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M2 GI/Nutrition > Pediatric Nutrition - Van Hoorn & Crouse > Flashcards

Pediatric Nutrition - Van Hoorn & Crouse Flashcards

1
Q

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?

A

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.

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2
Q

How many calories should a pregnant woman eat per day if she weighs:

  1. Ideal (normal) Body Weight
  2. >120% IBW
  3. <90% IBW
A
  1. 30 kcal/kg
  2. 24 kcal/kg
  3. 36-40 kcal/kg

Recall: One dietary calorie (_C_alorie) = one kcal.

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3
Q

When are prenatal vitamins recommended for a pregnant woman?

A

Always!

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4
Q

Why is sufficient iron intake important for a pregnant woman?

A
  • Prevents anemia
  • Supports fetal growth
  • Allows production of additional blood
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5
Q

What sources of iron are recommended for a pregnant woman?

A
  • Lean beef / pork
  • Whole grains
  • Dark leafy greens
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6
Q

Name two notable micronutrients that influence iron absorption.

A
  • Vitamin C improves absorption
  • Calcium can block absorption

[OJ seems like a double-edged sword…]

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7
Q

Why is folic acid important for a pregnant woman?

What are recommended sources of folic acid for a pregnant woman?

A

Decreased risk of birth defects

Sources:

  • Fortified grains
  • Beans
  • Dark leafy greens
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8
Q

Why is calcium important for a pregnant woman?

A
  • Prevents bone loss (in mother)
  • Improves fetal bone growth
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9
Q

What are recommended sources of calcium for pregnant women?

A
  • Dairy products
  • Fortified orange juice
  • Fish with bones
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10
Q

What is the recommended weight gain for a mother with a baseline BMI of:

  1. <18.5
  2. 18.5-24.9
  3. 25-29.9
  4. >30
A
  1. 28-40 lb
  2. 25-35 lb
  3. 15-25 lb
  4. 15 lb
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11
Q

What are three complications related to overweight or obesity during pregnancy?

A
  1. Gestational diabetes
  2. Macrosomia (excessive birth weight of the newborn)
  3. Eclampsia
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12
Q

What is a notable eating disorder seen in some pregnant women?

A

Pica

An eating disorder characterized by an appettie for non-food materials, such as dirt, paper, clay, sand, glass [yikes], etc.

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13
Q

Why are pregnant women recommended to limit fish consumption?

Which fish as especially cautioned against?

A

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
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14
Q

Which foods should be avoided by pregnant women to reduce the risk of listeriosis?

A
  • Soft cheeses
  • Raw fish (sushi)
  • Deli meats
  • Unpasteurized milk
  • Smoked seafood
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15
Q

Name some benefits of breastfeeding over formula.

A
  • 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
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16
Q

What macronutrient recommendations are given to a woman who is breastfeeding?

A
  • 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
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17
Q

What micronutrient recommendations are given to breastfeeding women?

A

Continue taking a prenatal vitamin!

  • Calcium: 1,000 mg/day
  • Folic acid: 500 µg/day
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18
Q

What growth chart should be used for premature infants?

A

Fenton 2003

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19
Q

What growth chart should be used from birth to 24 months for a generally healthy infant?

A

WHO growth charts

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20
Q

What growth chart should be used from 2-20 years old for generally healthy children?

A

CDC growth charts

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21
Q

What specific metric is followed using the CDC growth chart?

What percentile is defined as overweight?

Obese?

A

Metric: BMI

Overweight: 85-95%ile BMI-for-age

Obese: >95%ile BMI-for-age

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22
Q

When is the Down Syndrome growth chart recommended?

A

Apparantly, this growth chart has fallen out of favor.

It is no longer recommended for use.

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23
Q

When should the Brooks specialty growth charts be used?

A

For a child with cerebral palsy.

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24
Q

What are the macronutrient requirements of infants?

(% CHO, % protein, % fat)

A

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.

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25
Q

What supplementary micronutrients are given **directly **to infants, and when?

A
  • 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
26
Q

Compare the cause and the general pathology of Kwashiorkor with that of Marasmus.

A

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
27
Q

How long should breast milk and/or formula be the sole source of nutrition for an infant?

A

For the first 6 months of life

28
Q

What is the most common cause of dental caries (cavities / tooth decay) in infants?

A
  • Cavities:
    • Use of a bottle or sippy cup while sleeping
    • Unchecked intake while awake with liquids other than water (esp. juice!)
29
Q

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?

A

GER (Gastroesophageal reflux)

Only considered GERD (Disease) if the reflux is accompanied by symptoms and complications (i.e., inadequate growth).

30
Q

How should an infant’s first food be chosen?

A
  • Foods that help to meet both energy and micronutrient needs
    • Iron-fortified cereals
    • Pureed meats
31
Q

How quickly should foods be introduced?

A

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)

32
Q

What recommendations are given for drinking juice in infants?

A
  • 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
33
Q

What recommendations are given for milk drinking in infants?

A
  • Not before 12 months of age
  • Only whole cow’s milk should be offered
34
Q

What stooling pattern is typical for breastfed infants?

For formula-fed infants?

A
  • Breastfed:
    • 3-4 per day
    • Soft
    • Medium-sized
    • Yellow
  • Formula fed:
    • Less frequent
    • Firmer
    • Tan-colored
35
Q

How does stooling pattern change with age?

A

As the infant ages, the volume of stools increases as the frequency decreases.

