Therapeutics Exam 3 (Pediatric Nutrition) Flashcards
What are the 5 nutrition basics of infants?
-Lack of caloric reserve
-Increased metabolic rate
-Higher growth rates
-Increased demands during illness
-Dependent on others for nutrition
How does the metabolic rate of infants compare to adults?
It is higher
-they have much higher nutritional needs
What is the typical weight range for an infant at birth?
3-4 kg
The weight of an infant doubles from their birth weight by how many months?
4-6 months
The weight of an infant triples from their birth weight by how many months?
12 months
By 12 months, an infant’s length increases by what percent?
50%
Adipose tissue distribution begins after what age?
age 2
(fat stores increase)
How do you decide whether to use the WHO growth chart or the CDC growth chart?
WHO: <2 years old
CDC: 2-20 years old
True or False: Growth is a linear process
FALSE
Multiple factors affect growth:
-Age
-Organ function
-Body composition
What organ in neonates requires the most energy to function?
Brain
What percent of a neonate’s basal energy expenditure is used by their brain?
50%
What is malnutrition?
Deficiencies or Excesses in nutrient intake
Imbalance of essential nutrients
Impaired nutrient utilization
What is a Z-score?
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)
What 2 factors may indicate that a pediatric patient is experiencing failure to thrive (aka growth faltering)?
-They fall down 2 major percentiles in growth
-Weight <3rd-5th percentile
What are the 3 causes of malnutrition?
Inadequate caloric intake
Inadequate absorption
Excessive energy
How many kcal are in breast milk?
20 kcal/oz
Which percentile do we use on a growth chart if we want to find an average?
50th (right in the middle of the percentiles)
What are the breast feeding recommendations by AAP and WHO?
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
What are the contraindications to breast feeding?
**HIV positive
DRUGS (elicit and non-elicit)
What are the 2 broad categories that drugs to avoid during breastfeeding fall into?
Drugs that can harm the infant directly
Drugs that reduce milk production
Which drugs can harm the infant directly?
Immunosuppressants
Chemotherapy
Radioactive agents
Which drugs reduce milk production?
Ergots
Decongestants
Antihistamines
What drug characteristic makes a drug more likely to be absorbed by the infant while breastfeeding?
High oral bioavailability
What drug characteristics increase the level of a drug in breastmilk?
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)
What are the indications for formula feeding?
-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
What is a human milk fortifier?
-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
Human milk fortifiers increase the calorie content of human milk to what?
22-28 kcal/oz
What are Term Formulas?
-Modeled after breastmilk
-Provide 19-20 kcal/oz
Carbohydrate source: Lactose
contain cow’s milk protein
Usually not concentrated
True or False: All infants should receive iron-fortified formula
True
Term, healthy infants will feed an average of how many timer per day?
6-9 times
Initially, breastfeeding parents are encouraged to breastfeed how many times per day?
8-12 times
As an infant grows older how does their feeding schedule change?
-Decreased amount of feedings per day
-Increased oz per feeding
(eat less often but greater quantities per feed)
What babies should be given Vitamin D3 (cholecalciferol)?
All breast-fed babies
-per CDC
What units are used for Cholecalciferol?
mCg or International Units (IU)
*use caution when selecting products with drops or mL
10 mCg of Cholecalciferol is equal to how many IU?
400 IU
For partially/fully breastfed infants, how much cholecalciferol should they receive daily?
400 IU (10mCg) daily
For formula fed infants, how much cholecalciferol should they receive daily?
200-400 IU (10 mCg) daily
*supplement until they receive 1000 mL/formula/day
(approx 30 oz/day)
Generally, for all term infants, how much cholecalciferol should they receive per day?
10 mCg
(around 400 IU)
True or False: Iron supplementation is recommended for all infants?
FALSE
*note that iron fortified formula is recommended for all formula-feeding babies
When is iron supplementation recommended in infants?
Premature neonates
Term infants with a deficiency
*not routinely recommended for healthy, breastfed infants
How much iron should a premature neonate needing supplementation receive?
2 mg/kg/day
How much iron should a term infant needing supplementation receive?
3 mg/kg/day
How much iron does ferrous sulfate contain?
20%
75 mg/ml of ferrous sulfate contains how much elemental iron?
15 mg elemental iron/ml
What are the symptoms of a zinc deficiency?
Dermatitis
Diarrhea
Infections
Altered wound healing
What is the normal concentration of zinc?
70-150 mCg/dL
Dosing of zinc is based on what?
Elemental zinc
***not zinc salt
What is the conversion factor for zinc sulfate to elemental zinc?
Zinc sulfate 44 mg= 10 mg Elemental Zinc
Which patients may require zinc supplementation?
-Premature infants
-Prolonged exclusive breast feeding after >6 months
-Parenteral nutrition
-IBD/Intestinal failure
-Vegan or vegetarian diets
-Generalized malnutrition
At what age should complementary foods begin to be initiated?
6 months
When introducing complementary foods to infants, what are some of the Do’s?
Introduce 1 new food every 4-5 days
Increase serving size gradually
Emphasize all food groups
Which foods should never be given to children <1 year old?
Honey
Cow’s milk
Choking hazards
Potential allergens
Using the Holliday-Segar method for calculating fluid requirements, how much fluid should a child up to 10 kg receive?
100 mL/kg
Using the Holliday-Segar method for calculating fluid requirements, how much fluid should a child who is 10-20 kg receive?
1000 mL + 50mL/kg for every kg >10
Using the Holliday-Segar method for calculating fluid requirements, how much fluid should a child who is > 20 kg receive?
1500 mL + 20mL/kg for every kg > 20
When selecting a fluid for infants, what do we always want to be in the fluid?
Dextrose
When calculating feeding requirements, what information do we need to know?
-Age/ postconceptional age if preterm
-Underlying medical conditions
-Current weight
-Number of feedings per day
1 oz = ? mL
30 mL
When formula requirements exceed fluid requirements what do we do?
Always calculate based on caloric needs
Exceptions:
-Fluid restricted patients
**use calorie-dense formulas for these
How do we calculate the caloric needs of a failure to thrive patient?
Use a “catch-up” growth plan
*Use weight that corresponds with the 50th percentile on the growth chart while doing calculations
What are the short-term options for alternative administration routes?
NG, ND, NJ, Orogastric Tube
What are the long-term options for alternative administration routes?
PEG, PEJ, surgical jejunostomy, gastrostomy (G-tube)
