SM_149b: Growth: Disease Specific Impact in Children Flashcards
Organic pediatric malnutrition has ___
Organic pediatric malnutrition has an underlying medical cause
____ should always be corrected when assessing growth
Children born <37 weeks premature until 24 months should always be corrected when assessing growth
Disturbances in ___ may be the first indication of an underlying disease state
Disturbances in growth may be the first indication of an underlying disease state
Describe the different growth curves
Growth curves
- CDC
- WHO: breast fed infants
- Premaature infants: 40 weeks - gestational age at birth (corrected = chronological age - adjustment for prematurityZ)
Describe daily weight gain in children
Daily weight gain in children
- 20-30 grams in first 3-4 months
- 15-20 grams in first year
- 5-10 grams at 12 months to 2 years
Describe height of children
Height of children
Girls = [(father height - 5 in) + mother height] / 2
Boys = [father height + (mother height + 5 in)] / 2
BMI is not applicable if ____
BMI is not applicable if age < 2 years
- Weight / length: assesses weight compared to height, indicator of acute malnutrition
- Length / heigh for age: indicator of chronic malnutrition and stunting
___ is the last growth parameter to decrease
Head circumference is the last growth parameter to decrease
Non-organic pediatric malnutrition has ___
Non-organic pediatric malnutrition has psychosocial origin leading to poor intake
Failure to thrive / growth faltering is ____ < 3 months and ____ > 3 months
Failure to thrive / growth faltering is acute < 3 months and chronic > 3 months
Describe anthropometry of children
Anthropometry of children
Describe appropriate growth charts
Appropriate growth charts
- WHO growth curve for children < 2 years of age
- BMI used for children > 2 years of age
- Weight / length < 2 years
Weight/length can indicate ____
Weight/length can indicate acute malnutrition
Length/height for age include ____ or ____
Length/height for age include chronic malnutrition or stunting
This is ____
This is normal weight
This is ___
This is obese
Failure to thrive or growth faltering is based on ____
Failure to thrive or growth faltering is based on established growth standards for age-sex
- Weight for age or weight/length < 5%
- Weight may cross more than 2 major percentiles
- Decrease in > 2 SD on growth charts over 3-6 months
Failure to thrive / growth faltering can occur due to ____, ____, ____, and ____
Failure to thrive / growth faltering can occur due to insufficient intake, losing calories, increased caloric demand, and inability to utilize calories appropriately
- Losing calories: vomiting / diarrhea, malabsorption
- Increased caloric demand: complex heart disease, liver disease, and pulmonary disease
- Inability to utilize calories appropriately: mitochondrial disease, chromosomal abnormality
Failure to thrive / growth faltering can occur in ___, ___, ___, and ___
Failure to thrive / growth faltering can occur in cystic fibrosis, IBD, celiac disease, and for social reasons such as poor maternal interaction with child and improper mixing of formula
Cystic fibrosis may present with ____, ____, and ____ and is a cause of ____
Cystic fibrosis may present with respiratory infections, poor weight gain, and fat malabsorption and is a cause of growth failure
- CFTR mutations
- Sweat Cl > 60 mmol/L on two separate occasions
- Immunoreactive trypsinogen concentration
Describe GI manifestations of cystic fibrosis
Cystic fibrosis GI manifestations
- Pancreatic insufficiency (∆F508) 90%
- Pancreatitis / pancreatic sufficiency: fat malabsorption (fat soluble vitamins A, D, E, and K)
- Meconium ileus / perforation leading to intestinal resection / short bowel syndrome
- Distal intestinal obstructive syndrome - severe constipation that may require intensive therapy
Describe functions of the pancreas
Pancreas functions
- Secretes alkaline fluid that neutralizes gastric acid
- Secretions have increased viscosity, blocking ducts of exocrine glands i.e. pancreas
- Contains multiple digestive enzymes to help with absorption
Goal for growth in a patient with cystic fibrosis is ____
Goal for growth in a patient with cystic fibrosis is > 50th percentile for weight/length and BMI
- Pancreatic enzyme replacement therapy is used to treat
Inflammatory bowel disease presents with ____, ____, ____, ____, and ____
Inflammatory bowel disease presents with abdominal pain, diarrhea, rectal bleeding, weight loss, and growth failure in pediatric populations
Growth failure / faltering is defined as ____, ____, or ____
Growth failure / faltering is defined as height < 5th percentile, decrease in height velocity below the 5th percentile, and fall off the growth curve
(higher incidence at diangosis in Crohn’s than ulcerative colitis)
Growth failure / faltering in IBD results from ____, ____, and ____
Growth failure / faltering in IBD results from inadequate caloric intake, malabsorption, and increased energy expenditure from chronic inflammation
- Inadequate caloric intake: gastritis, esophagitis, fear of worsening symptoms
- Increased energy expenditure from chronic inflammation: pro-inflammatory cytokines, decreased IGF-1, and exogenous steroids
____ with IBD have greater risk of growth failure
Boys with IBD have greater risk of growth failure
(treat all with remicade and humira)
____ is an immune-mediated disorder that is triggered by gluten allergy in genetically susceptible persons after the introduction of solid food
Celiac disease is an immune-mediated disorder that is triggered by gluten allergy in genetically susceptible persons after the introduction of solid food
Celiac disease presents with ____, ____, ____, and ____
Celiac disease presents with abdominal pain, diarrhea, constipation, and growth faltering
- Diagnosis: various IgA assays
Someone with scalloping and nodularity on endoscopy may have growth faltering due to ___
Someone with scalloping and nodularity on endoscopy may have growth faltering due to celiac disease
Celiac crisis in children presents with ____, ____, and ____ and often occurs after use of ____
Celiac crisis in children presents with severe diarrhea, hypoproteinemia, and electrolyte abnormalities and often occurs after use of corticosteroids
Describe non-organic growth faltering
Non-organic growth faltering
- Post-partum depression
- Economic reasons: improperly prepared formula
- Young mother with lack of social support
- Maternal-child bonding issues: colicky infant
- Inpatient monitoring of weight gain sometimes necessary
