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Clinical 3 > Pediatrics intro > Flashcards

Pediatrics intro Flashcards

1
Q

define postmenstrual age

A

postmenstrual age- age from 1st day of the last menstrual period
gestational age, chronological and corrected ages are more frequently used

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2
Q

define chronological age

A

chronological age- actual age of the born baby

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3
Q

define corrected age

A

Corrected age, or adjusted age, is your premature baby’s chronological age minus the number of weeks or months he was born early. e.g. baby born 10 weeks early and now he is 3 month-> 12 completed weeks since being born; out of 12 weeks: 10 weeks of pregnancy and 2 weeks of his age that he would have been born

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4
Q

define gestational age

A

gestational age- from 1st day of last menstrual period till the day of birth; used for a period of pregnancy till birth; used to describe the age of premature infant e.g. a child born 10 weeks early-> gestational age of 30 weeks (30 out of 40)

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5
Q

list gestational, chronological, corrected and postmenstrual age of a bb that is 10 weeks premature and u see him 3 month after being born

A

baby has 42 weeks postmenstrual, 42 weeks gestational age, 2 weeks corrected age and 12 weeks chronological age

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6
Q

how old should an infant be to be considered viable?

A

22 weeks

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7
Q

until what age is GA age used for preterm bbs? why

A

usually corrected Ga age is used until baby is 2 years-> this is more reflective of possible issues

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8
Q

definitions of different stages of pre-term and pos-term infants

A
  • Preterm:GA<37 weeks at birth
  • Extremely preterm: GA<28 weeks at birth
  • Very preterm:28-31 6/7 weeks at birth
  • Moderately preterm: 32-33 6/7 weeks at birth
  • Late preterm: 34-36 6/7 weeks at birth
  • Term: GA>37 weeks
  • Postterm: 42 to 46 weeks after birth
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9
Q

Birth weight classification

A
  • Microprem: <750g at birth
  • ELBW: <1000g at birth
  • VLBW : 1000-1499g at birth • LBW : 1500-2500g at birth
  • Normal : <2500g at birth
  • SGA: < 10th %ile birthweight for GA
  • AGA: 10th - 90th %ile birthweight for GA
  • LGA: >90th %ile birthweight for GA
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10
Q

what is IUGR?

A

Intrauterine growth restriction

• Failure of the fetus to achieve normal predicted growth in utero

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11
Q

what are the causes of IUGR?

A

probably had compromised nutrition while in utero
usually happens early-
before 2 weeks

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12
Q

types and causes of IUGR

A

Symmetric IUGR: 20-30% of all cases of IUGR
• Weight, length and head circumference less than 10th %ile.
- Indicative of chronic malnutrition
common causes:
- genetic disorder-> smaller potential of growth
may be due infections during
pregnancy
- early onset

Asymmetric IUGR
• Length and head circumference are appropriate but weight is below the 10th %ile. Better head sparing Indicative of an acute insult in nutrition usually in 3rd trimester
characteristic of acute insult- not enough nutrition or oxygen due to placental insufficiency (preeclampsia)

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13
Q

which score is used to assess health at birth?

A

Apgar

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14
Q

describe APGAR score

A

Appearance, Pulse, Grimace
Activity, Respiration

  • Neonatal health assessment
  • Scored out of 10 at 1 min, 5mins and 10 mins
  • Provide information on delivery event
  • Risk of perinatal depression
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15
Q

when is mid-upper arm assessment is used?

A

Mid-upper arm: more in community and research setting, reflects malnutrition

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16
Q

when is upper arm and lower limb assessment used?

A

handicap kids

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17
Q

fenton’s growth chart is used for which kids?

A

pre-term

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18
Q

fenton vs WHO

A

who is used for term infants

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19
Q

what are the types of WHO growth curves for brith-24 months babies

A
  1. length for age and weight for age

2. head circumference and weight for length

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20
Q

which ages are covered by WHO curves?

