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Pediatrics Exam 1 > Lecture 4 - Nutrition And GI > Flashcards

Lecture 4 - Nutrition And GI Flashcards

1
Q

What is optimal infant and young child feeding?

A

immediate - post partum skin to skin within 1 hour

6 months - of exclusive/full breastfeeding

continued breastfeeding with appropriate complementary foods and feeding for 1 year or longer as mutually desired by mother and baby

both AAP and WHO agree that there should be 6 months of exclusive/full breastfeeding

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2
Q

How long should mothers breastfeed for?

A

the first 6 months of exclusive breast feeding

average for 1 year of breastfeeding, up to 2 years (and beyond…)

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3
Q

Women who were encouraged to breastfeed were more than ____times more likely to initiate breastfeeding.

A

4

lower socioeconomic and minorities were impacted the most (more likely to breast feed)

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4
Q

What are the contraindications to breastfeeding (maternal)?

A

HIV, human T cell lymphotrophic virus 1 and 2
acute TB (until 14 days after treatment)
herpes lesions on nipple
active varicella
drugs of abuse and alcohol abuse
maternal medications (JUST LOOK IT UP)

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5
Q

Which drugs of abuse are often okay during breastfeeding?

A

methadone

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6
Q

What are contraindications of breastfeeding (infant)?

A

galactosemia
tyosinemia
PKU

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7
Q

What benefits does the infant get from breastfeeding?

A

complete nutrition
reduced incidence of: URI, otitis media, GI infections, NEC, IBD, asthma, obesity, type 1 DM, SIDS
higher IQ scores

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8
Q

What are the benefits of breastfeeding for the mother?

A 
decreased post-partum bleeding
possible decrease in post partum depression 
reduction in breast and ovarian cancer 
may decrease risk of HTN, CVD 
promotes infant mother bonding 
saves money
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9
Q

How do you educate the mother on appropriate technique for breast feeding?

A

ideally you want the nipple aimed at the top of the mouth and the baby has a large amount of breast in the mouth
the babies nose should be FREE from the breast and the chin should be on the breast
the bottom lip should be flipped outward but you probably won’t see it
the alveolar should be seen the most above the babies mouth
the mother should not feel any pinching
if the baby does not attach well this means the breast produces less milk over time

cheeks dimpling show a shallow attachment

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10
Q

What are the early cues that the infant is hungry?

A

hand to mouth
arousal
rooting

crying is a late sign of hunger

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11
Q

If the baby hasn’t showed any signs of hunger cues or has been sleeping, how often do you want to wake the baby to feed them?

A

every 4 hours

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12
Q

In the first 24 hours of life, how much breast milk does the baby typically drink?

A

2-15mL (this is like 3 teaspoons)

this number slowly grows over the first few days

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13
Q

What is the typical number of urine outputs you should expect in an infant?

A

number of urination = day of life
until they are about a week old

then it should be 6-8 urinations per day to assure adequate hydration

urine usually colorless by day 3-4

brick dust after day 3 is potentially worrisome

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14
Q

When do we expect the first stool to pass in infancy?

A

meconium

within 1st 48 hours

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15
Q

What supplement might be low in infant during breastfeeding?

A

iron (if clinically indicated within the first 6 moths —then everyone gets it after 6 months in foods)

vitamin D RIGHT AWAY

AAP also suggests you avoid cow’s milk before 12 months
and provide fluoride after 6 months

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16
Q

What is the most commonly used formula?

A

cow’s milk protein

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17
Q

If a parent is vegan, what can you suggest for infant formula?

A

soy based formula

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18
Q

Infant dx with galactosemia should be given what kind of formula?

A

soy based formula

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19
Q

Milk protein allergy

A

aka “food protein” allergy

present in first 1-2 months of life

causes food protein proctolitis

  • painless, gross blood in stool
  • presents in first 1-2 months of lie
  • resolve within days to 2 weeks after agent is stopped

resolves by 12 months of age

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20
Q

EPIES

A

food protein induced enterocolitis syndrome

non IgE mediated response to food

this can be medical emergency

clinical dx
presents between 2 and 7 months of age

severe repetitive vomiting and diarrhea within hours of trigger food intake

cow’s milk and soy most common

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21
Q

Lactose intolerance

A

intolerance to milk sugar

full-term infants are born with sufficient enzyme to breakdown lactose –pre-term babies might not have enough enzymes

non-inflammatory

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22
Q

Primary vs secondary lactose intolerance

A

primary is RARE

secondary lactose intolerance after gastroenteritis (transient) or celiac disease

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23
Q

When can solid foods be started?

A

4-6 months of age
head control and oral-motor coordination influence timing

one new food every 3-5 days (single ingredients)

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24
Q

When can infants have cows milk?

