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Pediatrics Exam 1 > Infant and Child Nutrition > Flashcards

Infant and Child Nutrition Flashcards

(65 cards)

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1
Q

Infants have innate
_____ of their caloric needs

A

self- regulation

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2
Q

Newborns lose ____% of their birth weight in 1st week (day 3 avg)

A

7-10

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3
Q

If infants not gaining their weight back, assess

A

o Feeding
o Urine output
o Stool output
o Signs of any other issues

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4
Q

T/F Preterm infant or malnourished pt needs more calories

A

T
need 120 kcal/kg/day

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5
Q

Basal expenditures in newborns vs. adults

A

Adult brain 2% of body
weight- uses 19% of energy

Infant brain- 10% of body
weight, 44% of energy

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6
Q

Gain back to birth weight should happen by week ____

A

2-3

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7
Q

Weight gain velocity, formula vs. breastfed:

A

0-3 months: Breastfed > Formula fed
6-12 months: Formula fed > Breastfed

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8
Q

Possible that visual acuity and possibly psychomotor development of formula-fed preterm infants is improved in formulas supplemented with _____

A

DHA (22:6ω3) and ARA (20:4ω6)
*Recommend to continue prenatal vitamin with DHA

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9
Q

Caloric needs formula ages 1-4

A

1000 kcal/day + 100 kcal/years old

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10
Q

Fat nutrition

A

o 9 kcal/g
o 50% of the caloric content in human milk
o Needed for absorption of fat-soluble vitamins and
development of CNS/brain
o Low energy cost to store

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11
Q

Protein nutrition

A

o 4 kcal/g
o Need protein! Infancy is high growth phase
o Source: food- amino acids
o No major stores

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12
Q

The protein content of human milk
decreases with time:

A

1.4–1.6 g/100 mL (early lactation)
0.8–1.0 g/100 mL (3–4 months)
0.7–0.8 g/100 mL (6 months)

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13
Q

Carbohydrate nutrition

A

o 4 kcal/g
o 40% of caloric content in breastmilk- as lactose

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14
Q

A note about lactase deficiency

A

o Lactase hydrolyzes lactose to glucose and galactose
o Levels highest in infants, decrease with age

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15
Q

Carbohydrate nutrition after age 2:

A

o 50%–60% of calories from carbs
o Complex carbs
o Limit sugar: <25 g added sugar

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16
Q

Iron supplementation in infants

A
  • Term baby supplies decrease around 4 mos.
  • Breastmilk lacks
  • Exclusive breastfed babies 4+ mos
  • 1 mg/kg per day of oral iron
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17
Q

Vit D supplementation in infants

A
  • Lack of maternal stores, sunscreen
  • 400 IU per day
  • Exclusively breastfed
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18
Q

Fluoride Supplementation

A
  • Lack of maternal stores, sunscreen
  • 400 IU per day
  • Exclusively breastfed
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19
Q

Standard American Diet

A

o Standard American Diet
o Heavy in processed, sugared foods
o Increases insulin resistance

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20
Q

____ of sugar = 1 teaspoon

A

4 grams

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21
Q

Parents’ feeding jobs:

A

Choose and prepare the food.
Provide regular meals and snacks.
Make eating times pleasant.
Step-by-step, show children by example how
to behave at family mealtime.
Be considerate of children’s lack of food
experience without catering to likes and dislikes.
Not let children have food or beverages
(except for water) between meal and snack
times.
Let children grow up to get bodies that are
right for them.

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22
Q

Children’s eating jobs:

A

Children will eat.
They will eat the amount
they need.
They will learn to eat the
food their parents eat.
They will grow predictably.
They will learn to behave
well at mealtime.

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23
Q

Breast milk is generally made up of:

A

*87% water
*7% lactose
*4% fat
*1% protein

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24
Q

Breastfeeding Recommendations

A

0-6 months: Exclusive breastfeeding
6+ months: Introduce solids (complementary foods), Continue breastfeeding
12+ months: Continue breastfeeding as long as desired, Expand solid food choices

