Peds Exam Lecture 4 Flashcards
what is optimal infant and young child feeding?
- immediate postpartum skin to skin
- breastfeeding within 1 hours
- 6 months of exclusive breastfeeding
- continue breastfeeding with appropriate complementary foods and feeding for 1 year or longer
- maternal nutrition and care
CI to breastfeeding
- HIV
- Human T-cell lymphocytic virus I or II
- active TB
- herpes on nipple
- active varicella
- drugs/alcohol
- maternal meds
- infant galactosemia
- infant tyrosinemia
- PKU (elevated phenylalanine)
how does breastfeeding help the mother?
- decr post partum bleeding
- possible decr in post partum depression
- reduction of breast and ovarian CA
- may decr HTN, CVD risk
- promotes bonding
how can normal urine output be gauged?
number per day = day of life
at what point does urine become colorless?
day 3-4
what is normal stool pattern?
4-6 BM per day by day 5
how many wet diapers per day in infant?
6-8
what should be avoided in the first 6 months? 12 months?
6 months - water, juice, solids
12 months - cow’s milk
when should normal iron supplementation begin and how?
6 months
iron rich foods or supplements
when does vitamin D supplementation begin? why?
immediately (PO QD) b/c human milk does not give enough vitamin D to prevent Rickett’s
what is are the types of protein included in most formulas except soy formula (in which soy protein is used)?
whey and casein
what carbohydrate is used in most formulas?
lactose
for which babies is hydrolyzed formula used?
those with fat malabsorption/maldigestion
for which babies is amino acid based formula used?
extreme allergy, intestinal failure
what is food protein proctocolitis?
painless blood in stool
presents in 1-2 months of life
resolves w/i days - 2 weeks
why is soy formula used?
vegan
galactosemia
hereditary or transient lactose intolerance
what is food protein induced enterocolitis syndrome (EPIES)?
non-IgE mediated response to food
vomiting, diarrhea with intake of food
what are the most common culprits in EPIES?
cow’s milk protein and soy
how is EPIES treated?
fluid resuscitation and anti-emetics avoid trigger (can reintroduce later in life)
when should solids be started?
4-6 months (when child developmentally ready)
how should solids be started?
single ingredients so can identify offending agent if rxn
what babies are susceptible to lactose intolerance and why?
premature babies
born without sufficient enzyme to breakdown lactose
symptoms of lactose intolerance
increased gas, diarrhea (osmotic load)
when does secondary lactose intolerance (more common than primary) typically present?
post gastroenteritis
celiac disease
why is whole milk used in the first 12-24 months?
better for brain development
when is low/fat free milk started?
after 2 years old
why are bottles discouraged?
caries and overconsumption
when are children supposed to transition to cups and utensils?
toddler/preschool
which nutritional deficiency puts a child at risk for edema and immunodeficiency?
protein
what is anaphylaxis?
reaction including skin/mucosa, respiratory compromise, hypotension/end organ dysfunction (sometimes GI sx)
skin sx of anaphylaxis
- pruritus
- flushing
- hives
- angioedema
respiratory sx of anaphylaxis
- dyspnea
- wheeze
- stridor
- hypoxemia
hypotension sx of anaphylaxis (rare)
- collapse
- syncope
- incontinence
epinephrine autoinjectors
Adrenaclick
EpiPen
Auvi-Q
how long observation post anaphylaxis?
4-8 hours
factors that compel admission post anaphylaxis?
- > 1 dose Epi needed
- IV fluids for hypotension
- laryngeal edema
- severe asthma
- trigger = ingestion
what is the difference between sensitization and allergy?
sensitization = detection of IgE on allergy test allergy = characteristic clinical sx upon exposure to an allergen + detection of specific IgE toward allergen
3 principle characteristics of allergic reaction
- objective
- immediate
- reproducible
typical sx of food allergy
- urticaria
- angioedema
- emesis
- rhinorrhea
- wheezing
- hypotension
- anaphylaxis
RF for developing a food allergy
- eczema
- asthma
- environmental allergies
- family hx of allergies
which food allergies are usually lifelong?
peanuts, tree nuts, seafood
is milk/food PROTEIN induced proctocolitis IgE mediated?
no
IgE mediated allergies
- milk
- eggs
- wheat
4 . soy - peanuts
- tree nuts
- seafood
what did the LEAP study show?
peanut allergy prevalence was less in consumption group than the avoidance group
why is GERD more pronounced in kids?
LES is less toned
what is GER?
passive passage into esophagus w/o regurg or vomit
normal response
occurs daily in infants
what age is GER common and when does it resolve?
1-6 months
resolves by 1 year
GERD sx
- regurg/vomiting
- weight loss
- irritability
- chest pain
- hematemesis
- dysphagia
- wheezing
- stridor
- cough
what is more commonly used to dx GERD in kids?
hx and PE (endoscopy not as helpful in kids)
what can be done for the “happy spitter” (GER)?
reassurance
if persistence - thicken food
FTT - acid suppression, refer to ped GI
what is the MC surgical disorder in neonates
pyloric stenosis
what can be used for kids w/heartburn?
PPI
pyloric stenosis sx
- vomiting (can be projectile)
- weight loss despite hunger
- hypertrophied pylorus
- metabolic alkalosis, electrolyte disturbances
tx for pyloric stenosis
- correct dehydration and alkalosis
2. pyloromyotomy
when is malrotation more common?
infancy
what are the sx of malrotation?
can be asx
- bilious emesis
- abd distention
- peritonitis
treatment for malrotation
Ladd’s procedure
what is a volvulus?
life threatening condition characterized by malrotation around the mesenteric axis
how is volvulus dx?
upper GI series shows corkscrew appearance of small bowel (not required to make dx!)
what is intussusception and where does it commonly occur?
telescoping of intestines
usually at ileocolic distribution
at what age does intussusception most commonly happen in kids?
2 y/o
classic triad for intussusception
- abd pain
- vomiting
- currant jelly stools
PE findings in intussusception
hypotonia, sausage mass in RLQ or RUQ
tx for intussusception
- fluid resuscitation
- antibiotics
- surgical consult
what is Meckel’s diverticulum?
congenital anomaly of GI tract
ectopic tissue (gastric or pancreatic)
usu w/i 2 ft from ileocecal valve
usu 2 ft long
who is most likely to have symptomatic Meckels?
children <2y/o
what is Hirschprung disease?
absence of ganglion cells in intestine
how does Hirschprung disease present in neonates?
- abd distention
- bilious emesis
- LBO
*could be asx other than delayed meconium passage
how does Hirschprung disease present in older kids?
constipation
gold standard dx for Hirschprung disease
rectal bx
how is Hirschprung disease tx?
resect aganglionic segment
sx tx for constipation in kids
Miralax, lactulose, milk of magnesia, stimulant laxative (not non-sitmulant!)
sx tx for constipation in babies
prune juice
how long should constipation be tx for?
continue tx for > 2 months and not stopped until sx gone for > 1 month
what is encopresis?
“overflow” - stool withholding (accumulation of stool in rectum)
liquid stool seeps around the mass of the stool
what is typically the cause of acute watery diarrhea lasting hours-days
viral or toxin
how to fluid resuscitate kid who is vomiting
spoonfuls of liquid every so often is all they can handle
what is typically the cause of bloody diarrhea or dysentary?
food protein allergy or infection (shigella, salmonella, campylobacter)
what infection can cause extraGI sx in kids < 3mon old?
salmonella can cause meningitis and osteomyelitis
what infections can cause prolonged or persistent diarrhea?
- giardia
- cryptosporidium
- C.diff
