Pediatrics Overview Flashcards
A child with cerebral palsy and a gastrostomy tube is admitted to the hospital for a fundoplication. This procedure is used to manage
gastroesophageal reflux
GER is most common in children with ____
neuroimpairment
What are the steps used to treat GER in children
change feeding regimen
change positioning during feeding
stat medications for reflux and motility
If treatment is refractory to GER, _____ is used a last resort management
Fundoplication or PEG-J extension
Premature infants with these types of conditions are at an increased risk for metabolic bone disease
- cholestasis
- immobilization
- Chronic steroid use
- very low birth weight <1500 grams
- chronic diuretic use
MBD is characterized by the development of
osteopenia and osteomalacia
When used in the assessment of critically ill children, how do predictive equations compare to indirect calorimetry
no consistent comparison can be found
Indirect calorimetry is the gold standard for the assessment of energy needs in the critically ill child and should be used whenever possible. When IC is not available, what should be used
Schofield or WHO equation
what is the most common nutrient deficiency in childhood
iron deficiency anemia
Term infants have enough iron stores for up to ____ months
6 months
Infant formulas are fortified with enough
iron
Iron content of breast milk is ______ than formula but more efficiently absorbed
less
exclusively breast fed infants require additional iron starting at ________ months old with supplementation or complementary foods
4-6 months old
Cows milk has iron but is ___________ because it is high in calcium
not efficiently absorbed
Children should not be introduced to cows milk before ___ months because they will be at risk for ______
12 months
iron deficient
An obese 12 year old is admitted to the hospital for an evaluation of sleep apnea. A diet history reveals she drinks 3 cans of soda, 24 oz of juice and 8 oz of chocolate milk a day. In what mineral may she be deficient
calcium
soda consumption in youth decreases ____ consumption
calcium
______ adolescents are at the highest risk of developing _____ deficiency
female
calcium
juice consumption should be
<8 oz a day school age/adolescence
<4-6 oz pre school children
<4 oz toddlers
Children should consume ____ servings a day of dairy to obtain enough calcium
2-3 servings
adolescents should consume ___ servings a day of dairy to obtain enough calcium
4
When does the American Academy of Pediatrics recommend universal screening for iron deficiency be performed in young children
12 months old
iron deficiency over time can lead to long term _______ deficits
neruodevelopmental
Selective screening for iron deficiency is done at any age for infants with the following risk factors
prematurity
low socioeconomic status
poor growth
exclusive Breast feeding without supplementation
When reviewing a child’s growth chart data , the child’s weight for length curve is falling below the 3rd percentile. What z-score indicates severely wasted
z score below =3
a z-score (also known as the std deviation) is where a child weight falls from the median or percentile in growth charts
50th
a positive change in standard deviation/z scores indicates
growth
a negative change in standard deviation/z scores indicates
slowing growth rate
what is the suggested daily amount of potassium required for maintenance of infants with PN
2-4 mEq/Kg
A 13 year old boy whose BMI is at the 97th percentile on the CDC’s growth chart for age and sex would be classified as
obese
BMI on growth charts is used for children ages over
2 years
a BMI between the 85th and 94th percentile is classified as
overweight
A BMI greater than or equal to the 95th percentile is classified as
obese
Which conditions are associated with delayed bone age in a child with a short stature (things that delay bone age)
hypothyroidism
Cushing syndrome
growth hormone deficiency
____ is a diagnostic test assessing a child with abnormal growth, using radiography of the knees or left wrist
bone age
Precocious Puberty is known as
advanced bone age
