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Fall 2024 > Therapeutics Exam 3 (Pediatric Nutrition) > Flashcards

Therapeutics Exam 3 (Pediatric Nutrition) Flashcards

1
Q

What are the 5 nutrition basics of infants?

A

-Lack of caloric reserve
-Increased metabolic rate
-Higher growth rates
-Increased demands during illness
-Dependent on others for nutrition

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2
Q

How does the metabolic rate of infants compare to adults?

A

It is higher
-they have much higher nutritional needs

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3
Q

What is the typical weight range for an infant at birth?

A

3-4 kg

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4
Q

The weight of an infant doubles from their birth weight by how many months?

A

4-6 months

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5
Q

The weight of an infant triples from their birth weight by how many months?

A

12 months

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6
Q

By 12 months, an infant’s length increases by what percent?

A

50%

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7
Q

Adipose tissue distribution begins after what age?

A

age 2

(fat stores increase)

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8
Q

How do you decide whether to use the WHO growth chart or the CDC growth chart?

A

WHO: <2 years old
CDC: 2-20 years old

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9
Q

True or False: Growth is a linear process

A

FALSE

Multiple factors affect growth:
-Age
-Organ function
-Body composition

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10
Q

What organ in neonates requires the most energy to function?

A

Brain

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11
Q

What percent of a neonate’s basal energy expenditure is used by their brain?

A

50%

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12
Q

What is malnutrition?

A

Deficiencies or Excesses in nutrient intake

Imbalance of essential nutrients

Impaired nutrient utilization

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13
Q

What is a Z-score?

A

A statistical analysis that tells us the distance and direction of an observation from a population mean

(ex: -4 would be 4 standard deviations lower than the population mean)

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14
Q

What 2 factors may indicate that a pediatric patient is experiencing failure to thrive (aka growth faltering)?

A

-They fall down 2 major percentiles in growth

-Weight <3rd-5th percentile

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15
Q

What are the 3 causes of malnutrition?

A

Inadequate caloric intake
Inadequate absorption
Excessive energy

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16
Q

How many kcal are in breast milk?

A

20 kcal/oz

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17
Q

Which percentile do we use on a growth chart if we want to find an average?

A

50th (right in the middle of the percentiles)

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18
Q

What are the breast feeding recommendations by AAP and WHO?

A

AAP: Exclusive breast feeding for first 6 months, optimally continue for 1 year, may extend beyond 1 year if desired

WHO: Suggests up to 2 years

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19
Q

What are the contraindications to breast feeding?

A

**HIV positive

DRUGS (elicit and non-elicit)

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20
Q

What are the 2 broad categories that drugs to avoid during breastfeeding fall into?

A

Drugs that can harm the infant directly

Drugs that reduce milk production

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21
Q

Which drugs can harm the infant directly?

A

Immunosuppressants
Chemotherapy
Radioactive agents

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22
Q

Which drugs reduce milk production?

A

Ergots
Decongestants
Antihistamines

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23
Q

What drug characteristic makes a drug more likely to be absorbed by the infant while breastfeeding?

A

High oral bioavailability

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24
Q

What drug characteristics increase the level of a drug in breastmilk?

A

Non-ionized

Small Molecular Weight

Low Protein Binding (free floating)

High Lipid Solubility (lots of fat in breast milk)

Long T1/2 (sticks around longer)

Low Vd (not bound to many things, free floating in blood stream, get delivered to breastmilk via blood)

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25
Q

What are the indications for formula feeding?

A

-Substitute for mothers who do not/cannot breastfeed

-Infants with human milk intolerance

-Transmittable maternal infection

-Maternal chemotherapy

-Infant fails to gain weight despite optimal breastfeeding

26
Q

What is a human milk fortifier?

A

-Additive to breast milk to make caloric intake greater

Breast milk does not adequately meet the nutritional needs of preterm infants

-Increase calories, minerals, vitamins, and protein

27
Q

Human milk fortifiers increase the calorie content of human milk to what?

A

22-28 kcal/oz

28
Q

What are Term Formulas?

A

-Modeled after breastmilk
-Provide 19-20 kcal/oz

Carbohydrate source: Lactose
contain cow’s milk protein

Usually not concentrated

29
Q

True or False: All infants should receive iron-fortified formula

A

True

30
Q

Term, healthy infants will feed an average of how many timer per day?

