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Which of the following statements is false?

a) the optimal glucose to sodium ratio to ensure sodium absorption by ORT is 2:1
b) the sodium-glucose cotransport system is destroyed in infective diarrhea caused by viruses or enteropathogenic bacteria
c) sodium-potassium-ATP pump on the basolateral membrane of the enterocyte provides the gradient that drives the process of glucose - sodium cotransport
d) glucose enhances sodium and water absorption


b) false, the cotranspot system is relatively intact in infective diarrhea caused by viruses and bacteria, whether invasive or enterotoxinegic, this is why ORT makes sense

ORT based on the glucose - sodium cotransport across the intestine membrane - sodium potassium ATP pump on the basolateral membrane of the enterocyte

the rest are true statements which explain the science behind ORT


Which of the following is not an effect of the reduced osmolality WHO recommended oral rehydration solution?

a) less IV solutions
b) lower stool volume
c) less emesis
d) hypernatremia


d) hypernatremia was reported with the use of the standard WHO solution with non cholera diarrhea

study comparing this standard solution to reduced osmolality ORS showed

less IV solutions (unplanned), lower stool volume, less emesis were advances of the oral rehydration solution with reduced osmolality

standard WHO solution: 90 mmol/L of sodium, 20 mmol/L of potassium, 80 mmol/L of chloride, 30 mmol/L of bicarbonate and 111 mmol/L of glucose, with an osmolarity of 311 mOsm/L.
revised WHO solution: reduced osmolarity (245 mOsm/L) ORS containing 75 mmol/L of sodium, 20 mmol/L of potassium, 65 mmol/L of chloride, 10 mmol/L of citrate and 75 mmol/L of glucose
**note that none of these have the 2:1 ratio shown in the last question; discuss; also, these have a lot less sodium that the body, does this work because the body is able to control the sodium (unlike with IV solutions?)


In which population has rice based oral rehydation therapy been shown to be especially effective?

a) children with cholera
b) children with non cholera diarrhea
c) children with E. coli
d) none of the above


a) has been shown to be especially effective in cholera, reduces stool output in these patients, not so much in other types of diarrhea
has been shown to reduce the need for unscheduled IV therapy

using starch from rice and other cereals helps reduce osmolarity while providing a favourable ratio of glucose to sodium, may also add calories without increasing osmolarity


Which of the following supplementations to oral rehydration solution has been shown to reduce the duration and severity of diarrhea?

a) glycine
b) alanine
c) zinc
d) glutamine


c) zinc fortified ORS can reduce the severity and duration of diarrhea; other substrates such as glycine, alanine and glutamine have not been shown to be superior to traditional ORS

because it is expensive, we don’t give zinc fortified ORS routinely (instead recommend the supplement 20 mg for 10-14 days for children with acute diarrhea, 10 mg/day for infants <6 months of age


A 3 year old girl with gastroenteritis has decreased urine output, tachycardia and a sunken anterior fontanelle. How should you give rehydration?

a) IV normal saline or Ringer’s Lactate 20 cc/kg - 40 cc/kg over 1 hour
b) oral rehydration solution 50 ml/kg over 4 hours and replace ongoing losses with ORS
c) oral rehydration solution 100 ml/kg over 4 hours then replace ongoing ORS
d) age appropriate diet


c) is the answer
this is moderate dehydration 5-10% dehydrated
(remember, that based on clinical signs is the best way to assess dehydration, weight isn’t super accurate)
based on the algorithm should rehydrate with ORS 100 ml/kg over 4 hours, replace ongoing losses with oRS, age appropriate diet after rehydration

oral rehydration is as effective as, if not more effective, than IV treatment for moderate dehydration, less adverse effects and shooter hospital stay, should be the first choice for mild-moderate dehydration ; cheaper, less traumatic, can administer at home


A 2 year old boy weighing 16 kg with gastroenteritis has significantly reduced urine output, very sunken anterior fontanelle, tachycardia, and very low energy. His Na level is 150. What is the appropriate rate for rehydration ?

