Peds Flashcards
how does the growth rate differ?
the growth rate (in toddlers & preschool) is slower than during the first year of life, but it is still constant. slows down till teenage growth spurt.
what is important to measure?
Why?
it is important to measure height nd weight in a precise manner & periodically
to monitor growth
what are the two main categories we refer to in age?
how to measure weight / height in each one?
Children < 2 years:
– Weighed without their clothes and diapers
– Determine the height in the supine position / recumbent length using
a horizontal measuring board
Children > 2 years
– Weighed with light clothes and without shoes (calibrated
scale)
– Measure height without shoes (standing) / stature
– Wall height measuring board
what two main categories for growth chart curves are there?
what are the available curves?
gender specific (one set for boys, one set for girls)
age specific (0 - 36 months, 2 - 20 years)
- weight for age
- weight for height
- height for age
- head circumference for age
- BMI - for - age (from 2 years old)
which curve do we use if the child is 2 - 3 years old (since there is an overlap between 24 - 36 months)?
why is measure and assessing growth important?
if the recumbent height is measured –> 0-36 months
if the standing height is measured –> 2 - 20 years
– To monitor growth regularly and identify deviations from the curve
– Evaluate height & weight because weight without
height does not indicate if the weight is adequate for the height
for ages 2 - 18 years old, terminology:
when is s/he underweight? normal weight? overweight? obese?
what is the BMI able to predict?
<5th percentile: underweight
5th - 84th percentile: healthy weight
85th - 94th percentile: overweight
>= 95th percentile: obese
to predict body fat in children >2 yo but not < 2 yo
for children < 2 years, which curve to use?
for children > 2 years, which curve to use?
For children <2 years: We use weight-for-height
– If weight-for-height> 95th percentile —Overweight
– If weight-for-height <5th percentile —–Underweight
* For children> 2 years old: We use BMI-for-age
– If BMI-for-age ≥85th percentile but <95th percentile
—— Overweight
– If BMI –for-age ≥95th percentile —-Obesity
what is BMI rebound / adiposity rebound?
what does it clearly reflect? what is the result of an early BMI rebound
increase in % body fat that occurs at 6 years of age on average. clearly reflected on the BMI - for - age growth chart.
An early BMI rebound (before 4 to 6 years) is associated with an increased risk of overweight and obesity in adolescence and adulthood
what are the challenges of dealing with children?
- Children do not understand the abstract concept of “health” and the dangers associated with overweight/obesity/underweight and picky eating
- Parents tend to give up very easily and want to see quick and concrete results during follow ups
- It is a LONG process! Minimum of 6-12 months!
innate ability to control energy intake & children (2 - 5 years)
- innate ability to regulate energy intake to meet their cloric needs
- avoid encouraging the child to “empty his plate” or to use food as a reward for over / undereating
- food intake varies from day - to - day but is stable over the course of a week
- healthy eating habits must be learned influence of parents, friends, siblings, media
- proper eating habits and preferences established at this age
Food preferences, development, appetite, and satiety:
what foods do they prefer?
what foods do they reject?
what tendency do they have regarding food?
like to eat ____
food intake linked to?
long term effect of likes / dislikes due to?
- sweet, slightly salty food (high nutritional density, associated with satiety and beautiful occasions).
- sour, bitter, spicy foods
- foods that are familiar
- reject food 8 - 10 times (new) before accepting it
- parental preferences: restricted / prohibited food used as highly desirable –> reward
- forcing children to eat foods negative effect
what are the responsibilities of the parents & caregivers?
what are the responsibilities of the children?
- parents & caregivers:
- “what” is offerred to children to eat
- “when” and “where”: the environment in which food is served - children:
- how much they eat
- if they eat the snack / food
what are the recommendations concerning liquids?
- drinking water to quench thirst
- <120 - 180 mL (< 4 - 6 oz) of fruit juices /day
- 2 glasses of milk / day
- consume enough fluids from food, drink, water
- needs increase with fever, vomiting, diarrhea or when children are in hot, dry, or humid environments
nutritional guidelines for children with a healthy weight:
– ½ of the grain products must be in the form of whole seeds
– Whole vegetables and fruits
– Low fat dairy products
– Children 2-8 years old: 2 glasses of milk / day
– Reduce the amount of added sugars
– DRIs: 2-3 years: fat 30-35% of kcal, 4-18: 25-35% of kcal
– Fat must come mainly from PUFAS and MUFAS
– Low mercury fish and shellfish
– Legumes, chicken & lean meats
– Limit foods rich in sugars & fats
– Parents must be good role models
sports recommendations
sports is important to maintain balance + reinforce muscles
- sedentary lifestyle: inc ris of obesity
- No TV for kids < 2 years
- no tv in kids bedrom
- 60 mins of vigorous activity most days of the week (preferably everyday)
- limit sedentary activities
