Feeding and fluids

Question 1

How is a term baby different to adults?

Answer 1

Term baby = 75% water
Increased surface/mass, metabolism, and RR
Decreased response to thirst, independence to drink, and glomerular filtration

Question 2

What fluids to children take in?

Answer 2

Eating/feeding

Drinking

Question 3

What fluids do children lose?

Answer 3

Urine 60%
Skin and lungs 35%
Stool 5%

Question 4

What is the fluid requirements of an infant?

Answer 4

150ml/kg/day

Question 5

What is the fluid requirements of a toddler?

Answer 5

100ml/kg/day

Question 6

What is the fluid requirement of a 4-8 year old girl?

Answer 6

1000-1400ml/day

Question 7

What is the fluid requirement of a 4-8 year old boy?

Answer 7

1000-1400ml/day

Question 8

What is the fluid requirement of a 9-13 year old girl?

Answer 8

1200-2100ml/day

Question 9

What is the fluid requirement of a 9-13 year old boy?

Answer 9

1400-2300ml/day

Question 10

What is the fluid requirement of a 14-18 year old girl?

Answer 10

1400-2500ml/day

Question 11

What is the fluid requirement of a 14-18 year old boy?

Answer 11

2100-3200ml/day

Question 12

What are the 2 big factors that can cause dehydration?

Answer 12

Reduced intake

Increased losses

Question 13

What can cause reduced intake?

Answer 13

Dysphagia/neurodisability - cerebral palsy, developmental delay
Vomiting - gastroenteritis, GORD, URTI, chemotherapy
Behavioural/psychiatric - food refusal, anorexia
Social - child neglect

Question 14

What can cause increased losses?

Answer 14

Gut - gastroenteritis, IBD, stoma, short gut syndrome
Kidneys - renal tubular disease, renal dysplasia, nephrogenic DI
Skin - burns, CF, sepsis/fever
Lungs - cardiorespiratory disease, CF, tracheostomy

Question 15

What are the symptoms of dehydration?

Answer 15

Vary by severity of dehydration

Lots of symptoms - as a general rule the more symptoms you have, the more dehydrated you are

Question 16

What percentage dehydrated is mild dehydration?

Answer 16

5%

Question 17

What percentage dehydrated is moderate dehydration?

Answer 17

5-10%

Question 18

What percentage dehydrated is severe dehydration?

Answer 18

> 10%

Question 19

What are the symptoms of mild dehydration?

Answer 19

Thirst
Dry lips
Restlessness
Irritability

Question 20

What are the symptoms of moderate dehydration?

Answer 20

Fewer wet nappies
Sunken eyes
Reduced skin turgor
Decreased urine output

Question 21

What are the symptoms of severe dehydration?

Answer 21

Reduced consciousness
Cold
Mottled peripheries
Anuria

Question 22

What are the symptoms of chronic deprivation of fluids or feeds?

Answer 22

Failure to thrive
Malnutrition
Developmental delay
Constipation
UTIs

Question 23

What are the treatment options for dehydration?

Answer 23

Natural - best
Enteral feeding
IV fluids - last resort

Question 24

Why is natural rehydration best?

Answer 24

Can regulate electrolytes themselves

Question 25

Why are IV fluid last resort?

Answer 25

Difficult to get access Difficult to get electrolyte balance correct Give if at high risk of aspiration

Question 26

What questions is it important to ask in a feeding history?

Answer 26

Determine whether breast or bottle fed? Latching? Duration? How often feeding? Has mother's milk come in? - c-section? Mother unwell? (takes longer for milk to come in) Can ask mother to express milk to see volume Teet right sized hole? Volume in bottle feed?

Question 27

What is normal breast feeding like?

Answer 27

In first few weeks need to feed every couple of hours, no more than 4 hours For about 15/20 minutes 20-30 mins every 3 hours Time between feeds gets longer as get older

Question 28

What are the NICE guidelines for treating children who aren't dehydrated?

Answer 28

Maintenance fluids

Question 29

What are the NICE guidelines for treating children who are dehydrated?

Answer 29

Maintenance + deficit 50ml/kg

Question 30

What are the NICE guidelines for treating children who are shoked?

Answer 30

Maintenance + deficit 100ml/kg + bolus

Question 31

What maintenance fluid should you give to a neonate and why?

Answer 31

10% glucose - need to be careful with babies and sugar levels dropping as don't have a lot of reserve

Question 32

What is the rate of fluids for a neonate?

Answer 32

Day 1 of life - 60mls/kg/day Day 2 of life - 90mls/kg/day Day 3 of life - 120mls/kg/day Day 4 of life - 150mls/kg/day

Question 33

When can you give a neonate electrolytes?

Answer 33

48 hours after birth | If significantly low can give before then

Question 34

What are the electrolytes requirements for neonates?

Answer 34

Na 3mmol/kg/day K 2mmol/kg/day Ca 1mmol/kg/day (rarely)

Question 35

When can you start giving fluids for 'older children'?

Answer 35

Around 2/3 months

Question 36

How much fluid can you give up to in boys?

Answer 36

2500ml

Question 37

How much fluid can you give up to in girls?

Answer 37

2000ml

Question 38

What is the formula for working out a child's weight?

Answer 38

(Age + 4) x2 = weight in kg

Question 39

What do you do if a child is clearly over or underweight for their age?

Answer 39

Work on ideal body weight

Question 40

What fluid should you give older children?

Answer 40

0.9% NaCl + 5% glucose (+/- KCl)

Question 41

How do you work out the rate at which you give fluids to older children?

Answer 41

First 10kg - 100ml/kg Next 10kg - 50ml/kg Every other kg - 20ml/kg

Question 42

How long do you correct a fluid deficit over?

Answer 42

24 hours

Question 43

What fluid bolus should you give?

Answer 43

20mls/kg of 0.9% NaCl | 10ml/kg more appropriate on some occasions

Question 44

What are the electrolyte requirements for older children?

Answer 44

First 10kg - water 4ml/kg, Na 2-4mmol/kg/day, K 1.5-2.5mmol/kg/day Second 10kg - water 2ml/kg, Na 1-2mmol/kg/day, K 0.5-1.5mmol/kg/day Subsequent kg - water 1ml/kg, Na 0.5-1mmol/kg/day, K 02.-0.7mmol/kg/day

Question 45

How do you treat DKA with fluids if shocked?

Answer 45

20ml/kg 0.9 NaCl over 15 mins then 10ml/kg 0.9% NaCl

Question 46

How do you treat DKA with fluids if not shocked?

Answer 46

10ml/kg 0.9% NaCl over an hour

Question 47

What are the differential diagnoses for unwell neonates?

Answer 47

THE MISFITS - Trauma - birth trauma, NAI - Heart disease/hypovolaemia - Endocrine emergencies - congenital adrenal hyperplasia/congenital hypothyroidism - Metabolic - electrolyte abnormalities - Inborn errors of metabolism - Seizures - Formula problem - diluting/concentrating formula - Intestinal disasters - necrotising enterocolitis, Hirschprung's - Toxins - maternal medication/ingestion, glucose - Sepsis

Question 48

How might a baby with congenital adrenal hyperplasia present?

Answer 48

``` Adrenal crisis Acidotic Hyponatraemia Hyperkalaemia Metabolic acidosis ```

Question 49

How might baby girls present with congenital adrenal hyperplasia?

Answer 49

Ambiguous genitalia - clitoris enlarged and genitals look more like those of male child

Question 50

How can you treat congenital hyperplasia antenatally?

Answer 50

Dexamethasone to mother - suppresses foetal adrenal androgen over secretion and prevention of genital malformations