a) pedialyte 72 ml/hr
b) pedialyte 52 ml/hr
c) IV 0.45 NS @ 72 ml/hr
d) IV 0.45 NS @ 52 ml/hr


a) amount of maintenance fluid should be reduced by 25% because these children have higher ADH levels **check if this makes sense (since we are replacing losses plus maintenance
10% dehydration x 16000 kg = 1600 ml to replace
moderate hypernatremia, replace over 48 hours as per RCH guidelines, therefore rate will be 33cc/hr for replacement plus the maintenance rate - 25% (52 (-13) ml/hr) =72 ml/hr (looking at the guideline is a bit less because they use moderate 7% loss to replace), likely a few different ways of doing this
if doing IV then should do D5NS

b) does not do replacement

**according to the algorithm once the patient is stable, can give ORS for severe dehydration, but this patient is still not totally stable so should continue IV

for hypernatremia, should give fluids so that Na is normalized over 48-72 hours
amount of maintenance fluid should be reduced by 25% because these children have higher ADH levels
http://www.rch.org.au/clinicalguide/guideline_index/Hypernatraemia/ (how to deal with hypernatremic dehydration *also clarify what type of fluid to use)

fluid therapy should always include: rehydration, replace losses, maintenance


Which is the best type of oral rehydration solution to use?

a) powder package
b) premixed
c) homemade
d) none of the above


b) premixed are recommended over the others even though the pre-packaged powders are easier to store, have longer shelf life and are less expensive, can easily lead o an imbalance of electrolytes with incorrect mixing


Which of the following is not true of carbonated beverages?

a) can cause diarrhea
b) low electrolytes
c) high carbohydrate
d) low osmolarity


d) actually has high osmolarity, can cause diarrhea if given in high quantities

free water can lead to hyponatremia or hypoglycaemia


All but which of the following is not a contraindication to oral rehydration therapy?

a) protracted vomiting despite small, frequent feeding
b) severe dehydration with shock like state
c) impaired consciousness
d) ongoing stool losses of >10 ml/kg/hr
e) paralytic ileus
f) monosaccharide malabsorption


d) these children should not be denied ORT despite the intense pooping because the majority of these children will respond to ORT

the others are contraindications to ORT
ORT successful in 95% of cases


Which of the following is not the appropriate advice to give a parent with a dehydrated baby?

a) stop breastfeeding while baby is dehydrated
b) can give regular formula to non breastfed babies who are dehydrated
c) early referring has both nutritional and clinical benefits
d) children with dehydration should be rehydrated then fed an age-appropriate diet


a) false - should continue breastfeeding throughout, even in the initial phases

the rest are true
nutritional and clinical benefits of early referring: induce digestive enzymes, improve absorption, enhance enterocyte regeneration, promotee recovery of disaccharidases, reduce duration of diarrhea, maintain growth and improve nutritional outcomes


How much of baby baby’s nutritional needs can be met by breast milk between the ages of 6-12 months?

a) 25%
b) 50% or more
c) 100%
d) none of the above


b) 50% or more between 6 -12 months (starts off lower, see below)
prior to this, all nutrition from breast milk (firsts 6 months)

12-24 months - 1/3 from breast milk, the rest from food

the energy contribution from complementary feedings is approximately one fifth of the total requirement (WHO, 2009; PAHO, 2003). By nine to 11 months, complementary feedings contribute just under half of the estimated total energy requirement.


Which of the following has not been associated with breastfeeding past 6 months?

a) increased risk of obesity and overweight
b) protect against infections, especially GI and resp
c) protect mother against breast cancer and ovarian cancer
d) improved sensitivity and bonding


a) opposite, decreases this risk

the others are based on limited evidence


Of Canadian mothers who breastfeed, how many breastfeed past 6 months of age?


57.4% continue breastfeeding, only 18% past one year
reasons for stopping: lack of milk; infant ready for food/self-weaned
closet nursing, not always socially acceptable to continue so people do it in secret


True or false -baby friendly initiatives help to improve the duration of breastfeeding


true - BFI initiative are known to improve the initiation, exclusivity and duration of breastfeeding
Breastfeeding protection, promotion and support increases the percentage of mothers who breastfeed their child beyond six months. offering breastfeeding support at all visits up to 9 months helps increase BF
need to educate dads and other social supporters about appropriate length of breastfeeding


What is the maximum tolerable daily level of vitamin D?