A
  1. birth-> 24 months

2. 24 month-> 19 yo

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21
Q

what are the types of WHO growth curves for 24 months-> 19yo

A
  1. height for age and weight for age

2. BMI for age

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22
Q

is weight or BMI a preferred method of assessment in curves for teens? Why

A

BMI

teens go through growth spurts at different points-> different weight at the same age

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23
Q

Specialized growth charts are available for the following conditions:

A
  • Prader-Willi syndrome
  • Cornelia deLange syndrome
  • Turner syndrome
  • Trisomy 21 (Down’s syndrome)
  • Rubinstein-Taybi syndrome
  • Marfan syndrome
  • Achondroplasia
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24
Q

Interpreting growth chart

When to be worried?

A

Plateauing: bb is not growing over time-> sign of chronic malnutrition
Falling off 50th %ile: bb is growing over time, but not fast enough-> sign of chronic malnutrition
Sharp decline: losing weight-> acute malnutrition e.g. trauma
Incline in BMI: child is gaining too much weight

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25
Q

Common Anthropometric Criteria for Diagnosing Failure to Thrive

A

Body mass index for age less than the 5th percentile
Length for age less than the 5th percentile
Weight deceleration crossing two major percentile lines (most common definition)
Weight for age less than the 5th percentile
Weight less than 75 percent of median weight for age
Weight less than 75 percent of median weight for length
Weight velocity less than the 5th percentile

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26
Q

more severe cases of failure to thrive is when

A

more severe cases of failure to thrive is when length and head circumference is also being affected, not just weight

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27
Q

Interpreting linear growth chart

congenital growth hormone deficiency

A

no need for nutritional intervention, but there is a need for hormone supplementation when hormones are supplemented, the growth will return to normal
the weight does not fall in the way that height does

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28
Q

Interpreting linear growth chart

Constitutional delay of growth and adolescence

A

curve starts to fall from 3rd percentile typically: small at first then rapid growth
no need to intervene

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29
Q

Interpreting linear growth chart

familial or genetic short stature:

A

short genetic potential, nothing u can do weight and height follow the same pattern

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30
Q

Interpreting linear growth chart

primary nutritional deficiency and severe illness:

A

weight starts to fall below 3rd percentile linear growth curve occurs in delay, later than weight
this signals for chronic malnutrition -> need for intervention

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31
Q

What is the first and the last thing to be affected in case of malnutrition on linear growth charts?

A

head crmc is the last thing to be affected in case of malnutrition
weight is the first things affected, the next is linear growth

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32
Q

how are weight and height affected when nutritional support is administered

A

weight will improve first, followed by the height

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33
Q

stunting- changes after administering nutritional support

A

may take years for height to improve

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34
Q

what are good markers of chronic malnutrition

A

height and head circumference

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35
Q

what are good markers of acute malnutrition

A

weight

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36
Q

__ is the adaptive response to suboptimal nutrition

A

Growth deceleration is the adaptive response to suboptimal nutrition

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37
Q

Interpreting linear growth in Stunting or Nutritional Dwarfism:

A

• -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

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38
Q

Interpreting linear growth” Short stature

need for nutr intervention?

A 
no nutritional intervention
• Familial/genetic
• Growth is parallel to the normal centile usually below the 5th %ile
• Final adult stature is short
- no need for nutritional intervention
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39
Q

to decide genetic vs nutritional cause of short stature :

A

1) check literature for child’s condition and expected growth
2) calculate mid parental height

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40
Q

What is post-natal fluid adaptation

A

In the wob, baby was surrounded by fluid-> now it is in the environment with no fluid

changes occur:
• Efflux of fluid ICF to ECF
• Excess ECF floods neonatal kidneys

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41
Q

Phases during the 1st week of life

dietary intake
urine output
weight

A 
Prediuretic phase 
Age: birth - 2 days
dietary intake: few drops
urine output: low proper milk let-down
weight: wt loss due to water loss via skin 
Diuretic phase 
Age: 1-5 days
dietary intake: low
urine output: abrupt increase as kidneys start working more
weight: wt loss
Homeostatic  phase 
Age: after 2-5 days
dietary intake: increase
urine output: decreases, then proportional to intake
weight: start to regain
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42
Q

is weight loss normal in newborns?

