Pediatric Nutrition Flashcards
Z-scores and percentile of growth in children
Z-score of 0 = 50th percentile
Z-score of -1/1 = 15th and 85th percentile
Z-score of -2/2 = 3rd and 97th percentile
Dietary recommendations for children 2yrs and older
3 regular meals per day plus one or two healthful snacks
Eat a variety of foods
Fat <35% of total kcal w/ sat fat <10% total kcal
Cholesterol <100mg/1000kcals (max 300mg/day)
Carbs = 45-65% total kcal and less than 10% kcal from simple sugars
Limit grazing behavior, eating while watching tv and sweetened beverages
Limit sodium intake
Why should, you not give fruit juice to children until at least 6 months of age (ideally 12 months)
Has lower nutrient density and is less likely to promote satiety
- has secretly high amount of sugar in them
Also high amounts have been shown to increase malabsorption, cause GI distress and tooth decay
Does servings or portion sizes change with growing older?
Portion sizes
What are key nutritional issues to take into consideration for toddlers and preschool age children?
Appetites fluctuate
Transitioning from bottles to cup by at least 24 months (should begin trying around 12-25 months)
Getting adequate iron and zinc levels in diet
Overconsumption of juice and sweetened beverages
What is a feeding “jag”
Begin around 2 years of age
- children will start resisting when given opportunities to try new foods
- may choose to eat a small number of foods they like
*to combat this offer new foods multiple times (8-10 times a day)
How do preschool children differ from younger children and school-age children?
Are more unpredictable in eating interests
- should AVOID restricting food intake or pressuring to eat more
They also pay attention to environmental cues a lot so when trying to develop and adhere to a predictable eating pattern, focus on:
- time of day
- portion size
- what others are eating
- packaging of food
How do school aged children differ from younger children in eating habits?
Actually understand basic nutrition (start of this)
Also beginning of when body shape/size and pressures of society and media start to influence eating. Habits
Also other people other than parents now play a bigger role ion attitudes towards eating
Key issues are getting an adequate amount of:
- fruits/vegetables
- calcium
- vitamin D
- Fiber
What are the key issues in adolescences
This is the main time of growth for all in this age range
Poor eating habits formed here = obesity and diet-related disease in later years
Often skip meals and increased fast food starts here
- also high incidence of dieting behavior and eating disorders
- need to be screened often and should make good use of MyPlate
Usually consume inadequate amounts of
- folic acid
- DEA vitamins
- B6 vitamins
- calcium
- iron *more seen in girls rather than boys
- zinc
- magnesium
What are the most common unhealthy dietary behaviors of US high school students?
1# dont drink milk
2# dont eat breakfast
3# tie between no vetables and drink a lot of soda
What are the highest pediatric populations at risk for malnutrition?
Hospitalized children (both acute and chronic)
Children with congenital anomalies, severe injuries, or chronic nutrient related conditions
Children affected by abuse/neglect
Acute vs chronic malnutrition
Acute:
- lasts fewer than 3 months and onset is sudden and severe
- muscle mass and weight loss is present (wasting)
- NO stunting
Chronic:
- lasts longer than 3 months and onset is gradual and severe
- wasting is still present just as much as acute
- stunting of growth is present
What are the 5 domains of pediatric malnutrition
Anthropometry (growth)
- z-scores
- weight
- height
- skin folds
- body circumferences
- reference charts
Chronicity
- illness related or not?
- acute vs chronic?
- is inflammation present?
Etiology
- same as chronic try
Pathogenesis
- starvation
- malabsorption
- nutrient loss
- hypermetabolism
- altered utilization of nutrients
Impact of malnutrition on functional status/outcomes
- loss of body mass
- muscle weakness
- delayed wound healing
- mental disturbances
Other than weight and BMI, what other methods can be used to measure nutritional status of children?
Midd-upper arm circumference
- measure at the ole Ramon process and acromium
- less affected by edema!
Handgrip strength
List of recommended indicators for inadequate nutrition
1) food/nutrient intake
- diet history
- direct observation
2) assessment of energy and protein needs
- indirect calorimetry (preferred method)
- standardized equations
- DRI for protein
3) growth parameters
4) weight gain velocity
* both 3 and 4 are measured the same way*
- z-scores and percentile charts
5) mid-upper arm circumference
6) handgrip strength
7) proxy measures