2500 IU
therefore should continue to supplement baby with 400 IU daily as long as they are receiving breastmilk, unlikely to over-reach the level
formula and cow’s milk contain vitamin D so babies that get this don’t need a supplement (see separate statement on vitamin D also)
after 2 years, no longer recommended supplement (at this point follow the food guide)3-8 year olds have the lowest levels of deficiency amongst any age group


True or false? breastmilk should be given before complementary foods at every meal


false - does not matter which you give first


Which of the following is not a good initial choice for a family starting their 6 month old on solid foods?

a) iron fortified cereal
b) meat
c) yogourt
d) meat alternatives


c) yogourt - not iron rich , should start with iron rich foods
then, between 6-9 months should give vegetables, fruit and milk products and yogourt

best to give food from family meals that has been mashed up to an appropriate consistency , don’t need commercial foods (may be high in sugar); if babies get used to eating nutritious foods, more likely to keep doing so when older


True are false - babies must have teeth to eat crackers


false - the older infant develops up and down munching abilities that allow them to munch on food, regardless of whether or not they have teeth (i.e. crackers, toast, breakfast cereal). starting at 6 months should give a
variety of soft textures (such as lumpy, and tender-cooked and finely minced, pureed, mashed or ground) and finger foods from six months of age. Safe finger foods include: pieces of soft-cooked vegetables and fruits; soft, ripe fruit such as banana; finely minced, ground or mashed cooked meat, deboned fish, and poultry; grated cheese; and bread crusts or toasts.


When do babies peak in their ability to eat purees?

a) 6 months
b) 8 months
c) 10 months
d) 24 months


c) ability to eat purees peaks at 10 months, ability to eat other foods continue to develop until 24 months, may take longer to eat varied textures but should continue to do so
infant 8 months -12 months - lateral movements of the tongue, can move food to the teeth


True or false - there are no long term consequences to delaying the introduction of lumpy foods


false - delaying the intro of lumpy foods beyond 9 months of age associated with feeding difficulties in older children and lower intake of nutritions foods
By 12 months of age, young children should be offered a variety of family foods with modified textures, such as ground, mashed, or chopped foods, with a tender consistency (Morris & Klein, 2000). Between 12 and 18 months, young children will acquire full chewing movements (WHO, 1998).


True or false - it is good to encourage children to clean their plate


false -making children clean their plate can lead to negative attitudes about feeding and eating habits and excessive weight gain; however restricting high calory foods is also bad because it might lead kids to eat too much of them when they are offered them
young infant - parents offer milk, baby decides everything else


Who should decide how much a kid should eat?


the kid should always decide how much
infant - they should decide how much and what they want to eat (when/where/how much) other than milk
older kid>12 months - parent should decide when and where they eat, again, the kid should decide how much


When should self-feeding first be offered?


can start from when first complementary foods are introduced, helps capture the window for learning these oromotor skills


True or false - sippy cups support the development of mature drinking skills


false - these don’t support the development of mature drinking skills, should give fluids other than breastmilk from open cup. using cup can reduce the chance of prolonged bottle feeding.
Use of bottles among young children has been associated with the consumption of excess calories and may contribute to the risk of obesity in childhood


True or false - symptoms of iron deficiency should be apparent as soon as iron deficiency begins


false - classical symptoms such as pallor, poor appetite, irritability and slowed growth and development may not happen until the deficiency is severe
iron deficiency-leads to iron deficiency anemia, leads to irreversible cognitive defects
iron stores last until 6 months - between 6-12 months kids grow a lot, leads to iron deficiency, continues 12-24 months


Which of the following infants is not at risk of having low iron stores?

a) birth weight >3000 g
b) iron deficiency mother
c) mother with diabetes
d) mother with excessive alcohol intake
e) babies who eat evaporated milk or cow milk


a) in fact, BW


How often should a 6 month old baby be offered iron rich foods?


