Pediatrics Flashcards
What are the 4 unusual patterns of growth?
- Plateauing: child has stopped growing; usually a sign of chronic malnutrition
- Sharp decline: weight loss; usually an acute malnutrition: insult; trauma, new diagnosis, stopped eating etc.
- Falling off 50th %ile: Still growing but at a slower velocity than normal
- Incline in BMI: making an obese/overweight child; probably need to adjust intervention
What is failure to thrive?
o Weight (or weight for height) is less than 2 SDs below the mean for sex and age o Weight curve has crossed more than 2 percentile lines after having previously achieved stable growth
What are the possible causes of FTT?
Infant Characteristics - Chronic medical conditions (e.g. Inadequate intake (swallowing dysfunction, anorexia, etc.), Increased metabolic rate (Bronchopulmonary dysplasia, congenital heart disease, fevers, etc.), Breathing, heart beat is so difficult that they need more energy to do it, Malabsorption (CF, short gut, IBD, celiac disease)) --> Usually children grow well within first few months, and suddenly start to fall off the curve - Premature birth or IUGR - Developmental delay - Congenital abnormalities - Intrauterine toxin exposure Family characteristics - Poverty - Unusual health and nutritional beliefs - Social isolation - Disordered feeding technique - Substance abuse - Violence or abuse
What is short stature? How can we determine which child will probably have short stature?
Familial/genetic
Growth is parallel to the normal centile, usually below the 5th percentile
Final adult stature is short; does not change if child is fed more.
Use mid-parental height equation to get an estimation of the height of the child around 18-19 years old
What are the calculations for mid-parental height?
Girls: ((father’ s height-13 cm)+(mother’ s height))/2
Boys: ((mother^’ s height+13 cm)+(father’s height))/2
What is constitutional growth delay?
Child might be growing at the lower end for height and weight, but their mid-parental height is higher.
Some children will not grow as early and have their growth spurt later on: normal
Usually, parents will have had the same kind of pattern of growth when they were young
What is stunting/nutritional dwarfism in regards to growth charts?
Fall in length
– 2 SD below the height for age curves; not necessarily associated with emaciation; short stature or poor growth may be the sole manifestations of nutritional inadequacy
Typical pattern in stunting: Weight starts to fall first, and length is maintained (body will always protect brain growth and linear growth first) - first aspect affected is weight. Can see that malnutrition is a problem if weight falls first. Then, as weight continues to fall, height will start to fall later on.
How much time does it take to correct a stunting?
3x as long as the stunting/malnutrition period
For young children, how often do you monitor weight? length? stature? HC? mid upper arm circumference?
Weight: 7 days Length: 4 weeks Stature: 8 weeks HC: 7 days (infants, 4 weeks up to 2 years of age) Mid-upper arm circumference: 4 weeks
What are normal growth velocity charts based on for normal children? For ICU children?
Normal: Based on age
ICU and IUGR: Based on age and weight-for-age percentile
What defines a baby from 0-2 years old to be underweight?
Weight for age < 3rd %ils
Severely underweight < 0.1 %ile
What defines a baby from 0-2 years old as stunted?
Length for age < 3rd %ile
Severely stunted < 0.1 %ile
What defines a baby from 0-2 years old as wasted?
Weight for length < 3rd %ile
Severely wasted < 0.1 %ile
What defines a baby from 0-2 years old as at risk of being overweight?
Weight for length > 85th %ile
What defines a baby from 0-2 years old as overweight?
Weight for length > 97th %ile
What defines a baby from 0-2 years old as obese?
Weight for length > 99.9th %ile
What defines a child from 2-19 years old as underweight?
Weight for age < 3rd %ile
Severely underweight < 0.1 %ile
What defines a child from 2-19 years old as stunted?
Height for age < 3rd %ile
Severely stunted < 0.1 %ile
What defines a child from 2-19 years old as wasted?
BMI for age < 3rd %ile
Severely wasted < 0.1 %ile
What defines a child from 2-19 years old as obese?
Age 2-5: BMI for age > 99.9th %ile
Age 5-19: BMI for age > 97th %ile
What defines a child from 2-19 years old as severely obese?
Age 2-5: N/A
Age 5-19: BMI for age > 99.9th %ile
What defines a child from 2-19 years old as overweight?
Age 2-5: BMI for age > 97th %ile
Age 5-19: BMI for age > 85th %ile
What do Hgb, Hct, TIBC, and ferritin assess?
Iron, B12 and folate status (anemia)
What do albumin, transferrin and prealbumin assess?
Indicator of visceral protein status (if no inflammation), poor nutrition status, slow growth, edema