
What are possible effects of iron deficiency?
Habits:
- High milk volume (recall: calcium limits absorption)
- Poor intake of solids
- Dieting
Effects:
- Poorer cognitive performance
- Delayed psychomotor development
Disregarding raw amount, why are sources of iron like meat, fish, and poultry better than sources like vegetables or grains?
Heme-iron sources are better absorbed than non-heme sources.
What groups of children / adolescents are at risk of micronutrient deficiencies, and may require vitamin-mineral supplementation?
- Anorexia, poor diet, fad diets
- Chronic disease (CF, IBD, liver disease)
- Deprived, abused, or neglected children
- Diet restriction to manage obesity
- Failure to Thrive
- Food allergies
- Omit food groups
What is the rule of thumb regarding the amount of food to give to toddlers / preschoolers?
How often do children in this age group need to eat?
- Offer 1 tablespoon of each food for every year of age
- May need to eat 4-6 times per day
Fussy eater problem solving time!
What are some possible solutions to a child that:
Refuses meat
- Offer smaller pieces
- Include with other foods
- Offer legumes, eggs, cheese, tuna
Fussy eater problem solving time!
What are some possible solutions to a child that:
Drinks too LITTLE milk
- Offer cheese and yogurt
- Use a straw!
- [Bonus points for crazy straws]
Fussy eater problem solving time!
What are some possible solutions to a child that:
Drinks too MUCH milk
- Offer water if thirsty
- Wean from bottle
- Limit milk to one serving per meal
Fussy eater problem solving time!
What are some possible solutions to a child that:
Refuses fruits / vegetables
- Offer sauces and dips
- Include in soups / casseroles
- Prepare tender, but not overcooked
- Continue to offer every other week
Fussy eater problem solving time!
What are some possible solutions to a child that:
Eats too many sweets
- Limit availability in the home
- Avoid using as bribes or reward
- Incorporate small amounts with meals
What are some potential food intake issues unique to school-aged children (6-12 years)?
- After-school snacks
- Fewer family meals
- Meals at friend’s houses
- Start to skip breakfast
- Preparing their own convenience foods
What are some potential food intake issues unique to adolescents?
- Frequent meal skipping (breakfast, lunch)
- Regular snacking
- High fast food intake
- There is potential for disordered eating with:
- Vegetarianism
- Athletes
- Eating disorders
What does “lacto-ovo” specifiy as far as diets go?
Lacto-ovo means a person (say a vegetarian) includes dairy and eggs (and typically fish as well) in their diet.
What micronutrients are important to assure adaquate intake of for a adolescent following a restrictive vegetarian diet?
- Vit B12
- Vit D
- Calcium
- Zinc
- Iron
- Long-chain omega-3 fatty acids
- Riboflavin
Consider vitamin and/or mineral supplements (though expanding the diet to include these micronutrients naturally is typically preferred.)
Name six medical complications that can result from
anorexia nervosa
- Amenorrhea
- Bradycardia
- Abnormal EKG
- Fatigue
- Dizziness
- Hypercholesterolemia
What are four medical complications that can result from
bulimia nervosa?
- Constipation & laxative dependency
- Dehydration
- Electrolyte abnormalities
- GI complications from frequent vomiting
- Esophagitis
- Reflux
- Gastritis
What special considerations should be made for adolescent athlete in terms of:
- Caloric intake?
- Vitamin/mineral supplementation?
- Likely need more calories than average adolescent
- The normal RDA should be sufficient, even for athletes
What special considerations are there for adolescent athletes regarding protein intake?
- May require 50-150% more than the RDA
- Discourage protein supplements
- Dehydrations
- Weight gain
- Ca2+ loss
- Kidney & Liver stress
What special considerations are there for adolescent athletes regarding water intake?
- Need 16oz. water for each pound of weight lost
- Sports drinks are not needed for workouts less than 60min