2x/day - should get offered 2x per day from 6-12 months, from 12-24 months should be offered at every meal


True or false - iron from cereals is equally bioavailable to iron from meat


false - from non meat sources( cereals, legumes, egg, tofu) is less bioavailable that from meat; even small servings of poultry, meat or fish contribute to intake because the iron is in the heme form
meat can also help to improve the availability of non heme iron by 150% (i.e. eating meat and plant together)
vitamin C also helps improve the absorption of non-heme iron
fish to avoid because of mercury: fresh or frozen tuna, shark, swordfish, marlin, orange roughy and escolar.avoid luncheon/processed meats (lots of salt)


What is not a true of cow’s milk ?

a) low in iron
b) improves iron absorption
c) excessive consumption can lead to iron deficiency
d) can cause GI bleeding and occult blood loss in babies


b) false - in fact, can inhibit iron absorption

the rest are true
the milk itself leads to trouble with iron (as mentioned) when it is the main milk source
should be delayed till 9-12 months; once babies are eating lots of different iron rich foods, less concern about iron deficiency associated - however, excessive consumption can lead to severe anemia (likely because not eating enough other iron rich foods)


What should be the maximum cow’s milk intake for young kids?

a) 300 ml
b) 400 ml
c) 550 ml
d) 750 ml


750 ml: if more, can displace other foods that give nutrients, also may lead to less fibre intake and constipation as a result. open cup may help reduce excess consumption
goat milk may lead to iron deficiency the same way as cow’s milk when introduced too soon
should get at least 500 ml of milk to maintain bone health


Name 4 foods that should not be given to a child under 4 year old


hard candies or cough drops, gum, popcorn, marshmallows, peanuts or other nuts, seeds, fish with bones; snacks using toothpicks or skewers.
hot dog - most fatal choking - safer when diced or cut lengthwise. Grate raw carrots and hard fruits such as apples. Remove the pits from fruits. Chop grapes
Thinly spread peanut butter on crackers or toast. Peanut butter served alone, or on a spoon, is potentially unsafe because it can stick in the palate or posterior pharynx and form a seal that is difficult to dislodge, leading to asphyxia (AAP, 2010). Finely chop foods of fibrous or stringy textures such as celery or pineapple.


what organism do you suspect when a child gets food poisoning after eating an egg that was cracked in the box



avoid lightly cooked, unpasterized foods for kids, cracked egg shells can lead to salmonella
however, can make an exception for the inuit follow the traditional ways - dry the food in the spring, freeze in winter, don’t hunt sick animals


True or false - pasteurized honey can be given to children < 1 year old


false - even pasteurization doesn’t kill the botulism spores
only 5% of Canadian honey has botulism, but enough spores to give botulism to an infant; in Canada, honey is the only food linked to botulism

symptoms include constipation, weak suck/cry, general weakness, lack of facial expression, poor head control, can get diaphragm paralysis end stage


How much of energy needs should be from complementary foods between 12-24 months


2/3 of energy needs

the other third from either breast milk or homo milk


true or false - overweight children between 12-24 months should have their fat intake restricted


false - no evidence, should not restrict in this age, the needs for energy are very high

strict limits on sodium, food additives, and the addition of vitamins and minerals foods for infants less than 12 months of age.


When can 2% milk be introduced o the child’s diet

a) 9 months
b) 1 year
c) 18 months
d) 24 months


don’t introduce until 2 years of age, can use some discretion with this, however skim is an absolutely no no under 2 years old
( skim, 1%) homo milk only since has more fat.
evaportaed or powdered milk is appropriate if prepared correctly
Pasteurized, full-fat goat milk may be used as an alternative to cow milk. If goat milk is used parents and caregivers should choose goat milk with added folic acid and vitamin D. lots of cross reacivey - if reaction to cow milk, then likely also reaction to goat milk


