Pediatric Nutrition

Question 1

What are some reasons that infant nutrition is different from adult nutrition?

Answer 1

(1) decreased caloric reserve (aka ability to store nutrients as fat)
(2) increased metabolic rate
(3) higher growth rate
(4) increased caloric need during illness (babies are sick all the time)

Question 2

Infant weight increases by a factor of ______ in the first 4-6 months, and by a factor of ______ in the first 12.

Answer 2

2, 3

Question 3

Infant length increases by _____% in the first 12 months.

Answer 3

50

Question 4

What are the two criteria listed that would classify a child under “failure to thrive”?

Answer 4

(1) fall in two major percentiles on the growth chart

(2) weight <3-5th percentile

Question 5

What are the AAP recommendations for the timeline of breastfeeding?

Answer 5

absolutely for the first 6 months, optimal to continue up to a year, can continue after that if desired

Question 6

What are some contraindications to breastfeeding?

Answer 6

(1) maternal HIV infection
(2) infectious TB
(3) human T-cell lymphotrophic virus type I or II
(4) untreated brucellosis
(5) DRUGS

Question 7

What kinds of drugs should a mother avoid, if possible, while breastfeeding?

Answer 7

(1) immunosuppressants
(2) chemotherapy
(3) lithium
(4) amphetamines
(5) radioactive drugs
(6) ergots (OTC for HA, heavy period)
(7) decongestants

6 and 7 decrease milk production, while the first 5 can directly harm the fetus through the breastmilk.

Question 8

How does molecular weight, lipid solubility, protein binding, volume of distribution, and half-life affect whether or not a drug will reach the breast milk?

Answer 8

(1) MW: inverse relationship
(2) lipid solubility: direct relationship
(3) protein binding: direct relationship
(4) volume of distribution: indirect relationship
(5) half-life: direct relationship

Question 9

What is the caloric density of breastmilk (and most formulas)?

Answer 9

20 kcal/oz

Question 10

What is the primary carbohydrate component of breastmilk?

Answer 10

lactose

Question 11

What are the two primary proteins and their relative abundance in human breastmilk?

Answer 11

70% whey

30% casein

Question 12

How are vitamin D and iron supplemented in premature and term infants?

Answer 12

In premature infants, vitamin D is supplemented in smaller amounts than term infants, and iron use is recommended. Term infants can receive 400 IU of vitamin D daily and do not need supplemental iron.

Question 13

What are the indications for formula feeding an infant?

Answer 13

(1) maternal chemotherapy
(2) infant not growing properly despite optimized breastfeeding
(3) maternal HIV infection
(4) infant cannot tolerate human milk

Question 14

Which two crucial elements of infant nutrition are missing from formulas?

Answer 14

fatty acids and Ig

Question 15

What is the usual concentration of preterm infant formulas?

Answer 15

22 or 24 kcal/oz

Question 16

What are the recommendations for introduction of complementary solid foods in the infant diet?

Answer 16

start at 4-6 months, introducing one food at a time and a new food about every 5 days

Question 17

For infants failing to thrive, calculate their daily caloric need based on the growth chart’s ______ percentile.

Answer 17

50th