Exam #1: Pediatric Nutrition

Question 1

Why is growth closely monitored in children?

Answer 1

Growth is an important indicator of proper nutrition

Question 2

Is BMI in children used the same as adults?

Answer 2

NO

Question 3

When does the most growth occur in children?

Answer 3

Infancy

*****Note that instructor calls infancy 0-2 years

Question 4

Where does most of the mass come from in the first 4 months of life?

Answer 4

Fat

Question 5

How does weight fluctuate in the first few weeks of life?

Answer 5

• Initial decline in first few days

- Should regain in 7-10 days

Question 6

Generally, when should an infant double & triple weight?

Answer 6

Double= 6 months
Triple= 1 year

Question 7

How big is an infants stomach at birth, day 3, and day 10?

Answer 7

Newborn= shooter marble

Day 3= ping pong ball

Day 10= egg

*****This is important to remind mothers of to prevent over-feeding.

Question 8

How do the energy requires of an infant compare to an adult?

Answer 8

Much higher as an infant

**Almost twice as much as adult comparatively; make sure parents are paying attention to hunger cues

Question 9

What are the protein requirements of infants?

Answer 9

V. high i.e. 2.2g/kg/d at birth, which declines with age

*****Note that these requirements increase with stress/ trauma/ illness

Question 10

What is the main dietary energy source in infants?

Answer 10

Lipids

Question 11

What vital functions do lipids play in the developing infant?

Answer 11

• Absorption of fat soluble vitamins
• CNS develoment
• Brain development

Question 12

What proportion of calories should come from fat in an infant?

Answer 12

40-50% or higher in the first year

Question 13

What proportion of calories should come from carbs?

Answer 13

30-60%

Question 14

Where should carbs come from in infants?

Answer 14

Cereals
Fruits
Veggies

Question 15

What vitamin must be supplemented in infants that are exclusively breastfed?

Answer 15

Vitamin D

Question 16

What vitamin is injected at birth to prevent bleeding or hemorrhage?

Answer 16

Vitamin K

Question 17

Does calcium need to be supplemented in infants?

Answer 17

No- human milk and formula have adequate sources of Ca++

Question 18

How can lactose intolerant infants get Ca++?

Answer 18

Cooked greens i.e. collard, mustard, kale

Question 19

What can iron deficiency lead to in infants?

Answer 19

Long term developmental & behavioral issues

Question 20

Should iron be supplemented in infants?

Answer 20

Yes, at 4-6 months

*****Note that cow’s milk is a poor source of iron

Question 21

What is the recommended feeding method for all infants?

Answer 21

Breastfeeding

Question 22

What is the major benefit to breastfeeding vs. formula?

Answer 22

Immune factors that are not in formula

Question 23

What are the four stages of human milk expression?

Answer 23

1) Colostrum
2) Transition milk
3) Mature milk
4) Extended lactation

Question 24

What are the characteristics of colostrum?

Answer 24

• Low fat
• High protein
• Rich in immunologic substances

Question 25

What are the characteristics of transition milk?

Answer 25

- Ig & protein decrease | - Fat, calories & lactose increase

Question 26

What are the characteristics of mature milk?

Answer 26

Fat, calories, & lactose remain high

Question 27

What happens to the composition of milk during extended lactation?

Answer 27

Vitamin and mineral content decrease

Question 28

How is breastfeeding assessed (for adequacy)?

Answer 28

1) Weight/ growth 2) Voiding i.e. # of wet diapers 3) Stooling 4) Feed-on-demand 5) Duration (10-20 min/ side) 6) Activity level of infant

Question 29

Is it normal for a breastfed infant to go several days without a bowel movement?

Answer 29

Yes, it can be...

Question 30

What is a common cause of constipation in a breastfed infant?

Answer 30

Iron supplementation

Question 31

What are the three major forms of formula?

Answer 31

- Ready to feed - Concentrate* - Powder* *Need to be mixed with water

Question 32

How does formula differ from breast milk?

Answer 32

Micronutrients in higher concentrations i.e. vitamins, minerals, and iron

Question 33

When are soy formulas recommended?

Answer 33

- Galactosemia - Lactase deficiency - Family values

Question 34

Why are Ca++, phosphorus, zinc & iron increased in soy formula?

Answer 34

Soy phytates & fiber interfere with absorption

Question 35

Why would you recommend protein hydrolysate formula?

Answer 35

Allergy to intact protein

Question 36

Why would you recommend an amino acid based formula?

Answer 36

Severe protein allergy after switch to protein hydrolyaste

Question 37

Why is cow's milk not recommended until age 1?

Answer 37

- Renal solute to high - Can lead to renal failure, dehyration, and GI bleed - Whey: Casein ratio off - Inadequate vitamins & minerals - Not enough fat - Low EFAs

Question 38

When can solids be started in an infant?

Answer 38

When infant is able to sit w/ head up or propped up

Question 39

How do you correct growth for premature infant?

Answer 39

40 weeks - GA= # weeks premature *****This is the correction factor that will be used until 2 years (24 months)

Question 40

What will a preterm infant be deficient in?

Answer 40

Fat

Question 41

How are premature infants initially fed?

Answer 41

Enteral (feeding tube) vs. parenteral (IV) | - PN= VLBW or ELBW

Question 42

What is adiposity rebound?

Answer 42

Increase in body fat in preparation for pubertal growth spurt

Question 43

How does protein need vary with childhood and adolescence?

Answer 43

- Decreased need as growth slows after infancy | - Increased at puberty

Question 44

Are multivitamins recommended in children?

Answer 44

NO

Question 45

What are the definitions of "overweight" and "obese" in childhood/ adolescence?

Answer 45

Overweight= 85th-94th percentile Obese= >95th percentile

Question 46

What are the defining features failure to thrive?

Answer 46

- Infants that fail to grow and develop at normal rate - Small head circumference - Muscular wasting - Weight loss/ poor weight gain

Question 47

What is the difference between primary & secondary FTT?

Answer 47

Primary= social/ environmental Secondary= originates from disease state

Question 48

What is necrotizing enterocolitis?

Answer 48

Acute inflammatory bowel disorder characterized by ischemic necrosis of GI ****Mostly seen in premature or LBW

Question 49

What are the major nutritional complications of CF in infants?

Answer 49

- Malabsorption especially of fat soluble vitamins - Essential fatty acid def. ******CF prevents release of pancreatic enzymes to small intestine

Question 50

What is the difference between acute and chronic diarrhea?

Answer 50

``` Acute= 3+ loose stools per day Chronic= 3+ for greater than 2 weeks ```

Question 51

What is the definition of constipation in infants?

Answer 51

Delay/ difficulty in passing stools present for 2+ weeks

Question 52

When is reflex a problem in infants?

Answer 52

When it interferes with growth *****Note that this is v. common & typically does NOT require intervention