Pediatrics - Growth & Nutrition Flashcards
What growth chart should be used for children <2? 2 or older?
WHO; CDC
How much intake should term infants have each day?
20-30 g/day
How much intake should 2-10 year olds have each year?
2-3 kg/year
Explain why there is a decrease in weight the week after birth?
contraction of ECF and diuresis
What are the two types of failure to thrive (FTT)?
organic (medical) and nonorganic (social)
What are OTC treatments for FTT?
breastfeeding, concentrated formula, avoid juice or cow milk, add rice cereal to foods
What are medical treatments for FTT?
megestrol(?), cyproheptadine(?) (in cancer-related cachexia), NOT growth hormone
What are the benefits to breastfeeding?
decreased URTIs, UTIs, necrotizing enterocolitis, meningitis, diarrhea, sepsis, SIDS, DM cancer, asthma, obesity
What is the recommendation for vitamin D in newborns?
400 IU/day
What is the recommendation for vitamin D in adolescents?
those not obtaining 600 IU through fortified milk qualify
What is the recommendation for fluoride in infants?
0.5 mg/day in >6 months
What are important points regarding fluoride supplementation? (2)
only needed for exclusively breastfed infants, children should not use fluorinated toothpaste until 2 or more years of age
What is the recommendation for iron in breastfed full-term infants?
1 mg/kg/day from 4-12 months
What is the recommendation for iron in breastfed pre-term infants?
2 mg/kg/day from 1-12 months
What is the recommendation for iron in formula fed full-term infants?
fortified formula containing FE 4-12 mg/L until 12 months
What is the recommendation for iron in formula fed pre-term infants?
additional 1 mg/kg/day to bring TDD to 2 mg/kg/day
What is the recommendation for solid foods in the diet? (4)
can start 4-6 months of age, should be single ingredients for at least a week before switching, includes cereals (rice, barley, oatmeal), start veggies/fruits/meats at 8-9 months
What is the recommendation for diet in toddlers? (2)
regular diet + whole milk until 2, watch fruit juice (limit to 4-6 oz/day)
What percent of infants experience GER within first 4 months of life?
up to 2/3
What are reasons for GER being more common in neonates?
shorter esophagus, delayed gastric emptying, decreased LES pressure, immature peristalsis
What are non-pharm treatments for GER?
sleeping supine, changing volume/frequency of feeding, thickening formula, parental reassurance
What are factors that can contribute to decreased LES pressure?
tobacco smoke exposure, intake of fatty foods, certain medications (theophylline, CCBs), gastric distension
What gene is associated with pediatric GERD?
13q14
What are risk factors GERD?
neurologic impairment (cerebral palsy), obesity, esophageal atresia, chronic lung disease, prematurity
What are signs/symptoms for GERD in infants?
regurgitation, vomiting, arching, irritability, poor weight gain, crying, Sandifer syndrome, food refusal, FTT, apparent life-threatening event (ALTE)
What are signs/symptoms for GERD in children 1-5 years?
regurgitation, abdominal pain, cough, food refusal, recurrent pneumonia, dental erosions
What are signs/symptoms for GERD in children 6 or more years?
reflux esophagitis
What is the definition for acid reflux?
esophageal pH less than 4.0 lasting 15-30 seconds
What does the reflux index score indicate?
percentage of total time that the esophageal pH is less than 4
What is considered an abnormal RI in infants and patients older than 1 year, respectively?
more than 12%, 7%
What is no longer recommended for infants and young children as a diagnostic test?
acid suppression trial
What is the most common surgical procedure for GERD?
Nissen fundoplication
What are the advantages of H2RAs? Disadvantages?
quick onset, cost-effective, no need to taper, liquid formulations; TOLERANCE
What are the advantages of PPIs? Disadvantages?
most potent; limited formulations, CYP genetic polymorphisms, adverse effects, cost, increased infection risk, rebound acid
What are the advantages of prokinetics? Disadvantages?
don’t actually suppress acid; significant AEs, limited data
What are the advantages of antacids? Disadvantages?
quick onset, variety of dosage forms, low risk of AEs; require frequent administration
What are the advantages of surface agents? Disadvantages?
coat may heal mucosa, low risk of AEs; limited data
What is first-line for mild GERD in pediatrics? Moderate to severe?
H2RAs; PPIs
When are prokinetics useful in pediatric GERD?
delayed gastric emptying
What CYP enzyme has activity level variations up until puberty? Why is this relevant?
2C19; PPIs are metabolized by this pathway
What is the duration of treatment in pediatric GERD?
12 weeks (taper PPIs over 4 weeks)