What is an acceptable amount of fruit juice for a 12-24 month old


125-175 ml/day
don’t need to give any, juice doesn’t have fiber, and has extra sugar, leads to less intake of healthy foods, increased sugars and bad teeth, and diarrhea


when should one eat commercial formulas until


until homo milk at 9-12 months
if they are on soy formula for dietary reasons, keep taking this until age 2, same goes for vegan<2 year who is not breasted
coconut milk, almond milk, rice and almod based milk - not appropriate, not enough nutrition/protein/minerals


how should one introduce foods that are potential allergens


not more than 1 a day, and wait 2 days before introducing a new potential food allergen after introduced successfully continue to offer it to ensure tolerance

for foods, can take up to 10 tries for a kid to eat it (this is normal)


how many Canadian paediatricians work in communities with populations >100000?

a) 20%
b) 40%
c) 60%
d) 80%


d) 80% work in these larger communities, smaller communities are most vulnerable to the lack of paediatricians
also, lots of paediatricians are retiring, they will need to be replaced, many are also reducing their work hours
increasing complexity of patient caseload, management of patients with chronic diseases or conditions, and increasing patient expectations.


Name 4 factors that are contributing to the increased need for paediatricians and complexity of care

  1. more surviving preemies
  2. more mental health and behavioural issues
  3. increasing obesity and increasing chronic health conditions
  4. many children who were formerly cared for only in teaching hospitals are now being managed in the community

no province has a HR plan for paediatrics (as of 2007)


Name 4 factors that are part of the ideal care model of a paediatrician

  1. primarily produce consultant care
  2. collaborative medical practice - work with , family doctors, social workers, nurses, psychologist etc
  3. should be available to produce ongoing comprehensive care to children with complex medical needs

Name 4 ways to improve access to care for the paediatric population

  1. pediatricians visiting rural hospitals or supporting through telemedicine
  2. encourage pediatricians to work in the community and in groups (outside the hospital setting)
  3. also need paediatricians in teaching hospitals.
  4. need paediatricians in community hospitals

Name the different types of care for acute and chronic health problems that Canadian children are entitled to


Newborn care, hospital care, access to a ICU and transport to a ICU, Child/Youth Protection assessment by a specialized team in a timely fashion,palliative care services

also all kids should have a primary provider
should also have continuity of care from peds if needed
should structure and use supports so their time is spent on activities that need their expertise


Name some special populations that need paediatric expertise in their care


First nations/Inuit/Aboriginal, chronically ill, vulnerable populations (SES, immigrants), mental illness, developmental problems, youth, serious acute or chronic illness
ways to ensure access: centres of excellence, research, collaboration, leadership, clinical collaboration, healthy workforce (work/life balance)


True or false- paediatricians should never be the primary health care provider


false - whereas overall, the primary provider should be a family doc or np, in some communities, it makes sense for the paediatrician to be the primary provider if it is needed to provide care. overall, paediatricians should focus on consultant care. transition of care is important for children that need ongoing care as they grow up.
also, if there aren’t enough other docs with training to provide care to children, then paediatricians need to do it
need multi-D teams to provide care to youth, renumeration models need to respect the time needed to provide this care as well as to take part in educational activities


Which of the following is not an appropriate recommendation regarding the use of probiotics?

a) reduce the duration of viral diarrhea
b) prevent antibiotic associated diarrhea
c) prevent atopic diseases
d) decrease NEC in at risk babies
e) may decrease symptoms of colic (but can’t recommend or refuse it based on current evidence)
f) may help with IBS


c) not enough evidence to recommend for the treatment or prevention or atopic disease (also for eczema)

keeping in mind that the effects of probiotics are strain and disease specific, physicians should consider recommending probiotics for the other indications, also may decrease some symptoms of IBS - LGG is the best overall, E. coli may reduce gassiness and bloating, VSL 3 may reduce overall scores, need more evidence

the government should get better labelling and more specific labelling for probiotics
no conclusions for travellers diarrhea, need more studies (the current studies had lots of limitation, adult only)


True or false - probiotics are completely safe in the immunocompromised child


false - there is a small risk of invasive infection in the immunocompromised child, and even smaller in the healthy child


What are probiotics?


They are live micro-organisms (i.e. lactobacilli, bifidobacteria, saccharomyces) which can have a health effect on the normal host. non pathogenic in the normal host, resist processing and able to survive in the digestive tract.
vs. Prebiotics (eg, fructo- and galacto-oligosaccharides) are nonviable food components which can confer a health benefit on the host by modulating intestinal microflora.


