Growth/Development/Nutrition

Question 1

What growth charts do you use for children <2 years?

Answer 1

WHO growth charts

Question 2

What growth charts do you use for children >2 years?

Answer 2

CDC growth charts

Question 3

How fast are term infants expected to grow?

Answer 3

20g/day (birth weight doubled by 4 months)

Question 4

How fast are children 2-10 years expected to grow?

Answer 4

2-3kg/year

Question 5

Why do newborns have an immediate decrease in weight?

Answer 5

Contraction of extracellular fluid and significant diuresis
- Weight should be regained by the first 1-2 weeks of life

Question 6

To what weight are infants generally expected to grow by the end of the first year of life?

Answer 6

Triple birth weight

Question 7

What is “failure to thrive” defined as?

Answer 7

• Weight-for-age <5th percentile on multiple occasions
  OR
• Weight deceleration that crosses two major percentile lines on a growth chart

Question 8

How can we treat FTT?

Answer 8

• Proper breastfeeding
• Formula supplementation (concentrated)

Question 9

T/F: Medications and growth hormone should be avoided in FTT infants

Answer 9

TRUE

Question 10

How many kcal dose breast milk contain?

Answer 10

20kcal/oz

Question 11

How long does the AAP recommend breastfeeding for?

Answer 11

First 6 months, with support for up to 1 year and beyond

Question 12

What is the energy requirement for a boy age 0-2 months?

Answer 12

107 kcal/kg/day

Question 13

What is the energy requirement for a boy age 3 months?

Answer 13

95 kcal/kg/day

Question 14

What is the energy requirement for a boy age 4-35 months?

Answer 14

82 kcal/kg/day

Question 15

What is the energy requirement for a girl age 0-2 months?

Answer 15

104 kcal/kg/day

Question 16

What is the energy requirement for a girl age 3 months?

Answer 16

95 kcal/kg/day

Question 17

What is the energy requirement for a girl age 4-35 months?

Answer 17

82 kcal/kg/day

Question 18

What is the vitamin D recommendation for infants?

Answer 18

400IU/day

Question 19

When can vitamin D supplementation be waived?

Answer 19

If the infant takes >1000mL/day of Vitamin-D fortified formula

Question 20

What is the vitamin D recommendation for adolescents?

Answer 20

400IU/day if not receiving at least 600IU from fortified milk

Question 21

When is fluoride supplementation indicated?

Answer 21

Exclusively breastfed infants at least 6 months old

Question 22

When can children start using fluorinated toothpaste?

Answer 22

2 years

Question 23

What is the iron requirement for a breastfed full term infant?

Answer 23

1mg/kg/day from months 4-12

Question 24

What is the iron requirement for a breastfed pre-term infant?

Answer 24

2 mg/kg/day from months 1-12

Question 25

What is the iron requirement for a formula-fed full term infant?

Answer 25

Fortified formula containing Fe 4-12 mg/L until 12 months

Question 26

What is the iron requirement for a formula-fed pre-term infant?

Answer 26

Fortified formula containing Fe 4-12 mg/L + additional 1 mg/kg/day to bring total daily dose to 2 mg/kg/day

Question 27

T/F: Gastroesophageal reflux disease is common in infancy and usually resolves by 12-14 months

Answer 27

FALSE: this is true for gastroesophageal reflux (GER)

Question 28

Up to ________ of infants experience recurrent regurgitation and vomiting within first 4 months, but only _____% have symptoms past 1 year

Answer 28

2/3, 5%

Question 29

What s/s point towards GERD?

Answer 29

- Heartburn - Excessive regurgitation - Food refusal - Abdominal pain

Question 30

What are possible complications of GERD?

Answer 30

- Reflux esophagitis - Hemorrhage - Barrett esophagus

Question 31

What is treatment for GER?

Answer 31

Assuring parents it's normal and will go away*** - Sleep in supine position - Change volume/frequency of feeding - Anti-reflux or hypoallergenic formula - Thicken formula to increase calories

Question 32

What is a risk factor for GERD?

Answer 32

Bottle-fed (as opposed to breastfed)

Question 33

T/F: A trial of acid suppression may be completed to diagnose GERD

Answer 33

FALSE!!! NOT recommended!!

Question 34

How can mild GERD be treated?

Answer 34

First line: PRN H2RAs

Question 35

How can moderate-severe GERD be treated?

Answer 35

First line: PPIs

Question 36

How can erosive esophagitis be treated?

Answer 36

First line: PPIs

Question 37

When should prokinetic agents be used in pediatrics?

Answer 37

Can be considered in delayed gastric emptying but usually not recommended

Question 38

When do pediatrics have LOW CYP activity?

Answer 38

6-12 months

Question 39

When do pediatrics have HIGHER CYP activity than adults?

Answer 39

1-4 years

Question 40

T/F: Children ages 1-10 required a higher dose of PPIs

Answer 40

TRUE: higher CYP3A4, CYP2C19 activity

Question 41

How long should PPIs be used for GERD?

Answer 41

12 weeks, then reassess Taper off over 4 weeks