what type of pre-term growth chart allows for comparison for pre-term infants from 22 weeks gestation age up through 10 weeks post term age
Fenton
What are the pros of using a Fenton growth chart
large sample size
validated tool
assess rate of growth OVER TIME
In newborns, potassium is not added to the PN solution until
kidney function is established
what is the daily maintenance fluid requirement for a 5 kg infant
500mL
The Holliday Segar Method estimates fluid requirements. For each 100 kcals metabolized ____mL of water will be needed
100
The Holliday Segar Method to estimate fluid needs should be used for neonates greater than
14 days old
How is the holliday segar method used
1st 10 kg provide 100mL/kg/day
2nd 10 kg (over 10kg): provide 50mL/kg/day
each additional kg over 20 kg, provide 20mL/kg/day
On radiographic examination a pediatric patient is found to have osteopenia and multiple fractures in various stages of healing. Serum lab results show calcium is low, phos is low, creatinine is normal, alk phos is high, 25-OH vit D is low, 1,25 dihyroxyvitamin D is low, and PTH is high. What is the likely diagnosis
Vitamin D Type Rickets
Signs/Sx of vitamin D type rickets are ______ serum calcium, _____ serum phos, ____ alk phos, _____ PTH, _____ 25-OH vit D 2, and ______1,25OH vitamin D3
normal to low calcium normal to low phosphorous high alk phos increased PTH low vitamin D 2 low vitamin D3
In vitamin D dependent rickets type 2, whate are the signs and symptoms. ______ 25 OH vitamin D 2 and _______ 1,25 dihydroxy vitamin D 3
low vitamin D2
ELEVATED VITAMIN D3
What is the recommended daily enteral elemental iron dose for preterm infants 1 month after birth
2-4 mg/kg/day (during stable growth) because the rate of growth and erythropoiesis slows down s/p birth and iron requirements are lower.
elemental iron supplementation in preterm infants starts around ___ month and should last until ______ months
2-4mg/kg/day for 4-8 weeks starting until 12-15 months old
Infants not getting human milk should receive ______ formula and preterm infants should get at least ____ mg/kd/day of elemental iron from 1-12 months of age
iron fortified formula
2 mg/d/day from 1-12 months old
what trace element should be supplemented in a child with chronic diarrhea
zinc
acute diarrhea lasts for < ____ days, persistent diarrhea lasts for more than ____ days, and chronic diarrhea lasts for > ____ days
14 days
14 days
30 days
Studies show that ______ decreases the duration of diarrheal episodes, decreased hospitalizations and decreased mortality
zinc
____ mg of zinc should be given a day when a child has 10-14 days of acute diarrhea and children under 6 months old should only receive ____ mg o zinc
20 mg
10 mg
is pancreatic insufficiency a contraindication to nasogastric feedings in a pediatric patient with cystic fibrosis
No, pancreatic enzymes can be given to help with absorption
what are contraindications to NG tube placement in pediatric patients with CF? (will need stomach or small bowel access)
upper airway secretion
nasal polyps
recurrent sinusitis
otitis
what is the best indication for the use of a soy based infant formula
galactosemia
why are soy based infant formulas not used in children with cow’s milk allergy?
a high percentage of children who are allergic to cow’s milk protein are also allergic to soy
patients with soy or cow’s milk allergies require which type of infant formula
hydrolyzed or free amino acid formula
An inborn error of metabolism that affects the body’s ability to metabolize galactose
galactosemia
A child or infant with galactosemia must _______ from the diet and use ______ based formulas
eliminate galactose from the diet
use soy based formulas
What is recommended to prevent vitamin D deficiency in a 1 month old infant who is fed human milk
give 400 IU of vitamin D a day soon after birth
how much vitamin D is recommended for exclusively breast fed infants
400 IU vitamin D
A seven month old fed reconstituted infant formula and other age appropriate complementary foods may be at risk of over-supplemetnation of which mineral?
