Pediatrics Flashcards
Essential amino acids obtain from diet
Histidine-for growth
Taurine-for vision&hearing
Carbohydrates
50% of total calories
Lactose primarily
Preterm, African American , Asian lactase deficient
Lipids
Do not restrict fats
Needed for rapid brain development
In first 2 years
Linoleic acid needed
DHA, ARA polyunsaturated fatty acids
For brain and eye development, especially for premature
Galactooligosaccarides
Good for beneficial flora growth
May increase diarrhea, flatulence
Preterm supplementation
Give multivitamin and minerals
Vitamin D
400 IU/day
Concern if 3rd birth
Dark skin
Sun exposure
Iron
Deficient at 1 year old.
Fe stores exhausted at 6 months
Give iron-fortified cereal/elemental
VitC enhances Fe absorption
Breastfeed
Exclusively for first 6 months
Mother child bond
Better school performance
Cost effective
Decrease risk of obesity, diabetes, asthma, cancer, infections
IgA, lactoferrin, lysozymes
Risk transmission of drugs&diseases
Milk based formulas
Nonfat cow milk
Vegetable oil (corn, sunflower for better fat absorption)
Lactose CHO
Soy based formula
Vegetarian families
Lactose intolerant
IgE allergy to cows milk
High renal solute load
Aluminum may lead to osteopenia
Manganese may lead to neuro sympts
Not for protein induced enteropathy, preterm infants, cystic fibrosis
Pre-thickened milk based formula
Infants with GERD
Thickened with maltodextrin and amylopectin
100x viscous in stomach to keep contents in stomach
Can give H2RA or PPI
Casein hydrolysate-based formula
For milk protein enteropathy
Hypoallergenic
Medium chain triglycerides MCTs!
Expensive
Enfamil pregestimil
Hydroxylate formula/MCT
For Short bowel syndrome
Steatorrhea
Cystic fibrosis
Enfamil nutramigen
Hydrosylate formula with amino acids
For Protein allergy
Severe diarrhea
Similac alimentum
Hydrosylate formula
For pancreatic insufficiency including cystic fibrosis
Amino acid based
If intolerant to casein-hydrolysate formulas
Hypoallergenic with 100% free amino acids
Milk fortifiers
For low birth weight infants
Added protein, calcium, phosphorus
Add to breast milk for premature
Underfeeding
Restless, crying, failure to gain weight
Constipation, can’t sleep, dry wrinkled skin
Overfeeding
Regurgitation, vomiting, diarrhea
Satiety signs
4-12: draw head from nipple, falls asleep, bites nipple
16-24 weeks: fusses or cries
Obstructs mouth with hands
Feedings
6-8 in first month
3-4 after 4 months
Quantity of milk/feeding increases with age
Formula preparation
Wash hands and tops of formula cans
Boil well water for 5 minutes and cool
Run tap water for 2 minutes to clear lead from pipes
Test temperature on back of hand
Shake bottle before feeding
Can store unused/ready-to-use in refrigerator for up to 48 hours
Too concentrated
Diarrhea
Hypernatremia
Renal failure
Too diluted
Irritability
Hyponatremia
Coma/brain damage
4-7 months
Introduce fruits
Cereals
Vegetables
7-10 months
Mashed fruits and vegetables
Finely cut and chopped meat and poultry
9-12 months
Soft combo foods
Casseroles, Mac and cheese
Spaghetti
Yogurt
1-2 years
Drink whole cow milk
Do not use in first year or else
Iron deficiency anemia
Impaired development
High renal solute load
2% if >2 years (no fat restrictions until 2 years)
Year 2
Reduction of caloric intake due to decelerating rate of growth
Likes and dislikes form
Poor eating habits for children
Poor hygiene, sleep, insufficient meal time (allow 10-20min at table)
Causes fatigue, limited attention span and poor performance in school
Pale complexion, susceptible to infection
Good eating habits
10-20 minutes at the table, not playing or walking
Offer milk instead of juice if thirsty
Whole milk until 2 years old
Overweight
85-95% BMI percentile
Or 30kg/m2
Obese
BMI>95%
> 30kg/m2
Infant vitals
Faster respiratory and heart rate
Lower blood pressure 80/45 +/- 15
Fever
Oral>99.5F or 37.5C
Rectal>100.4 or 38C
Sleep position
Remove all fluffy and loose bedding
Keep baby’s face uncovered
Teething
6-36 months
Restless, thumb sucking, decreased appetite
Give alcohol free topical anesthetic
Benzocaine baby gel
Chew on firm object wrapped in soft cloth
Parents avoid smoking
Increased sudden infant death syndrome
Ear infection
Asthma
Allergy
Lower respiratory infection
