Pediatrics - Israel Flashcards
how much should infant weight increase in 4-6 months?
birth weight should double
how much should infant weight increase in 12 months
birth weight should triple
how much should infant length increase by 12 months
birth length should increase by 50%
What growth chart should be used for age <2?
World Health Organization
What growth chart should be used for ages 2-20?
CDC
malnutrition definition
deficiencies OR excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization
results of malnutrition
wasting, stunting, underweight, obesity, micronutrient deficiencies, refeeding syndrome
how to recognize failure to thrive (growth faltering)
fall of 2 major percentiles, and weight below the 3-5th percentile
what are causes of malnutrition
inadequate caloric intake, inadequate absorption, or excessive energy expenditure
what is the caloric requirement for an infant?
85-120+ kcal/kg/day
(85-105 for <6 months) (100-120+ for preterm infant)
what is the caloric requirement for a 7-12 year old
50-75 kcal/kg/day
what is the caloric requirement for a 12-18 year old
30-50 kcal/kg/day
what is the caloric requirement for a 6-12 month old?
80-100 kcal/kg/day
what is the caloric requirement for a 1-7 year old?
75-90 kcal/kg/day
what is the protein requirement for a low birth weight/ pre-term infant
3-4g/kg/day
what is the protein requirement for an infant (1-12 months)
2-3g/kg/day
what is the caloric requirement for children?
1-10 years old:
1-2 g/kg/day
what is the caloric requirement for adescolents?
0.8-1.5 g/kg/day
AAP recommendations for breastfeeding (WHO recommendations?)
exclusive bf for 6 months, continue up to 1 year old (WHO suggests up to 2 years)
Breastfeeding advantages for newborns
optimal nutrients, decreased risk oof infections and immune-mediated diseases, psychological and cognitive advantages
breastfeeding advantages for mothers
decreased post-partum bleeding, faster time to pre-pregnancy weight, decreased risk of breast and ovarian cancer, increase child spacing, mother-infant bond
what is the caloric density of breast milk?***
20 kcal/ounce
What are contraindications to breast feeding?
active maternal TB, HIV positive, human t-lymphotropic virus, untreated brucellosis, ebola infection, use of illicit drugs, and medications
Drugs to avoid in breastfeeding
immunosuppressants, chemo, radioactive agents, others that can harm the infant
drugs that reduce milk production
ergots, decongestants, antihistamines
what are characteristics of drugs that increase absorption into breastmilk?
non-ionized
small molecular weight
low protein binding
high lipid solubility
long t1/2
low Vd
what are characteristics of drugs that decrease absorption into breastmilk?
ionization
large molecular weight
high protein binding
low lipid solubility
short t1/2
high Vd
what are indications for formula feeding?
substitute or supplement for mothers who cannot/ do not breastfeed
infants with human milk intolerance
maternal infection transmissible through breastfeeding
maternal chemotherapy
infants failing to gain weight
what are human milk fortifiers
increase calories, minerals, vitamins, and protein
available as liquid and powder
increase calorie content to 22-28 kcal/oz
term formulas info
provide 19-20 kcal/oz
carb source is lactose
contains cows milk protein
all infants should get iron-fortified formula
what is a typical feeding schedule for term-healthy infants
6-9 feedings per day
initial breastfeeding 8-12 times per day
Vitamin D3 (Cholecalciferol) concentration
400 IU = 10mcg
indications for cholecalciferol for premature babies
premature neonates <1.5kg = 5 mcg daily
premature neonates >1.5 kg = 5-10mcg daily
indications for D3 in term infants
breastfed: 10mcg daily
formula fed: 10mcg daily until receiving 1000mL formula/day
iron supplementation indications
premature: 2mg/kg/day
term infants: not required
term infants w/ deficiency: 3mg/kg/day
zinc deficiency symptoms
dermatitis, diarrhea, infections, altered wound healing
zinc concentration in zinc sulfate
44mg zinc sulfate = 10mg elemental
what patients may need zinc supplementation
premature, prolonged exclusive breastfeeding >6 months, parenteral nutrition, IBD, vegan or veggie diet, malnutrition
when to initiate complementary foods?
~6 monthsh
do’s of introducing new foods
1 food every 4-5 days
emphasize all food groups
gradually increase servings
don’ts of introducing new foods
never put anything other than breast milk or formula in a bottle
never give to children <1 year: honey, cows milk, choking hazards, potential allergens
fluid requirements
up to 10kg = 100ml/kg
10-20kg = 1000mL + 50 mL/kg for every kg >10
>20 = 1500mL to 20mL/kg for every kg>20
mL/oz conversion
1 ounce is 30mL
how to calculate caloric need for patients with failure to thrive
use 50th percentile weight to calculate caloric need