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25
If a woman is meeting many obstacles and breastfeeding begins to be a roadblock to mental or physical health:
o Better to have a happy mom and fed baby o Not all or nothing- something is better than nothing
26
Breastfeeding basics- Timing
o Goal: Breastfeeding every 2-3 hours on demand, approx. 30-45 min o Alternate starting breast o As baby grows and schedule establishes, breastfeed Q 3 hrs o Best not to watch the clock for how long to feed- watch the baby and breast emptying o Pushing away from breast, turning head, breast emptied, unlatches
27
Sleep, Eat, Awake/Play cycle
o Establishes a predictable schedule of needs and feedings o Removes some guesswork for mom and baby o Newborns mostly eat and sleep o Roughly 3 hour cycles begin after 4-6 weeks (may lengthen as solid foods start) o Watch baby for cues! For hunger and sleep o Don’t nurse to sleep- baby falls asleep, doesn’t get full feed only a snack, gets hungry to soon (bedtime ok)
28
Assess the latch:
o Should include more breast tissue of areola, not just the nipple (not like a binky) o Should not be painful o Should see baby’s jaw moving o Chin should touch breast and they can breathe through the nose o Should hear sound of swallowing every few sucks o If latch hurts, try again- break latch by pulling gently on corner of baby’s mouth
29
Breastfeeding-Problems
Engorgement Nipple pain Plugged Ducts Mastitis “Low Supply” “Not enough”
30
Engorgement
* Physiologic or demand mismatch * Sxs: Hard, full breast * Tx: ibuprofen Q 6-8 hrs, warm packs before/cold backs after feeding, cabbage leaves, express *small* qty of milk to relieve pain
31
Nipple pain treatment
* Sxs: Sharp, stabbing, bleeding, scabbing, blisters * Tx: FIX THE LATCH! * Nipple cream- lanolin * Newman’s Ointment (All Purpose Nipple Ointment) * Contains an antifungal, steroid, mupirocin * Apply small amt after breastfeeding until pain/cracks heal, up to 10 days
32
Plugged Ducts
* Statis of milk + inflammation * Poor drainage, compression, narrowing of ducts * Sxs: Breast pain, wedge section of hard tissue * Tx: Optimize latch, start on affected breast, warm packs before/cold packs after feeding, Ibuprofen, Lecithin 1200 mg 3-4x/day; * Therapeutic ultrasound!
33
Mastitis
* Stasis of milk + infection * Sxs: Fever, flu-like, chills, fatigue, breast pain, wedge of redness * Tx: Ibuprofen @ 6-8 hrs; if sxs are mild (redness), supportive care for 24 hours; if progress (fever)- antibiotics * Therapeutic ultrasound! * Dicloxacillin 500 mg Q 6 hrs x 10 days * Cephalexin/Clindamycin in PCN allergy
34
Low supply breastfeeding issue
* Indicators of “low supply”=insufficient weight gain or diaper output * Insecurity because can’t count ounces from a breast * Increased breastfeeding increases supply * Tx: Check growth, reassure, educate * Feed on demand * Reducing breastfeeding and supplementing will decrease supply
35
Complementary foods @ 6 mos.
o No specific order- focus on first foods that are higher in iron and zinc such as puréed meats and rice cereal. o Baby cereals, fruits, veggies o Introduce allergenic foods (peanuts, eggs fish etc) at 6 months same as other foods o Advance from thin to thick puree, to finger food (8-10 mo) to self-feeding o Avoid choking hazard foods
36
Congenital lactase deficiency-
rare autosomal recessive disorder o Mainly occurs in Finland and Western Russia o Persistent watery diarrhea from birth o Require a change to a lactose-free formula
37
Developmental lactase deficiency-
temporary lactase deficiency in premature infants o Gut bacteria can usually adapt, manage sxs
38
Colic is defined as:
crying ≥3 hours per day ≥3 days per week <3 months of age. for no apparent reason, otherwise healthy infant
39
Colic episodes consistent findings:
Episodes with start and stop, inconsolable * "screaming," "piercing," "distressing," or "irritating“ * facial flushing, clenched fists, difficulty consoling * Late afternoon/early evening Usually starts between age 2-6 weeks * May peak ~6 weeks old Gradually resolves by 3-4 mos.
40
Colic- Management
* Caregiver support and education * Soothing techniques- so many to try * Change feeding technique * Time-limited trial of mom’s diet- no milk or a hypoallergenic (eg, no milk, eggs, nuts, wheat), or for formula fed babies- extensive hydrolysate infant formula * Give permission to put baby down in crib and walk away to calm down * Support system
41
Clinical Features of iron deficiency
* Microcytic, hypochromic anemia * Lethargy * Pallor * Irritability * Cardiomegaly * Poor feeding * Tachypnea