A

for formula fed infants —introduced at 1 year of age
ideally Whole milk 12-24 months (out of a sippy cup!)
low fat/skim milk >24 months

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25
Why should infants drink cows milk out of a sippy cup vs bottle?
to help prevent carries | to decrease consumption
26
What supplement must you make sure the mother has if she has a vegan diet and is breastfed?
vitamin B12
27
What is the definition of anaphylaxis shock?
acute onset of illness (min to hours) with skin and or mucosa: -pruritis, flushing, hives, angioedema and either: respiratory compromise or hypotension/end or damage skin sxs occur in >80% of anaphylaxis
28
What are the recommended doses for epi in children?
0. 15mg <25kg | 0. 3 >25kg
29
Where do you administer epi?
IM to the lateral aspect of thigh even if you have IV access -- still do IM
30
Who gets admitted to the hospital for anaphylaxis shock?
``` if they had >1 dose epi IV fluids for hypotension laryngeal edema severe asthma ingestion as trigger (worry about later effects) ```
31
Sensitization
The detection of specific IgE toward an allergen through skin prick, intradermal, or serum specific IgE testing
32
IgE mediated hypersensitivity
characterist clinical sxs upon exposure to an allergen AND the detection of specific IgE toward that allergen
33
What foods account for >90% of all food allergies?
Cow's milk, egg, soy, wheat, peanuts, tree nuts, fish, and shellfish
34
GER vs GERD
GER = gastroesophageal reflux passive passage of gastric content into esophagus with or without regurg/vomiting NORMAL physiologic process, usually after meals, cause few or no sxs occurs several time a day in infants, children, adults GERD = disease troublesome sxs and/or complications when reflux of gastric contents occurs
35
Currant jelly stools
seen in the triad for intussuscpetion other things that can mimic this: - omicef ABX - hot cheetos
36
What do you do if a mother of a newborn infant has active varicella?
isolate mother give infant VZIG express milk when no breast lesions breastfeed when no longer contagious
37
How much fluid should a 2 day old infant be eating?
5-15ml
38
On day 2-3, what is the amount of fluid an infant needs?
15-30ml
39
On day 3-4, what is the amount of fluid an infant needs?
30-60ml
40
On day 4-5, what is the amount of fluid an infant needs?
45-60ml (like 2 oz)
41
Meconium passes in the first 48 hours, then what happens?
Transition by day 4, seedy and yellow by day 5 (4-6 stools per day by day 5) stool with every feeding is normal can be quite liquidly
42
1 in ____ children in the US are obese
5
43
Does absence of skin sxs exclude anaphylaxis?
no
44
When do you see GI sxs in anaphylaxis?
if the pt is has KNOWN allergy and previous exposure vomiting and abdominal pain
45
When do you see hypotension in anaphylaxis?
RARE after exposure to known allergen typically NOT seen in children
46
What are the recommended doses for epi in anaphylaxis?
0. 15mg <25 kg | 0. 3 mg >25 kg
47
How do you administer Epi?
even if they're in the ER you give IM to the lateral aspect of the thigh
48
After anaphylaxis, how long does the pt need to be monitored in the ED?
4-8 hours
49
When might a pt who had anaphylaxis be admitted to the hospital?
if you had to give them > 1 g dose of Epi if they needed IV fluids for hypotension laryngeal edema severe asthma ingestion as trigger ---worry about later effects
50
What are risk factors for development of food allergies?
eczema asthma environmental allergies family hx of allergies
51
LEAP study
learning about early introduction of peanuts
52
If an infant has severe eczema or egg allergy, or both, when is the earliest that you can introduce them to peanuts?
4-6 months
53
When is GER most common?
infants age 1-6 months peak 3-4 months in infants may occur 100x a day most GER in infants resolves by 12 months of age
54
What are the clinical features of GERD?
regurgitation/vomiting, weight loss or poor weight gain, irritability, heartburn/chest pain (older children), hematemesis, dysphagia, wheezing, stridor, cough, hoarseness
55
At what age, if GER is still present, should you refer to a GI specialist?
>18 months
56
What can you do for parents who are worried about GER in their infant?
reassure them consider adding rice cereal to food to thicken food dont lay child down flat after they eat
57
What can you do for older children who have heart burn?
PPI for 8 - 12 weeks | if no improvement after 2-4 weeks or if relapse after treatment d/c and consult GI
58
Pyloric Stenosis
MC surgical disorder in neonates more common in caucasian males ``` usually presents 3-6 months of age vomiting (non-bilious) projectile vomiting weight loss despite ravenous hunger hypertrophied pylorus "olive" might be palpable ``` hypochloremic, hypokalemic, metabolic alkalosis, dehyrdation
59
What is the most common surgical disorder in neonates?
Pyloric Stenosis
60
When/how do pts with pyloric stenosis present?
3-6 months of age with projectile vomiting and possible palpable olive - hypertrophic pylorus
61
What is the treatment for pyloric stenosis?
correct dehydration and alkalosis surgical correction with pyloromyotomy ---complications rare
62
Malrotation