36
Q

What are some red flags to watch for in terms of infant feeding problems?

A
  • 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
37
Q

What macronutrient distribution is recommended for toddlers through adolescence?

(% CHO, % fat, % protein)

A
  • 50-60% CHO
  • 10-15% protein
  • 25-30% fat

Similar to adult distribution, with ~5% more fat & ~5% less protein.

38
Q

In terms of children and adolescents, which four populations are at the most risk of protein deficiency?

A
  • Dieters
  • Athletes who restrict intake
  • Vegetarians
  • Those with food allergies
39
Q
  1. What are two benefits of adequate dietary fiber?
  2. How much dietary fiber is needed for a 6-12mo old?
  3. How much is needed for children older than 2 years?
A
  1. Benefits:
    • Prevents constipation
    • Protects against heart disease
  2. 6-12 months: gradually increase to 5g/day by 1st birthday
  3. >2 years: (child’s age + 5g) per day
40
Q

Calcium is critical during adolescence to achieve peak bone mass. Name three eating habits in adolescents that present a risk for inadequate calcium intake.

A
  1. Low milk intake
  2. High soda intake
  3. Low vitamin D
41
Q

What are benefits of adequate Vitamin D intake?

A
  • Bone health
  • Disease prevention
    • Cancer
    • Autoimmune
    • Infectious
42
Q

How much Vitamin D is required early in life? After that?

At what point does the amount switch?

A
  • 400 IU/day for first 12 months of life
    • Remember: Starts with the first day of life
  • 600 IU/day after 12 months
43
Q

What eating habits in childhood / adolescence present a risk for iron deficiency?

What are possible effects of iron deficiency?

A

Habits:

  • High milk volume (recall: calcium limits absorption)
  • Poor intake of solids
  • Dieting

Effects:

  • Poorer cognitive performance
  • Delayed psychomotor development
44
Q

Disregarding raw amount, why are sources of iron like meat, fish, and poultry better than sources like vegetables or grains?

A

Heme-iron sources are better absorbed than non-heme sources.

45
Q

What groups of children / adolescents are at risk of micronutrient deficiencies, and may require vitamin-mineral supplementation?

A
  • 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
46
Q

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?

A
  • Offer 1 tablespoon of each food for every year of age
  • May need to eat 4-6 times per day
47
Q

Fussy eater problem solving time!

What are some possible solutions to a child that:

Refuses meat

A
  • Offer smaller pieces
  • Include with other foods
  • Offer legumes, eggs, cheese, tuna
48
Q

Fussy eater problem solving time!

What are some possible solutions to a child that:

Drinks too LITTLE milk

A
  • Offer cheese and yogurt
  • Use a straw!
    • [Bonus points for crazy straws]
49
Q

Fussy eater problem solving time!

What are some possible solutions to a child that:

Drinks too MUCH milk

A
  • Offer water if thirsty
  • Wean from bottle
  • Limit milk to one serving per meal
50
Q

Fussy eater problem solving time!

What are some possible solutions to a child that:

Refuses fruits / vegetables

A
  • Offer sauces and dips
  • Include in soups / casseroles
  • Prepare tender, but not overcooked
  • Continue to offer every other week
51
Q

Fussy eater problem solving time!

What are some possible solutions to a child that:

Eats too many sweets

A
  • Limit availability in the home
  • Avoid using as bribes or reward
  • Incorporate small amounts with meals
52
Q

What are some potential food intake issues unique to school-aged children (6-12 years)?

A
  • After-school snacks
  • Fewer family meals
  • Meals at friend’s houses
  • Start to skip breakfast
  • Preparing their own convenience foods
53
Q

What are some potential food intake issues unique to adolescents?

A
  • Frequent meal skipping (breakfast, lunch)
  • Regular snacking
  • High fast food intake
  • There is potential for disordered eating with:
    • Vegetarianism
    • Athletes
    • Eating disorders
54
Q

What does “lacto-ovo” specifiy as far as diets go?

A

Lacto-ovo means a person (say a vegetarian) includes dairy and eggs (and typically fish as well) in their diet.

55
Q

What micronutrients are important to assure adaquate intake of for a adolescent following a restrictive vegetarian diet?

A
  • 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.)

56
Q

Name six medical complications that can result from

anorexia nervosa

A
  • Amenorrhea
  • Bradycardia
  • Abnormal EKG
  • Fatigue
  • Dizziness
  • Hypercholesterolemia
57
Q

What are four medical complications that can result from

bulimia nervosa?

A
  • Constipation & laxative dependency
  • Dehydration
  • Electrolyte abnormalities
  • GI complications from frequent vomiting
    • Esophagitis
    • Reflux
    • Gastritis
58
Q

What special considerations should be made for adolescent athlete in terms of:

  1. Caloric intake?
  2. Vitamin/mineral supplementation?
A
  1. Likely need more calories than average adolescent
  2. The normal RDA should be sufficient, even for athletes
59
Q

What special considerations are there for adolescent athletes regarding protein intake?

A
  • May require 50-150% more than the RDA
  • Discourage protein supplements
    • Dehydrations
    • Weight gain
    • Ca2+ loss
    • Kidney & Liver stress
60
Q

What special considerations are there for adolescent athletes regarding water intake?

A
  • Need 16oz. water for each pound of weight lost
  • Sports drinks are not needed for workouts less than 60min

M2 GI/Nutrition (43 decks)

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