Pediatric Oncology Nutritional Management-Chapter 15

Question 1

What are the most common Childhood

Answer 1

Leukemia
Brain and spinal cord
Neuroblastoma
Wilms tumor
Hodgkin's and Non-Hodgkin's lymphoma
Rhabdomyosarcoma
Retinoblastoma
Bone cancers including
 osteosarcoma and Ewing's sarcoma

Question 2

Because of research in consistencies, usual energy needs per age of children should be assumed, suggesting that the____maybe the MOST APPROPRIATE TOOL for estimating energy needs in NORMAL-WEIGHT children with cancer

Answer 2

DRIs

or Dietary Reference Intakes for estimated energy requirements (EER) for children

Question 3

For children and adolescents less than 20 years of age__________are used to diagnose overweight and obesity

Answer 3

BMI-for-age growth charts

When possible, energy requirements of obese pediatric patients should be accessed via indirect calorimetry

Body mass index should be used to screen children for obesity

Question 4

BMI for age at or above gender-specific_____percentile reflects obesity.

Answer 4

95th percentile

Question 5

A BMI between the_____and the_______percentile reflects an overweight status.

Answer 5

85th and 95th percentile.

Question 6

What type of Childhood Cancer is it common to find obesity in the children, particularly in those who have received cranial irradiation?

Answer 6

Survivors of ALL

Question 7

Are the energy needs of children with cancer greater or less than children without cancer?

Answer 7

The needs of children with cancer may be greater, lower, or similar to the needs of healthy children.

Question 8

What are the four ways that CATCH UP GROWTH is evaluated in children with cancer?

Answer 8

Weight for stature below 5th percentile on the WHO or CDC clinical growth charts

Weight or height deficit of more than 2 percentiles from usual percentile channel on the WHO or CDC growth charts

Weight for length less then 5th percentile or less than 80% of IBW for height per the WHO growth charts

Body mass index less then 5th percentile on the CDC growth charts

Question 9

The children’s oncology group reports that cancer treatment may increase protein needs by what percentage?

Answer 9

50%

Question 10

Albumin and pre-albumin may not always give adequate indications of protein stores what maybe it better an alternate tool to indicate protein status and adequacy of protein intake in children?

Answer 10

Nitrogen balance studies

Question 11

What is the best method for estimating fluid needs and children with cancer?

Answer 11

Holliday Segar method:

1-10 kg. ….100mL x kg

11-20 kg…1000mL for 1st 10kg+50mL/kg/day per kg for each 11-20kg

Over 20 kg…1500mL for 1st 20kg+20mL/kg/day for each kg over 20

Question 12

What is the PROTEIN intake recommendation for boys and girls with cancer?

Answer 12

Age.                Protein intake needed (g/kg/day)
0-6m.             1.52
7-12m.          1.2
1-3 y.               1.05
4-8y.                0.95
9-13y.             0.95
14-18.            0.85

Question 13

Children with which type of pediatric cancers are at the highest nutritional risk

Answer 13

Wilms tumors (stages lll & V, unfavorable history and relapsed disease)

Neuroblastoma (stage 3 & 4)

Metastatic solid tumors

Non-hodgkin lymphoma (stages 3 & 4 and relapsed)

Acute & Chronic Myelogenous leukemias (new & relapsed)

Medulloblastoma and other brain tumors

Question 14

Pediatric cancers with the lowest nutritional risk

Answer 14

Acute lymphocytic leukemia with good prognosis

Non-metastatic solid tumors

Advanced diseases in remission during maintenance treatment

Question 15

A suggested criteria of monitoring the degree of malnutrition in children is to use the anthropometry in relation to reference curves using Z SCORES.

What Z scores indicate mild, moderate and severe malnutrition?

Answer 15

Mild malnutrition (z score

Question 16

One way to evaluate children for nutritional risk is to use anthropometric measurements. An important part of this is to valuate growth. What are the best ways to evaluate growth in children?

Answer 16

Use BMI standards to assess weight

Use 2006 WHO charts to assess and track growth of children up to 2 years of age, and this should be measured in the Supine position for LENGTH

Children ages 2 years old to 20 years old should be evaluated using the 2000 CDC charts to assess and track growth measured via standing HEIGHT

Finally, use Z scores and consider a decrease of more than one Z score problematic

Question 17

What are the daily vitamin D requirements for children between the ages of one month and 18 years?

Answer 17

1 months to 12 months. 400 IU

1 to 13 years. 600 IU

14 to 18 years. 600 IU

Question 18

What are the calorie and protein needs of a pediatric patient with HSCT?

Answer 18

Age. Calorie. Protein
0-12m. BMR x 1.6-1.8. 3g
1-6 y. BMR x 1.6-1.8. 2.5 -3
7-6 y. BMRx 1.4-1.6. 2.4g
11- 14 y. BMRx 1.4-1.6. 2g
15-18y. BMRx 1.5-1.6. 1.8g
19+y. BMR x 1.5. 1.5g

Question 19

How much calcium should children during cancer treatment have?

Answer 19

0-6 mo.  200mg
7-12 no.  260mg
1-3 yr.      700mg
4-8 yr.      1000mg
9-18 yr.   1300 mg
1500 mg If osteoporosis  corticosteroids