abnormal intestinal rotation and fixation 60% will present with sxs in the first month of life bilious emesis abdominal distention peritonitis (if untreated)
63
When do you see bilious emesis?
with malrotation in children typically in the first month of life or a bit later in infancy must consider Volvulus in these pts
64
Volvulus
life threatening condition associated with malrotation and twisting of the intestine on the mesenteric axis needs to be considered in an infant/child with bilious emesis
65
How do you dx volvulus?
clinical upper GI series can demonstrate "corkscrew" appearance of the small bowel negative imaging doesnt rule out volvulus surgical consultation and operative intervention are essential
66
Intussusception
telescoping of intestines can involve any section of the bowel, however usually limited to the ileocolic distribution can be life-threatening --> bowel ischemia can occur as intestine is completely obstructed
67
When do you typically see intussusception?
can occur at any age but incidence is highest in children under age of 2 ``` cause is idiopathic in <2 consider pathologic in >3 years -Meckel's diverticulum -polyp -lymphoma -vasculitis from HSP ```
68
What is the classical triad seen with intussusception?
abdominal pain vomiting currant jelly stools
69
What are other things that might present with currant jelly stools?
intussusception hot cheetos omnicef ABX
70
Are infants with intussusception consolable when in distress?
no
71
How is intussusception dx?
US or CT or air contrast enema
72
What is the treatment for intussusception?
fluid resuscitation ABX surgical consultation - options inclue air contrast enema or exploration
73
Meckel's Diverticulum
Rule of 2! most common congenital anomaly of GI tract ~2% of the population contains rests of ectopic tissues (2 types: gastric or pancreatic) usually within 2 feet from ileocecal valve most commonly 2 inches long children <2 years have highest risk of sxs Meckel's
74
How can pts with Meckel's Diverticulum present?
SBO lower GI bleed intussusception
75
How is Meckel's diverticulum dx?
Meckel's scan high specificity low sensitivity
76
What is the treatment for Meckel's diverticulum?
stabilization - may need PRBCs surgical consult -operative management may be warranted even if Meckel's scan is negative
77
Hirschprung's Disease
1 in 5000 births absence of ganglion cells in the intestine --when you don't have ganglion cells in the rectum, the rectum can not relax --this means straining with each stool
78
How do neonates with Hirschprungs disease present?
``` abdominal distention bilious emesis large bowel obstruction OR otherwise healthy infant with delayed passage of meconium ```
79
Delayed passage of meconium
might be Hirschprung's disease
80
How does an infant/older child with Hirschpurng's disease present?
constipation | child that require rectal stimulation to pass stool
81
How is Hirschprung's dz dx?
refer to Ped GI/ped surgery supported by rectal exam: -increased tone; explosive bowel movement after exam KUB may demonstrate lower bowel obstruction Gold standard: rectal biopsy --> histology demonstrates absence of ganglion cells
82
What is the gold standard in dx Hirschsprung's disease?
rectal biopsy | --> absence of ganglion cells
83
What is the treatment for Hirschuprungs disease?
surgical resection of the aganglionic segment colostomy followed by endorectal pull through at later date complications: - Hirschprungs associated enterocolitis - constipation - stricture - fecal incontinence
84
What is the DDx for constipation?
``` infants: hirschsprungs allergic proctitis anorectal malformation hypothyroidism cystic fiborsis spinal cord abnormalities ``` ``` older children: Hirschsprungs celiac disease hypothyroidism anatomical abnormalities ```
85
What is the initial treatment for constipation?
assess for large volume of stool in rectum --disimpact vial oral or rectal "clean out" before starting treatment Polyethylene Glycol PEG-3350 (Miralax) - can also consider lactulose, milk of magnesia, stimulant laxatives - infants - prune juice
86
How long should infants/children with constipation be on treatment?
>2 months | should not be stopped until the child is >1 months without sxs
87
Encopresis
most commonly related to "overflow" and presence of constipation stool withholding --> accumulation of large mass of stool in rectum liquid stool seeps around the mass of stool; cannot be controlled treatment aimed at underlying constipation (stool softeners) timed sitting after meals and in afternoon in conjunction with oral laxative use
88
What is the most common cause of bloody stools in peds pts?
Shigella infection also consider: Salmonella Camphylobacter jeguni
89
What should you be thinking if a child has acute watery diarrhea lasting several hours to days?
viral or toxin mediated
90
What should you be thinking if a child has diarrhea lasting >7 days?
Giardia, cryptosporidium, C. diff chronic disease - celiac, IBD
91
What are some reasons a neonate might have acute abdominal pain?
NEC hirschsprung meconium ileus (think about CF) perforation
92
What are some reasons an infant might have acute abdominal pain?
``` colic acute gastroenteritis intussusception incarcerated hernia volvulus (malrotation) ```

Pediatrics Exam 1 (6 decks)

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