Name 5 factors that influence the gut microflora of a baby

  1. type of delivery
  2. type of feeding
  3. gestational age
  4. environment
  5. presence of antibiotics
    because breastmilk contains bifidobacteria and galacto-oligosacchardes, breastmilk fed babies have more lactobacilli and bifidobacteria than formula babies. once babies start eating food, their flora resembles adult flora.

Which of the following is not a function of the intestinal bacteria?

a) compete with pathogenic bacteria
b) metabolize short chain carbs into short-chain fatty acids
c) increase mucin secretion
d) decrease gut permeability
e) modulate the gut’s immune function


b) this is a role of the colonic bacteria, SCFA are the preferred fuel for enterocytes, can also acidify colonic content and help with water absorption.

the function of the intestinal bacteria: contribute to the gut’s barrier function by competing with pathogenic bacteria, increasing mucin secretion, decrease gut permeability, modulate the immune function (the gut microflora is a complex ecosystem supporting the structure and function of the intestinal microflora)
**not that here the intestinal and colonic bacteria and talked about separately


How do probiotics modify the gut microflora?

  1. lower the pH by increasing the production of small chain fatty acids (SCFAs)
  2. produce anti microbial compounds and antitoxins
  3. compete with other bacteria for nutrients and proteins
    * *different strains have different mechanisms of action

Which 2 probiotics were best shown to reduce the prevalence of antibiotic associated diarrhea?

  1. saccharomyces boulardii
  2. Lactobacillus rhamnosus
    NNT was 10 in one study, 7 in the other
    yogourt with probiotics not effective
    intention to treat - less impressive results - ?compliance issues

True or false - probiotics may be helpful to prevent relapses of C. diff


true - no evidence that helps to prevent or treat, may have a role in preventing relapses in people with recurrent C diff, no paediatric studies


Which of the following cases is probiotics likely to be the least helpful for decreasing the duration of acute infectious diarrhea?
a) duration of illness


d) does not help with bacterial diarrhea

best for rotavirus diarrhea, for duration of illness


What is the definition of antibiotic associated diarrhea?


> 3 (or equal to) stools/day
for >2 (or equal to) days
occurring up to 2 weeks of initiation of antibiotics
occurs in 30% of patients


Name one group that may benefit from probiotics for the prevention of infectious diarrhea


overall, may have modest impact on reducing infectious diarrhea (prevention) may consider for
1. non breastfed infants (more pronounced effect)
2. long term facilities
3. child care with recurrent infections
LGG reduced the incidence particularly in non breastfed infants (others did too in individual studies S boulardii, Bifidobacterium bifidum, Lactobacillus casei, Bifidobacterium lactis, and Lactobacillus reuteri)
Bifidobacterium breve and Streptococcus thermopiles decreased the incidence of dehydration


Which of the following is false of infantile colic?

a) higher counts of lactobacilli
b) some evidence that it might be helped by probiotic
c) lactobacillus reuteri most likely probiotic to be useful
d) overall insufficient evidence to recommend for or against the use of probiotics to manage colic

a) false - in fact lower counts of lactobacilli
the studies (2) show that crying time may be reduced While there may be a role for probiotics in treating infantile colic, there is insufficient evidence to recommend for or against using probiotics to manage this condition. A recent CPS practice point on infantile colic reached the same conclusion.

True or false - probiotics should be used for all preterm infants at risk of NEC


**false - can be considered for prevention of NEC in preterm infants >1 kg, no evidence for <1 kg
probiotics may help prevent NEC
should approve giving them live microorganisms with caution
impotant to also promote breastfeeding since this is most important
which one to use: breast milk supplemented with lactobacillus and bifidobacteria had a significantly lower incidence of NEC and deaths than infants receiving unsupplemented breast milk.[47]-[49] The severity and incidence of NEC was lower in infants given a mixture of Bifidobacterium infantis, B bifidus and S thermophilus.[50]
In three recent meta-analyses, enteral probiotic supplementation significantly reduced the incidence of severe NEC (RR 0.32 to 0.36) and mortality (RR 0.40 to 0.47) without systemic infection with the bacteria used as probiotic


