Peds Obesity Flashcards
AAP suggests exclusive breastfeeding until how old
6 months
when should you wean a baby off breastfeeding ?
1 year old
what are advantages of breastfeeding
- emotional connection
- less illnesses for baby
- reduces SIDS
- reduces obesity
- decreased risk of postpartum hemorrhage
what are disadvantages of breastfeeding
- maternal fatigue
- special diets
- pain
- latching issues
- vitamin D supplementation
infants lose up to (…) of their birth weight
7%
when should the birth weight be regained?
10-14 days of age
follow up newborn exam should be performed in office (…) after birth
3-5 days
infants must gain (…) per day
15 grams
(…) fed infants grow more rapidly at 3-4 months
formula
what is the theory of childhood obesity in formula fed babies
- 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
t/f no supplementation is needed in formula fed babies
true
when can you introduce single grain rice cereal?
4 month
when can you introduce baby foods?
6 months
when can you introduce meats?
9 months
why should you wait longer to introduce meats?
increases risk of diabetes
how does a baby show readiness for complementary foods?
- 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
purpose of introducing rice grain to diet?
adds additional iron
if single grain cereals are tolerated, you can introduce (…) in later weeks
mixed cereals
whole cows milk is introduced at (…)
12 months
milk consumption is limited to (…)
16oz/day
whole milk can be given until (…)
2 years
toddlers should try foods (….) before they decide they dont like it
10 times
you can give 1/2 a Flinstone vitamins at (…)
18 months
t/f you should not reward children with food
true
carbs should be (…) of the daily calories
55-60%
(…) of grains should be whole grains
1/2
fats should be (…) of total calories
<30%
if 1 parent is obese, there is a (…) in risk of obesity for the child, and (….) if both parents are obese
3x for 1 parent
15x for both parents
(…) bedtimes are correlated to childhood obesity
later
what is leptin
A hormone produced by adipose (fat) cells that acts as a satiety factor in regulating appetite.
what is ghrelin
hormone secreted by the stomach that triggers feelings of hunger
what meds are associated with obesity
- steroids
- sulfolylureas
- OCPs
- antidepressants
- antipsychotics
hormone levels in obesity:
-leptin
-estrogen
-cortisol
-GH
-insulin
-testosterone
- leptin: increased
- estrogen: increased
- cortisol: increased
- GH: decreased
- insulin: resistance
- testosterone in men: decreased
- testosterone in women: increased
GH and growth in obese children
grow rapidly at first and the GH drops so obese children have stunted growth
organ systems and associated problems with obesity
-cardio
-resp
-ortho
-GI
-GU
-psych
-growth
-CNS
-skin
- 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
diagnosis of childhood obesity
- BMI chart
- history of diet and exercise
- PE
- labs
pertinent history questions for obese children
- diet and exercise
- screen time
- family history
- associated symptoms
- medications
diagnosis of HTN in child
3 or more elevated reading on 3 different occasions at least 1 week apart
t/f acanthothis nigricans can improve when glucose levels normalize
true
barriers for providers in childhood obesity
- time constraints
- lack of knowledge in current recommendations
- lack of patient motivation
- communication barriers
how to approach childhood obesity
- avoid using words like obese, thick, fat, overweight
- instead use excess weight, elevated BMI
cholesterol screening recommendations for children
- 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
treatment of childhood obesity
- dietary modifications
- sleep modifications
- exercise modifications
- accountability
- treat underlying disease
diet modifications for childhood obesity
- 5 fruits and vegges per day
- eat breakfast
- limit fast food and soda
- eat as a family
t/f diet drinks have been shown to have more associated weight gain than regular soda
true
4 golden rules of eating
- divide responsibilities
- eat when your body is hungry
- dont make children clean the plate
- eat together
effects of lack of sleep
- increase ghrelin
- decrease leptin
- increase cortisol
- increase insulin resistance
exercise modifications for childhood obesity
- join a sporting activity
- exercise together
- limit TV/electronics to under 2 hours per day
mental health and childhood obesity
- increased stress
- increased anxiety and depression
- increased suicide attempts
medication management of childhood obesity
- topamax
- phentermine
- qsymia
stipulations for most bariatric surgeries
- over 15 yo
- BMI over 40 or 100% IBW
MC surgical option for childhood obesity
gastric bypass
normal vitamin d intake
600 U/day
if vit D is 20-29…
OTC vitamin D3 1000U/d and recheck every 3 months
if vit D is under 20…
Rx vitamin D2 50,000 U/weekly and recheck in 3 months
what patients should you consider PCOS in?
hirsutism, acne, oliguria, elevated testosterone
what patients should you consider kleinfelter in?
tall, hypogonadism, decreased testosterone
Prader-Willi Syndrome
loss of paternally expressed genes
MC syndromic form of obesity
Prader-Willi syndrome
s/s of prader-willi
- hyperphagia
- short stature and GH deficiency
- resistant to diet and exercise
major criteria for prader willi syndrome
- hypotonia
- feeding issues
- hypogonadism
- facial abnormalities
- developmental delay
- hyperphagia
- excessive weight gain
follow up for pediatric obesity
assess BMI and vitals every 1-3 months
if there has been no change in weight after 3-6 months of interventions…
consider referral to weight loss specialist or dietitian