A

6-9 times

31
Q

Initially, breastfeeding parents are encouraged to breastfeed how many times per day?

A

8-12 times

32
Q

As an infant grows older how does their feeding schedule change?

A

-Decreased amount of feedings per day
-Increased oz per feeding

(eat less often but greater quantities per feed)

33
Q

What babies should be given Vitamin D3 (cholecalciferol)?

A

All breast-fed babies

-per CDC

34
Q

What units are used for Cholecalciferol?

A

mCg or International Units (IU)

*use caution when selecting products with drops or mL

35
Q

10 mCg of Cholecalciferol is equal to how many IU?

A

400 IU

36
Q

For partially/fully breastfed infants, how much cholecalciferol should they receive daily?

A

400 IU (10mCg) daily

37
Q

For formula fed infants, how much cholecalciferol should they receive daily?

A

200-400 IU (10 mCg) daily

*supplement until they receive 1000 mL/formula/day
(approx 30 oz/day)

38
Q

Generally, for all term infants, how much cholecalciferol should they receive per day?

A

10 mCg

(around 400 IU)

39
Q

True or False: Iron supplementation is recommended for all infants?

A

FALSE

*note that iron fortified formula is recommended for all formula-feeding babies

40
Q

When is iron supplementation recommended in infants?

A

Premature neonates
Term infants with a deficiency

*not routinely recommended for healthy, breastfed infants

41
Q

How much iron should a premature neonate needing supplementation receive?

A

2 mg/kg/day

42
Q

How much iron should a term infant needing supplementation receive?

A

3 mg/kg/day

43
Q

How much iron does ferrous sulfate contain?

A

20%

44
Q

75 mg/ml of ferrous sulfate contains how much elemental iron?

A

15 mg elemental iron/ml

45
Q

What are the symptoms of a zinc deficiency?

A

Dermatitis
Diarrhea
Infections
Altered wound healing

46
Q

What is the normal concentration of zinc?

A

70-150 mCg/dL

47
Q

Dosing of zinc is based on what?

A

Elemental zinc

***not zinc salt

48
Q

What is the conversion factor for zinc sulfate to elemental zinc?

A

Zinc sulfate 44 mg= 10 mg Elemental Zinc

49
Q

Which patients may require zinc supplementation?

A

-Premature infants
-Prolonged exclusive breast feeding after >6 months
-Parenteral nutrition
-IBD/Intestinal failure
-Vegan or vegetarian diets
-Generalized malnutrition

50
Q

At what age should complementary foods begin to be initiated?

A

6 months

51
Q

When introducing complementary foods to infants, what are some of the Do’s?

A

Introduce 1 new food every 4-5 days

Increase serving size gradually

Emphasize all food groups

52
Q

Which foods should never be given to children <1 year old?

A

Honey
Cow’s milk
Choking hazards
Potential allergens

53
Q

Using the Holliday-Segar method for calculating fluid requirements, how much fluid should a child up to 10 kg receive?

A

100 mL/kg

54
Q

Using the Holliday-Segar method for calculating fluid requirements, how much fluid should a child who is 10-20 kg receive?

A

1000 mL + 50mL/kg for every kg >10

55
Q

Using the Holliday-Segar method for calculating fluid requirements, how much fluid should a child who is > 20 kg receive?

A

1500 mL + 20mL/kg for every kg > 20

56
Q

When selecting a fluid for infants, what do we always want to be in the fluid?

A

Dextrose

57
Q

When calculating feeding requirements, what information do we need to know?

A

-Age/ postconceptional age if preterm
-Underlying medical conditions
-Current weight
-Number of feedings per day

58
Q

1 oz = ? mL

A

30 mL

59
Q

When formula requirements exceed fluid requirements what do we do?

A

Always calculate based on caloric needs

Exceptions:
-Fluid restricted patients
**use calorie-dense formulas for these

60
Q

How do we calculate the caloric needs of a failure to thrive patient?

A

Use a “catch-up” growth plan

*Use weight that corresponds with the 50th percentile on the growth chart while doing calculations

61
Q

What are the short-term options for alternative administration routes?

A

NG, ND, NJ, Orogastric Tube

62
Q

What are the long-term options for alternative administration routes?

A

PEG, PEJ, surgical jejunostomy, gastrostomy (G-tube)

Fall 2024 (10 decks)

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