Fluoride due to the tap water
high amounts of fluoride in a child’s diet can cause
disrupted tooth enamel/mineralization (enamel fluorosis)
which pediatric patients are at the highest risk for enamel flurosis?
infants on re-constituted formulas used with tap water
non-nutritive sucking helps prevent ___________ in children
oral aversion
non-nutritive sucking should be used in the enterally fed neonate less than _______ weeks corrected gestational age to promote__________
< 32 weeks
to promote oral feeding when developmentally ready
suck/swallow coordination is usually developed between __ and ___ weeks gestation
32-34 weeks
what are the benefits of non nutritive sucking
improves digestion of EN feedings
encourages oral development
stimulates lingual lipase, gastrin, insulin, motilin and vagal innervation during EN feedings
which equation is typically used to measure energy needs in pediatrics
Schofield equation
if a child is under weight, which weight should you use to calculate energy needs in pediatrics
ideal body weight as they need rapid weight gain
children with cystic fibrosis require _____ energy needs
increased
why are energy needs elevated in children with cystic fibrosis
increased work of breathing, decreased nutrient absorption from pancreatic insufficiency
what is the maximum dose in units of lipase/kg/meal for PERT therapy
2,500 units
too high of a dose of lipase or PERT enzyme therapy can increase the risk of developing
fibrosing colonopathy
children with cystic fibrosis require _____% of energy needs for optimal growth
120%
supplement fat soluble vitamins in the _____ form for optimal vitamin absorption in children with CF
water miscible (children with CF have fat malabsorption)
Infants with cystic fibrosis require additional sodium due to high losses, so salt needs to be supplemented. Infants who are 0-6 months old require ____ teaspoons/day and ____ teaspoons if older than 6 months
1/8 teaspoon/day
1/4 teaspoon/day
when is enteral nutrition indicated in children with cystic fibrosis
if the child cannot meet their energy needs with po intake alone
other than fat soluble vitamins, what else important to supplement in children w/ CF
calcium as they have a high risk of osteoporosis
if a child’s health insurance does not cover enzymes in children with CF, can generic enzymes be supplemented?
no, they are not water miscible
A 14 year old female with cystic fibrosis weighs 50 kg and is 63” tall with pancreatic insufficiency. She takes PERT at meals at a dose of 25,000 units of lipase per capsule. What is her max per meal?
25,000 units x 50 kg = 125,000 units total divided by 25,000 units per capsule, is 5 capsules per meal
in the critically ill child, are standard equations used to calculate energy needs?
no, they are inaccurate
if indirect calorimetry is not available to measure energy needs in critically ill children, which equations should be used, should a stress factor be used?
Schofield or WHO equations
NO stress factors should NOT be used
overfeeding in critically ill children can cause _____ ,_____and _____ leading to increased time on the vent and increased PICU length of stay
cholestasis
hyperglycemia with increased infection
what is the gold standard for measuring energy needs in children with burns
indirect calorimetry
the general goal of % of energy needs for children with burns are about ____ to ___%of their REE
120-130%
children with burns greater than _____% BSA usually need nutrition support to meet their elevated nutrition needs
20% BSA
what types of children in the ICU require lower energy needs
traumatic brain injury
cerebral palsy
Trisomy 21
protein needs ____ during periods of stress, critical illness and short bowel syndrome in children
increase
as child ages, protein needs typically _____ in healthy children
decrease
children from 0-12 months usually require ____g/kg/day of protein
1.5 g/kg/day
children from 13 months to 3 years usually require ____ g/kg/day of protein
1.1g/kg/day
children 4 to 13 years old typically require ___ g/kg/day of protein
0.95
children between the ages of 14 and 18 years old typically require ___ g/kg/day of protein
0.85
protein needs during injury _________ due to nitrogen loss and acute inflammation
increase
protein needs roughly _____ during injury and illness . Children of 0-2 years require ___ to ___ g/kg/day protein, 2-13 years old require ___ to ___ g/kg/day and ages 2-18 years old need ___g/kg/day protein
double
2-3 g/kg/day
1.5-2 g/kg/day
1.5 g/kg/day
excessive protein intake of ____ to ___ g/kg/day can contribute to negative consequences such as ___ and ___