A

weight loss after birth is normal for both term and preterm

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43
Q

First week of live: term vs preterm in terms of acceptable weight loss, regain time and z core

A

Preterm
15% weight loss is acceptable
Regain by 10-14days
loose Not more than -0.8 Z score. If lost more than that-> failure to thrive

Term
7-10% wt loss is acceptable
Regain by 7-10 days

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44
Q

when is nutr intervention appropriate in terms of weight regain by bbs

A

if baby hasn’t started to regain weight by day 5

45
Q

First week of life: Who are the babies at risk?

A

these babies are at risk of not being able to regain their birth weight-> have to be monitored more closely

  • C section mothers
  • Multiple birth mothers
  • Infants who have not latched on or nursed effectively for 12hrs
  • Mothers of NICU infants
  • Infants <37 weeks and less than 2.5kg
  • Mothers with breast surgery
  • Mothers with history of breastfeeding failure
  • Antepartum mothers at risk of preterm delivery
46
Q

what are the methods of assessing adequacy of feed?

A
  • number of diapers
  • frequency of feed, stool and peeing
  • weight change before and after feed
47
Q

Number of diapers as baby grows

A

for the first 6 days, baby should have as many diapers as days old
diaper should get heavier with urine each day, especially after day 3, as the supply of milk increases
once the baby is 6 days old: 6-8 soaked diapers per 24h

48
Q

Size and frequency of stool

A

0-2 days: at least 1 stool per day
3+ days: 2-3 per day
after 4 weeks, the pattern of stool may change to 1 stool every 1-10 days
if baby’s stomach is soft, baby is happy and having 6-8 diapers every 24 hours, this small number of bowel movements is normal

stool should be about 2tbsp

49
Q

when should baby stop loosing weight

A

stop at 4 days

50
Q

once weight has been regained, what should the rate of weight gain be?

A

once the weight has been regained, babies should gain 25-30g on average per day over the next few months

51
Q

stool color change

A

day 1-2: dark green or black (meconium)
day 3-4: brown, green or yellow
day >5: yellow

52
Q

hunger cues

A

Early signs: stirring, rapid eye movement, suckling sounds, mouth opening, hand to mouth or suckling liking movements, rooting
Late: fussiness, irritability, exhaustion, sleep, crying (need to calm them down, otherwise it will help difficulty latching)

53
Q

feed time and frequency

A

Newborns feed 8-12x da; Duration: 20-45 mins

Older babies may feed less frequently and for a shorter period of time as they become more efficient

54
Q

good latch characteristics

A

Latch: wide-open mouth, the angle at the corner of the mouth between 130-150 degrees, corners of the mouth shouldn’t touch, chin is touching the breast, the head is tilted back, nose not touching the breast

55
Q

when does volume of milk increase?

A

after 4 days

56
Q

reasons for failure to thrive while breast feeding

A

Maternal causes:
- Poor let down and/or poor production

Infant causes:
- High energy requirement and/or low net intake and/or poor intake

57
Q

Breastfeeding assessment questionnaire

A

• Ask these questions by day 5-7 of
birth
• If parents answer No to any of these questions, there is an issue with feeding

  • Does baby have several bowel movements in 24 hours
    that are mustard yellow with curds in them?
  • Does baby have 5-7 wet diapers in 24 hours?
  • Do your breasts feel full before feeding and softer after
    feeding?
  • If there’s been nipple soreness, has this been resolved?
  • Do you hear swallowing when the baby is breastfeeding?
  • Is the baby eating at least 8 times in 24 hours?
  • Does the baby seem satisfied after a feeding?
  • Is there a lack of sore, tender, or red and firm areas in
    either breast?
  • Has the baby started gaining 1/2 - 1 ounce per day?
58
Q

Signs that baby is drinking enough

A
  • Wakes up on his own when hungry
  • Feeds well and often (8 times or more per day, q 2-3hrs initially)
  • Seems full after drinking
  • Heavy diapers
  • Gaining weight adequately
59
Q

Signs that baby is not feeding enough

A
  • Drowsy, sleepy and hard to wake up for feeding
  • Less than 6 feeds per day
  • Feeds less than 10 minutes, mom does not feed transfer
  • Dark yellow urine, small amt of urine, orange stains in urine after the first 2 days
  • Stool still has meconium, after the fifth day
  • Less than 1 BM per 24hrs between 5 do. and 4 weeks
60
Q

