Pediatrics - Growth & Nutrition

Question 1

What growth chart should be used for children <2? 2 or older?

Answer 1

WHO; CDC

Question 2

How much intake should term infants have each day?

Answer 2

20-30 g/day

Question 3

How much intake should 2-10 year olds have each year?

Answer 3

2-3 kg/year

Question 4

Explain why there is a decrease in weight the week after birth?

Answer 4

contraction of ECF and diuresis

Question 5

What are the two types of failure to thrive (FTT)?

Answer 5

organic (medical) and nonorganic (social)

Question 6

What are OTC treatments for FTT?

Answer 6

breastfeeding, concentrated formula, avoid juice or cow milk, add rice cereal to foods

Question 7

What are medical treatments for FTT?

Answer 7

megestrol(?), cyproheptadine(?) (in cancer-related cachexia), NOT growth hormone

Question 8

What are the benefits to breastfeeding?

Answer 8

decreased URTIs, UTIs, necrotizing enterocolitis, meningitis, diarrhea, sepsis, SIDS, DM cancer, asthma, obesity

Question 9

What is the recommendation for vitamin D in newborns?

Answer 9

400 IU/day

Question 10

What is the recommendation for vitamin D in adolescents?

Answer 10

those not obtaining 600 IU through fortified milk qualify

Question 11

What is the recommendation for fluoride in infants?

Answer 11

0.5 mg/day in >6 months

Question 12

What are important points regarding fluoride supplementation? (2)

Answer 12

only needed for exclusively breastfed infants, children should not use fluorinated toothpaste until 2 or more years of age

Question 13

What is the recommendation for iron in breastfed full-term infants?

Answer 13

1 mg/kg/day from 4-12 months

Question 14

What is the recommendation for iron in breastfed pre-term infants?

Answer 14

2 mg/kg/day from 1-12 months

Question 15

What is the recommendation for iron in formula fed full-term infants?

Answer 15

fortified formula containing FE 4-12 mg/L until 12 months

Question 16

What is the recommendation for iron in formula fed pre-term infants?

Answer 16

additional 1 mg/kg/day to bring TDD to 2 mg/kg/day

Question 17

What is the recommendation for solid foods in the diet? (4)

Answer 17

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

Question 18

What is the recommendation for diet in toddlers? (2)

Answer 18

regular diet + whole milk until 2, watch fruit juice (limit to 4-6 oz/day)

Question 19

What percent of infants experience GER within first 4 months of life?

Answer 19

up to 2/3

Question 20

What are reasons for GER being more common in neonates?

Answer 20

shorter esophagus, delayed gastric emptying, decreased LES pressure, immature peristalsis

Question 21

What are non-pharm treatments for GER?

Answer 21

sleeping supine, changing volume/frequency of feeding, thickening formula, parental reassurance

Question 22

What are factors that can contribute to decreased LES pressure?

Answer 22

tobacco smoke exposure, intake of fatty foods, certain medications (theophylline, CCBs), gastric distension

Question 23

What gene is associated with pediatric GERD?

Answer 23

13q14

Question 24

What are risk factors GERD?

Answer 24

neurologic impairment (cerebral palsy), obesity, esophageal atresia, chronic lung disease, prematurity

Question 25

What are signs/symptoms for GERD in infants?

Answer 25

regurgitation, vomiting, arching, irritability, poor weight gain, crying, Sandifer syndrome, food refusal, FTT, apparent life-threatening event (ALTE)

Question 26

What are signs/symptoms for GERD in children 1-5 years?

Answer 26

regurgitation, abdominal pain, cough, food refusal, recurrent pneumonia, dental erosions

Question 27

What are signs/symptoms for GERD in children 6 or more years?

Answer 27

reflux esophagitis

Question 28

What is the definition for acid reflux?

Answer 28

esophageal pH less than 4.0 lasting 15-30 seconds

Question 29

What does the reflux index score indicate?

Answer 29

percentage of total time that the esophageal pH is less than 4

Question 30

What is considered an abnormal RI in infants and patients older than 1 year, respectively?

Answer 30

more than 12%, 7%

Question 31

What is no longer recommended for infants and young children as a diagnostic test?

Answer 31

acid suppression trial

Question 32

What is the most common surgical procedure for GERD?

Answer 32

Nissen fundoplication

Question 33

What are the advantages of H2RAs? Disadvantages?

Answer 33

quick onset, cost-effective, no need to taper, liquid formulations; TOLERANCE

Question 34

What are the advantages of PPIs? Disadvantages?

Answer 34

most potent; limited formulations, CYP genetic polymorphisms, adverse effects, cost, increased infection risk, rebound acid

Question 35

What are the advantages of prokinetics? Disadvantages?

Answer 35

don't actually suppress acid; significant AEs, limited data

Question 36

What are the advantages of antacids? Disadvantages?

Answer 36

quick onset, variety of dosage forms, low risk of AEs; require frequent administration

Question 37

What are the advantages of surface agents? Disadvantages?

Answer 37

coat may heal mucosa, low risk of AEs; limited data

Question 38

What is first-line for mild GERD in pediatrics? Moderate to severe?

Answer 38

H2RAs; PPIs

Question 39

When are prokinetics useful in pediatric GERD?

Answer 39

delayed gastric emptying

Question 40

What CYP enzyme has activity level variations up until puberty? Why is this relevant?

Answer 40

2C19; PPIs are metabolized by this pathway

Question 41

What is the duration of treatment in pediatric GERD?

Answer 41

12 weeks (taper PPIs over 4 weeks)