42
Clinical Features of zinc deficiency
* Mild: impaired growth, poor appetite, impaired immunity. * Moderate to severe: mood changes, irritability, lethargy, impaired immune function, increased susceptibility to infection; acroorificial skin rash, diarrhea, alopecia.
43
Clinical Features of copper Deficiency
* Osteoporosis * Enlargement of costochondral cartilages, * Cupping & flaring of long bone metaphyses * Spontaneous rib fractures * Neutropenia & hypochromic anemia resistant to iron therapy * Defect of copper metabolism (Menkes kinky hair syndrome) results in severe CNS disease.
44
Clinical Features of selenium Deficiency
* Skeletal muscle pain & tenderness, macrocytosis, loss of hair pigment. * Keshan disease, often fatal cardiomyopathy in infants & children
45
Clinical Features of fluoride Deficiency
* Low intake increases incidence of dental caries
46
Clinical Features of Iodine Deficiency
* Neurologic endemic cretinism (severe mental retardation, deaf mutism, spastic diplegia, & strabismus) occurs with severe deficiency. * Myxedematous endemic cretinism occurs in some central African countries where signs of congenital hypothyroidism are present.
47
Clinical Features of phosphorus Deficiency
* Muscle weakness * Bone pain * Rhabdomyolysis * Osteomalacia * Respiratory insufficiency
47
Clinical Features of magnesium Deficiency
* Neuromuscular excitability * Muscle fasciculation * Neurologic abnormalities * ECG changes (prolonged QTc, atrial/ventricular ectopy, atrial tachyarrhythmias & torsades de pointes)
47
Clinical Features of calcium Deficiency
* Osteopenia or osteoporosis * Tetany
47
Clinical Features of sodium Deficiency
* Anorexia * Vomiting * Hypotension * Mental apathy * Severe malnutrition * Hypermetabolism may lead to excess intracellular sodium, affecting cellular metabolism.
48
Clinical Features of chloride Deficiency
* Associated with failure to thrive & especially poor head growth * Anorexia * Lethargy * Muscle weakness * Vomiting * Dehydration, hypovolemia.
49
Clinical Features of potassium Deficiency
* Muscle weakness * Mental confusion * Arrhythmias
50
Clinical Features of thiamine (B1) Deficiency
Beriberi * Cardiac syndrome with cardiomegaly, tachycardia, a loud piercing cry, cyanosis, dyspnea, & vomiting
51
Clinical Features of riboflavin Deficiency
* Sore throat * Cheilosis * Angular stomatitis * Glossitis * Dermatitis of nasolabial fold & genitals * Photophobia * Indistinct vision
52
Clinical Features of Niacin Deficiency
* Pellagra (raw skin) * Photosensitive pigmented dermatitis * Diarrhea
53
Clinical Features of Patothenic acid (B5) deficiency
* “Burning feet syndrome” (paresthesias & dysesthesias)
54
Clinical Features of pyroxidine (B6) Deficiency
* Stomatitis * Glossitis * Cheilosis * Irritability * Confusion * Depression * Peripheral neuropathy * Microcytic anemia * Seizures
55
Clinical Features of biotin Deficiency
* Dermatitis around the eyes, nose & mouth * Conjunctivitis * Alopecia * Altered mental status * Lethargy * Hallucinations * Parathesias * Myalgia * Anorexia * Nausea
56
Clinical Features of folic acid Deficiency
* Vague symptoms (fatigue, irritability, cognitive changes) * Growth retardation * Delayed CNS development * Diarrhea * Neural tube defects * Macrocytic anemia
57
Clinical Features of Cobalamin (B12) Deficiency
* Megaloblastic anemia * Hypersegmented neutrophils * Neurologic degeneration * Paresthesias * Gait problems * Depression
58
Clinical Features of carnitine Deficiency
* Newborns & infants tend to present with more severe multisystemic disease triggered by infection or fasting, often with acute encephalopathy, liver failure, & cardiac involvement, while older children & adults tend to present with exercise- induced myalgias, weakness, & fatigue.
59
Clinical Features of Vitamin A Deficiency
* Pathological dryness of the conjunctiva & cornea * Poor bone growth * Hyperkeratosis * Impaired humoral and cell mediated immune function
60
Clinical Features of Vitamin D Deficiency
* Rickets ( failure of mineralization of growing bone and cartilage) * Osteomalacia (impaired bone mineralization → bone pain)
61
Clinical Features of Vitamin E Deficiency
* Ataxia * Hyporeflexia * Loss of proprioceptive & vibratory sensation
62
Clinical Features of Vitamin K Deficiency
* Bleeding diathesis. * Bleeding may be seen in the skin, the gastrointestinal tract, genitourinary tract, gingiva, lungs, joints, or the central nervous system * Hemorrhagic disease of newborn (all newborns get Vit K shot)

Pediatrics Exam 1 (6 decks)

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