week 2 Flashcards
what growth measures are routinely collected in UK children
weight - baby, school age and sometimes pre school age
head circumference - only as a baby
length - only as a baby and if they cannot stand
height - after age 2
BMI - after age 2
how is weight measured
using clincal grade electronic scales
wearing light indoor clothes and no shoes
babies weighed naked
how is head circumference measured
using a non-elastic plastic tape
measured 3 times or more - until at least 2 are the same
how is length measured
using a stiff or rigid board
how is height measured
using rigid measure with t piece or stadiometer
shoes off, feet flat
what does it mean if a patient is outside +2SD or -2SD on a growth chart
not healthy at all
standard centile lines
lines on the growth chart are evenly spaced at 2/3 SD and include extreme outer centiles
what does a height on the 25th centile mean
should be around 25 children shorter and 75 taller
how did WHO build an ideal growth chart
6 different cohorts from around the world using the same protocol and criteria:
child healthy
breastfed for first 4 months and impartially for a year
no smoking
prosperous mothers
how to tell if an individuals growth is normal
both weight and height tend to track within one centile space
weight commonly varies over short term in pre school years due to illness
height may show wide variation due to measurement error
what makes a child short
genetic - polygenic inheritance rate of maturation - some grow faster than others severe chronic illness and treatment chromosomal anomolies: turners, downs growth hormone deficiency chronic undernutrition
describe the 3 severities of malnutrition
severe acute malnutrition - below 3 standard deviations of median weight or height, visible severe wasting or presence of nutritional oedema
moderate malnutrition - weight loss and 2 to 3 SDs below the median weight or height
acute malnutrition - 1 to 2 SDs below median weight or height
3 types of malnutrition
mineral deficiency
protein energy malnutrion
avitaminosis
BMI for an obese adult
> 30 for obesity
>25 for overweight
what medical problems is obesity associated with
type II diabetes ischaemic heart disease cerebrovascular disease osteoarthritis hypertension some cancers psychological problems
social problems associated with obesity
body image dichotomy
difficulty engaging in some common social activities eg gym or employment
stigma
economic problems associated with obesity
sick leave
costs to NHS
causes of obesity
genetic predispositions leptin and appetite control insulin production and fat deposition individual diet and exercise patterns deprivation, learning disability, gender and race obesogenic environment technological progress
what is an obesogenic environment
readily available, cheap and heavily marketed energy rich foods
increase in labour saving devices eg lifts
increase in passive and motorised personal transport eg cars instead of walking
decreased participation i nactive leisure pursuits and total energy expenditure
milk-producing cells
lactocytes
function of oxytocin in breastmilk
stimulates myoepithelial cells to contract, pushing the milk into lactiferous ducts and towards the nipple
function of montgomery tubercles
glands which secrete a sebaceous fluid that lubricates the nipple and protects the skin
fluid has an individual aroma attracting infant to the mother
control of lactation
suckling sends powerful stimulus via higher sensors in the hypothalamus to posterior pituitary - secretes oxytocin
this acts on smooth muscle in alveoli which contract and inject milk into the lactiferous ducts
same stimulus acts on anterior pituitary to produce lactin - stimulates lactocytes to secrete milk for the next feed
milk contains feedback inhibitor of lactation which inhibits milk production when it accumulates
protein in human milk
main one is alpha lactalbumin and is associated with the destruction of over 40 types of cancer cells
carbohydrate in milk
Lactose is the main primary carbohydrate - provides 40% of total calories
improves the absorption of calcium and promotes growth of healthy bacteria
components of human milk not in formula
stem cells growth factors immunoglobulins leukocytes lactoferrin oligosaccharides human milk lipids IL-7
describe colostrum
first milk produced from breasts from 16 weeks of pregnancy consists of thick, yellowish fluid rich in vit A antibodies and anti-infective proteins
benefits of breastfeeding
immune protection:
breastfeeding activates broncho-entero-mammary pathway - when mother inhales pathogens, lymph nodes in the lungs and small intestine manufacture specially sensitised lymphocytes which migrate to the breasts and create antibodies
promotes development of the brain:
contains long-chain polyunsaturated fatty acids such as docosahexaenoic which support brain development and intelligence
promotes maturation of gut:
epidermal GF promotes healing, neuronal GFs promote development of peristalsis - help reduce chance of necrotising enterocolitis
protects mothers health:
protects against postpartum haemorrhage and depression, ovarian and breast cancers, heart disease and type II diabetes
importance of skin to skin contact
triggers lactation and mothering hormones
triggers calming hormones in the baby
stimulates digestion
stimulates instinctive feeding behaviors
enables infants skin to become colonised by protective bacteria from mothers skin