0-3 months feed recommendations and tips

A
  • Exclusive breastfeeding or formula feeding
  • Sterile feeding procedures to be done until 4mo/4moCGA
  • Still requires feeding at night
  • At 2 months, feeding progressively becomes shorter
  • At 3 months,
  • Baby tends to look around while nursing
  • Baby start to sleep longer at night, transition from 8 to 6 feeds, however each baby is different
61
Q

what to do when expressed milk is not available

A

If expressed breastmilk is not available, offer commercial infant formula that is prepared safely

62
Q

supplements in breast-fed babies

A

Give a liquid vitamin D supplement of 400 IU (10 mcg) daily to infants who are fully or partially breastfed. Non-breastfed infants do not require a vitamin D supplement because infant formula contains vitamin D

give it to all infants or children younger than 2 years who are breastfed or receiving breastmilk until diet includes ≥400 IU per day of vitamin D from dietary sources

63
Q

milestones: 1 month, 2 month, 4 month, 6 months

A

By 1 month:
• Sucks well on the nipple
By 2 months:
• Feeds every 2 to 4 hours during the day and may
need to feed during the night
By 4 months:
• Holds head steady when supported in a sitting position
At about 6 months, signs of developmental readiness for complementary foods:
• Has better head control
• Can sit up and lean forward
• Can let parent know when they are full (turns
head away)2
• Can pick up food and try to put it in their mouth

64
Q

red flags 0-4 months

A

• Has < 6 wet diapers each day after 5 days
• Loses > 10% of birth weight within the first 2 weeks;
or by 2 weeks, does not regain birth weight or does not gain ≥ 20 g per day
• Consumes cow’s or goat’s milk (including pasteurized or
raw), plant-based beverages (soy, rice, almond),
evaporated milk or homemade formula
• Consumes water, juice, herbal teas or other liquids
• Introduces complementary foods too early (before infant
is showing signs of developmental readiness), including
adding cereal to a bottle
• Uses a propped bottle or infant is not supervised during
feeding
• Feedings are forced or restricted
• Skips feeds in attempts to facilitate longer sleep times
• Parent has depressive symptomatology in the early
postpartum period (may impact breastfeeding duration,
self-efficacy and increase breastfeeding difficulties)

65
Q

red flags 6-9 months

A

• Does not consume iron-rich foods daily
• Consumes cow’s or goat’s milk or plant-based beverages (soy, rice, almond) as main milk source
• Consumes fruit juice, fruit drinks/punch, sports drinks, pop or beverages containing artificial
sweeteners or caffeine (coffee, tea, hot chocolate)
• Consumes raw or unpasteurized milk or milk products or unpasteurized juice
• By 9 months, lumpy textures have not been introduced or consumed
• Unsupervised during feedings
• Feedings are forced, restricted or infant is pressured to eat

66
Q

what are infant formulas made of

A

based on cow milk

67
Q

infant formula types, indication for use and notes

A

Cow’s milk-based
● Standard breastmilk substitute for healthy-term infants

Partially hydrolyzed cow’s milk-based
● Indications for use: None
● Contraindicated for infants with cow’s milk protein allergy
● No advantage over standard cow’s milk-based infant formulas on the digestive system

Lactose-free
● None
● Contraindicated for galactosemia, congenital lactase deficiency and cow’s milk allergy

Soy-based
Indications for use:
● Galactosemia
● Congenital lactase deficiency
● Cultural or religious reasons e.g. kosher
Notes:
● May consider for cow’s milk protein allergy if diagnosis for non-IgE-mediated cow’s milk protein allergy can be ruled out

Extensively hydrolyzed protein
● Physician-confirmed food allergies or malabsorption syndromes that cannot tolerate formula based on intact cow’s milk protein or soy protein

68
Q

what is the most common food alergy in babies

A

cow milk

69
Q

when is there cow milk allergy

A

• Usually occurs in babies younger than 1 year of age., will usually overcome is with age

70
Q

2 types of milk allergy in babies

A

IgE mediated
Immediate reaction
Hives, rashes, wheezing, swelling in face, eczema, runny nose, vomiting, diarrhea
Start within minutes to 2 hours of ingestion of CMP

Non-IgE mediated (intolerance)
Delayed reaction
Itchy skin, eczema, colic, reflux, vomiting (large amount), mucus or bloody stools, poor wt gain
Within 48hrs to 1 week of drinking CMP

71
Q

treatment for cow milk allergy in babies

A

cow free diet until 9-12 months

72
Q

at what age can u give cow milk?