True or false - Probiotics might help to reduce childhood respiratory illnesses, antibiotic use and absences from child care due to illness.


true - Probiotics might help to reduce childhood respiratory illnesses, antibiotic use and absences from child care due to illness, however need more studies to make definitive conclusions


true or false - children who are atopic have lower counts of lactobacilli and bifidobacteria


true - however studies which have looked at giving probiotics to children or to their mothers in pregnancy have failed to demonstrate a protective effect, also no benefit to eczema

for allergic colitis, need more studies (one showed potential but need more, not enough to make a conclusion now)


Which of the following is not a repotted side effect of probiotics?

a) systemic and local infections
b) LGG sepsis in immunocompromised patients
c) saccharomyces sepsis in immunocompromised patients
d) bifidobacterial systemic infection


d) no reports of bifidobacterial systemic infection (nor or lactobacilli sepsis after it was introduced into dairy products in finland)

systemic and local infections, LGG and saccharomyces sepsis in immunocompromised patients are possible side effects

efficacy of probiotics both strain and disease specific, need adequate amounts, need to learn this as doctors
overall the recommendations at the end are stated as considering recommending probiotics


Which probiotics is not available in Canada?


LGG not available when the statement was written (2012)


What was a disadvantage of the CDC growth charts?


described how a population of children grew, without acknowledging whether this rate of growth was optimal


True or false - growth patterns of pre-school children from different ethnic backgrounds are comparable


true - increasing evidence that growth patterns of well-fed pre school children of diverse ethnic backgrounds should have the same growth rates. upported the use of a single international growth reference based on healthy, well-nourished children from different geographical and genetic origins, who had fully met their growth potential. .
until recently, didn’t exist


True or false - the children studied for the growth charts for WHO were exclusively breastfed for 4-6 months


true - since they wanted to look at growth under optimal conditions (and before, WHO used to say 4 months exclusive)


When should standing height start being measured?


from age 2 onwards

recumbent length until 2-3 years old


When should head circumference be monitored


from 0-2 year old
measurements at all well-child visits
should do them at acute visits for kids that don’t come to well-child visits


When should corrected age be used until when monitoring the growth of premature infants?


until 24-36 months

should also monitor the growth of premature infants after discharge using the WHO growth charts


At what age should BMI start being used?


BMI should be used from age 2 and onwards

weight for length, weight/length for age or percentage of ideal body weight should be used for babies <2 years old


What percentile for children < 2 years old is considered severely underweight?underweight?


severe underweight: <3rd percentile


What percentile of height for children < 2 years old is considered stunted?severely stunted?


stunted: <3rd percentile

severely stunted: 0.1 percentile


What percentile for children <2 years old is considered wasted? severely wasted?


wasted: weight for length <0.1st percentile


What percentile for children <2 years old is considered at risk for overweight?


at risk for overweight : >85th percentile
overweight>97th percentile
obese >99.9th percentile


What measure should be used for kids >10 years old?


BMI after age 10 (use those percentiles for different assessments of weight category); however, earlier in the statement say you should use BMI after age 2 ***I think we should use it after age 2 would be the best interpretation since they say this more times in the statement


Which babies grow more quickly in the first 6 months of life? breastfed or bottle-fed


breastfed more quickly in the 1st 6 months, less so in the next 6 months
since the WHO babies were mostly breastfed, the WHO charts will reflect their pattern better (because on the CDC ones they looked like they grew too much in the 1st 6 months, and not enough in the next 6 months)


True or false - overall the WHO growth charts (compared to the CDC growth charts) will result in higher rates of children classified as underweight in the first 6 months of life.


will also result in higher rates of children classified as stunted, overweight and obese after that time
Assessing the pattern of weight, linear growth and weight relative to length and whether the infant is breast or non-breastfed is necessary before suggesting changes in feeding.


What is the cut-off for overweight in 5-17 years olds?


> 85th percentile , obese is >97th percentile
DIFFERENT from the criteria in 2-5 year old (overweight is >97th and obese is 99.9) think younger kids are allowed to be chubbier