4-6 g/kg/day
metabolic acidosis
azotemia
In infants less than 6 months avoid giving ______ due to inadequate nutrient intake and possible electrolyte imbalances
free water
how are fluid needs calculated in children
Holiday-Segar Method
the holiday-segar method of fluid needs provides ____mL/kg for infants 1-10 kg
100mL/kg
the holliday-segar method of fluid needs provides _______mL + ______mL/kg for every kg over 10 kg up until 20 kg
1000 mL + 50mL/kg
The holliday-segar method of fluid needs provides _______mL + ____mL/kg for every kg over 20 kg of weight
1500 mL + 20mL/kg
what are the benefits of breast milk
increased resistance to infections, increased GI maturity, decreased risk of overfeeding, decreased risk of NEC in preemies, decreased risk of allergies
breast milk contains _____ kcal/oz
20 kcal/oz
breast milk contains ___ to ___ grams/mL of protein
0.9-1.4 grams/mL
breast milk contains __ to ___ grams of fat/mL
3.5-3.9 g fat/mL
pre-mature infants require ____ kcal/oz of formula for weight gain
24 kcal/oz
infant formula for pre-mature infants are higher in
protein, fat, calcium, phosphorous, and zinc
infant formula for pre-mature infants post discharge contain ____ kcal/oz until 9 months of age
22 kcal/oz
Standard infant formula contains ___kcal/oz
20 kcaloz
infants with ______ CANNOT have standard formula as they cannot consume lactose
galactosemia
infants with galactosemia require ____ based formula
soy
should infants with cow’s milk protein allergy use soy based infant formula’s?
no they usually also have soy allergy
low lactose infant formulas are used for infants with
suspected lactose intolerance
Anti-Reflux infant formula are for infants with severe ____ who are not gaining weight appropriately. It has a ____ component that makes the formula more viscous which makes it harder to bring back up
GER
starch component
if an infant is on an acid blocker medication, will anti-reflux medications work?
no because the starch relies on the stomach acid to thicken the ofrmula
caseine hydrolysate infant formula is used in infants with _____ protein allergy
milk
elemental infant formula is an amino acid based formula is used for infants with
severe food allergies, malabsorption
vitamin _____ is supplemented prophylactically to ALL newborns
vitamin K
_____IU a day of vitamin D is recommended for exclusively breast fed infants
400 IU/day
for infants breast fed and on formula, what is the recommendation for vitamin D?
routinely monitor levels and supplement as needed
for infants getting 100% goal volume of infant formula, what are the recommendations for vitamin D supplementation
NO supplementation of vitamin D is necessary unless they have a malabsorption disorder
which children/infants are at most risk for a vitamin D deficiency
breast feeding without supplementation
dark pigmented skin (melanin acts as SPF)
born earlier than 32 weeks gestation
geographic location
recent immigration from developing country
malabsorption disorders such as epilepsy, CP, SBS, biliary atresia, phenobarbital medications
phenobarbital medications in infants can lower _____ vitamin
vitamin D
when are vitamin B12 levels of concern in infants
if the baby is exclusively breast fed and mom is vegan s
when should iron be fortified in infants
by 4-6 months old
when does fluoride need to be supplemented ?
after 6 months of age based on the water supply (rural areas and well water)
0.25mg/day of this is needed to be supplemented in some infants from 6 months to 3 years old
fluoride
Cow’s milk should not be given before
1 year
why is Cow’s milk inappropriate for children
low in iron
low in vitamin C and E
low in essential fatty acids
has a high renal solute land due to limited ability to concentrate the urin as I stooging high in milliosmoles
elemental formulas for children 1-10 years old is used for
malabsorption and food protein allergies
elemental formulas for children 1-10 years old contains
free amino acids, 240-3ckal/oz
semi elemental formulas for children 1-10 years old contains
protein as peptides and amino acids , 30-45 kcal/oz
when would Semi-Elemental formula for children 1-10 years old be used
malabsorption
a polymeric formula for children 1-10 years contains these properties
fiber is calorie dense 30kcal/oz 44-53% carbs 35-45% fat 12-15% protein
when are orogastric tubes recommended for children
premature infants <34 weeks with nose breathing, lack of gag reflux
basilar skull fractures
when are NG tube appropriate for children requiring enteral nutrition
normal gastric function
no risk of aspiration
short term use