A

at 9-12 months
3.25% pasteurized milk only
not more than 750ml

73
Q

when can u start giving solid foods?

A

4-6 months start introducing solids (iron rich foods are a priority)

74
Q

what is the division of responsibility

A

parent decides what to give, child decides what to eat

75
Q

dangerous of consuming more than 750ml of milk

A

iron anemia

76
Q

what are the signs of readiness to feed

A
  • Has good head and neck control
  • Can sit without support
  • Can lean forward and open mouth when interested
  • Can turn head when uninterested in food or not hungry
  • Can pick up food and try to bring it to his/her mouth
77
Q

what should be the first foods to be introduced?

A
  • Start with food rich in iron because their iron stores get used up
  • No one food recommended as first, typically iron fortified baby cereal, but meat is also ok
78
Q

how often should iron rich foods be consumed?

A

6-12 months: min 2x day

12months+: minimum 3 times a day

79
Q

why is iron intake important for kids?

A
  • Essential for neurodevelopment
  • Baby have iron reserves until around 6 months old
  • No iron in breastmilk
  • Iron reserves may be even lower if mother was anemic or baby was born premature
80
Q

what is the order for introducing solid foods?

A
  • Once iron rich food introduced, no particular order to follow
  • Do not introduce cow’s milk before 9-12 months
  • Do not introduce dairy until good sources of iron are accepted
  • When cow’ milk is introduced, give 3.25% milk
81
Q

when should complimentary food be introduced to infants at no or low risk for food allergy,

A

or infants at no or low risk for food allergy, introducing complementary foods at about 6 months is recommended.

82
Q

what are the characteristics of kids with high allergy risk?

A

Infants considered to be at high risk for allergic disease have either a personal history of atopy or a first-degree relative with atopy.

83
Q

when should common allergic foods be introduced to kids at high risk?

A

For high-risk infants, and based on developmental readiness, consider introducing common allergenic solids at around 6 months of age, but not before an infant is 4 months of age.

84
Q

when should breastfeeding be stopped?

A

Breastfeeding should be protected, promoted and supported for up to 2 years and beyond.

85
Q

texture porgression

A

4-6 months: smooth puree
7-9 months: soft and finely chopped
12 months: small pieces, finger food

  • Progress rapidly across textures as tolerated
  • Wait 2-3 days before each new food
  • Ensure that lumpy textures are offered no later than nine months. Encourage progress towards a variety of textures, modified from family foods (without added salt or sugar), by one year of age
86
Q

Introduction of solids: How much?

A
  • Start with 3-5ml (1/2 – 1 teaspoon)
  • Increase to 15ml per serving (1 tablespoon) but for
  • Initially not for nutrition oral development
  • To develop oral and motor skills
  • For exploration and experimentation
  • Offer small amount at a time
87
Q

breastfeeding:solids percentages across ages

A

0 to 6 months: 100% breast, 0% solid
6 to 8 months: 80 % breast, 20% solid
9 to 11 months: 50% breast, 50% solid
12 to 24 months: 30% breast, 70% solid

88
Q

12-24 months milestones

A
  • Growth slows compared with the first year resulting in decreased appetite and erratic and unpredictable food intake
  • Unfamiliar foods are often rejected the first time

By 12 to 18 months:
• Acquires full chewing movements
By 24 months:
• Eats most foods without coughing and choking
• Eats most of the same foods as the rest of the family with some extra preparation to prevent choking
• Eats with a utensil with little spilling
• May only consume 4 or 5 well accepted foods

89
Q

is canada food guide appropriate for toddlers?

