Peds Obesity

Question 1

AAP suggests exclusive breastfeeding until how old

Answer 1

6 months

Question 2

when should you wean a baby off breastfeeding ?

Answer 2

1 year old

Question 3

what are advantages of breastfeeding

Answer 3

• emotional connection
• less illnesses for baby
• reduces SIDS
• reduces obesity
• decreased risk of postpartum hemorrhage

Question 4

what are disadvantages of breastfeeding

Answer 4

• maternal fatigue
• special diets
• pain
• latching issues
• vitamin D supplementation

Question 5

infants lose up to (…) of their birth weight

Answer 5

7%

Question 6

when should the birth weight be regained?

Answer 6

10-14 days of age

Question 7

follow up newborn exam should be performed in office (…) after birth

Answer 7

3-5 days

Question 8

infants must gain (…) per day

Answer 8

15 grams

Question 9

(…) fed infants grow more rapidly at 3-4 months

Answer 9

formula

Question 10

what is the theory of childhood obesity in formula fed babies

Answer 10

• formula fed babies are on scheduled feeds and finish the whole bottle
• breast fed babies feed when they are hungry and stop when they are full

Question 11

t/f no supplementation is needed in formula fed babies

Answer 11

true

Question 12

when can you introduce single grain rice cereal?

Answer 12

4 month

Question 13

when can you introduce baby foods?

Answer 13

6 months

Question 14

when can you introduce meats?

Answer 14

9 months

Question 15

why should you wait longer to introduce meats?

Answer 15

increases risk of diabetes

Question 16

how does a baby show readiness for complementary foods?

Answer 16

• able to hold head up
• able to sit unassisted
• brings objects to mouth showing interest in foods
• ability to track spoon and open the mouth

Question 17

purpose of introducing rice grain to diet?

Answer 17

adds additional iron

Question 18

if single grain cereals are tolerated, you can introduce (…) in later weeks

Answer 18

mixed cereals

Question 19

whole cows milk is introduced at (…)

Answer 19

12 months

Question 20

milk consumption is limited to (…)

Answer 20

16oz/day

Question 21

whole milk can be given until (…)

Answer 21

2 years

Question 22

toddlers should try foods (….) before they decide they dont like it

Answer 22

10 times

Question 23

you can give 1/2 a Flinstone vitamins at (…)

Answer 23

18 months

Question 24

t/f you should not reward children with food

Answer 24

true

Question 25

carbs should be (...) of the daily calories

Answer 25

55-60%

Question 26

(...) of grains should be whole grains

Answer 26

1/2

Question 27

fats should be (...) of total calories

Answer 27

<30%

Question 28

if 1 parent is obese, there is a (...) in risk of obesity for the child, and (....) if both parents are obese

Answer 28

3x for 1 parent 15x for both parents

Question 29

(...) bedtimes are correlated to childhood obesity

Answer 29

later

Question 30

what is leptin

Answer 30

A hormone produced by adipose (fat) cells that acts as a satiety factor in regulating appetite.

Question 31

what is ghrelin

Answer 31

hormone secreted by the stomach that triggers feelings of hunger

Question 32

what meds are associated with obesity

Answer 32

* steroids * sulfolylureas * OCPs * antidepressants * antipsychotics

Question 33

hormone levels in obesity: -leptin -estrogen -cortisol -GH -insulin -testosterone

Answer 33

* leptin: increased * estrogen: increased * cortisol: increased * GH: decreased * insulin: resistance * testosterone in men: decreased * testosterone in women: increased

Question 34

GH and growth in obese children

Answer 34

grow rapidly at first and the GH drops so obese children have stunted growth

Question 35

organ systems and associated problems with obesity -cardio -resp -ortho -GI -GU -psych -growth -CNS -skin

Answer 35

* cardio: HTN * resp: asthma , OSA * ortho: joint pain * GI: reflux * GU: menstrual irregularities, micropenis * psych: anxiety and depression * growth: stunted * CNS: pseudotumor cerebri * skin: acanthosis nigricans

Question 36

diagnosis of childhood obesity

Answer 36

* BMI chart * history of diet and exercise * PE * labs

Question 37

pertinent history questions for obese children

Answer 37

* diet and exercise * screen time * family history * associated symptoms * medications

Question 38

diagnosis of HTN in child

Answer 38

3 or more elevated reading on 3 different occasions at least 1 week apart

Question 39

t/f acanthothis nigricans can improve when glucose levels normalize

Answer 39

true

Question 40

barriers for providers in childhood obesity

Answer 40

* time constraints * lack of knowledge in current recommendations * lack of patient motivation * communication barriers

Question 41

how to approach childhood obesity

Answer 41

* avoid using words like obese, thick, fat, overweight * instead use excess weight, elevated BMI

Question 42

cholesterol screening recommendations for children

Answer 42

* all children between 9 and 11 * should be screened between 2 and 10 if they have FH of blood vessel disease, FH of elevated cholesterol, and any child with heart disease, diabetes, HTN, or are obese

Question 43

treatment of childhood obesity

Answer 43

* dietary modifications * sleep modifications * exercise modifications * accountability * treat underlying disease

Question 44

diet modifications for childhood obesity

Answer 44

* 5 fruits and vegges per day * eat breakfast * limit fast food and soda * eat as a family

Question 45

t/f diet drinks have been shown to have more associated weight gain than regular soda

Answer 45

true

Question 46

4 golden rules of eating

Answer 46

* divide responsibilities * eat when your body is hungry * dont make children clean the plate * eat together

Question 47

effects of lack of sleep

Answer 47

* increase ghrelin * decrease leptin * increase cortisol * increase insulin resistance

Question 48

exercise modifications for childhood obesity

Answer 48

* join a sporting activity * exercise together * limit TV/electronics to under 2 hours per day

Question 49

mental health and childhood obesity

Answer 49

* increased stress * increased anxiety and depression * increased suicide attempts

Question 50

medication management of childhood obesity

Answer 50

* topamax * phentermine * qsymia

Question 51

stipulations for most bariatric surgeries

Answer 51

* over 15 yo * BMI over 40 or 100% IBW

Question 52

MC surgical option for childhood obesity

Answer 52

gastric bypass

Question 53

normal vitamin d intake

Answer 53

600 U/day

Question 54

if vit D is 20-29...

Answer 54

OTC vitamin D3 1000U/d and recheck every 3 months

Question 55

if vit D is under 20...

Answer 55

Rx vitamin D2 50,000 U/weekly and recheck in 3 months

Question 56

what patients should you consider PCOS in?

Answer 56

hirsutism, acne, oliguria, elevated testosterone

Question 57

what patients should you consider kleinfelter in?

Answer 57

tall, hypogonadism, decreased testosterone

Question 58

Prader-Willi Syndrome

Answer 58

loss of paternally expressed genes

Question 59

MC syndromic form of obesity

Answer 59

Prader-Willi syndrome

Question 60

s/s of prader-willi

Answer 60

* hyperphagia * short stature and GH deficiency * resistant to diet and exercise

Question 61

major criteria for prader willi syndrome

Answer 61

* hypotonia * feeding issues * hypogonadism * facial abnormalities * developmental delay * hyperphagia * excessive weight gain

Question 62

follow up for pediatric obesity

Answer 62

assess BMI and vitals every 1-3 months

Question 63

if there has been no change in weight after 3-6 months of interventions...

Answer 63

consider referral to weight loss specialist or dietitian