A

1/2 plate of veggies-> not enough energy will be provided

toddlers require a lot of calcium and Vit D requirements-> canadian food guide is not sufficient

90
Q

toddler feeding problems

A
  • Excessive liquid intake, impeding acceptance of solid foods
  • Grazing, unstructured mealtimes
  • Prolonged feeding time (>30 minutes)
  • Inadequate or immature oral-motor skills (unable to handle complex textures
  • Sensory integration issues (will consume only foods of one color and/or texture)
91
Q

Picky eaters behavioural strategies

A
  • Offer liquids primarily between meals, and limit drinking during meals
  • Encourage a structured and consistent schedule for 3 meals and 2-3 snacks daily
  • Limit meals to 20-30 minutes
  • Eliminating grazing behaviour on liquids and foods between meals
  • Use a timer to have the child sit at the table for a finite period of time
  • Offer food in a divided plate
  • Offer 1 new or non preferred foods with 1 to 2 preferred foods
  • Continue to offer non preferred food in a positive way
  • Encourage exploration of a non preferred food (sensory)
  • Establish a non-food reward system (for children older than 1 yo) were positive behaviour is praised
  • Be as consistent as possible
  • Encourage training and cooperation of all caregivers
  • Encourage family mealtimes
  • Provide age appropriate portions and developmentally appropriate texture
92
Q

rate of weight and height change across ages

A

<1 y.o high weigh changes 5-10 y.o: decreased weight change rate
adolescence: weight and hight change speeds up

93
Q

% of adult height gained during adolescense

A

15-20% of adult height is gained during adolescence

94
Q

onset of growth spurt boys vs girls

A

Growth spurt starts later in
boys than girls with
higher peak velocity than in
girls

95
Q

link between kcal and linear growth

A

Linear growth can be slowed or delayed if severely restricted in kcal or kcal expenditure is increased

96
Q

% final ideal weight gained during adolescence

A

• 25-50% of final ideal weight is gained during adolescence

97
Q

factros that affect timing and weight gain in teens

A

• Timing and amount of weight gain greatly affected by kcal intake and
expenditure

98
Q

Changes in body composition and skeletal mass in teens: girls vs boys as well as timking

A
  • Pre-pubertal, proportion fat and muscle for boys and girls are similar
  • Normal % body fat is 23% in women and 15% in men post-adolescence
  • ~45% of skeletal mass is added during adolescence
  • By 20yo, 90% of total bone mass is gained
99
Q

delayed puberty and bones

A

• Delayed puberty = failure to gain bone mass at normal rate and lower mineral bone density

100
Q

• _ is one the environmental factors determining the onset of puberty

A

• Nutrition is one the environmental factors determining the onset of puberty

101
Q

what is tanner scale used for?

A

assesses appropriate growth in adolescent period

shows at which age different maturations stages need to be achieved

102
Q

what is there an opportunity for in teens?

A

It is the second-best window of opportunity to catch up with proper growth and development, if provided with adequate nutrition.
• Especially useful for handicapped children, delayed maturation stages can reflect possible malnutrition

103
Q

True or False. The WHO growth charts for Canada can be used for children with special health care needs.

A

true

104
Q

0-5 Years
percentiles and indicators to use to determine the following conditions
underweight, stunted, wasted, possible risk of overweight, overweight. obese

A

Underweight
Indicator: Weight-for-age
Percentile: <3rd

Stunted
Indicator: Length-for-age
Percentile: <3rd

Wasted
Indicator: Weight-for-length/BMI
Percentile: <3rd or <89% IBW

Possible Risk of Overweight
Indicator: Weight-for-length/BMI
Percentile: >85th

Overweight
Indicator: Weight-for-length/BMI
Percentile: >97th

Obese
Indicator: Weight-for-length/BMI
Percentile: >99.9th

105
Q
  1. True or False. The 50th percentile is the goal for each child.
A

false

106
Q

when to be concerned: Head circumferencefor-age (0-2 years)

A

below 3rd percentile and growing slowly
OR
above 97th percentile and growing rapidly

107
Q

when to be concerned:
0 – 2 years
Weight-for-length or BMI

A

above 97th percentile

108
Q

when to be concerned: 2-19 yo- bmi for age

A

above 97th percentile

Clinical 3 (17 decks)

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