Nutrition

Question 1

Infant Nutrition

Answer 1

• Breastfeeding and bottle feeding are both acceptable methods
• Breastmilk and formula provide all the infant’s nutritional daily requirements until 4 to 6 months of age

•Cognitive developmental is supported by an adequate diet in infancy

Question 2

Infants - Solid Food readiness

Answer 2

• Tongue extrusion reflex (necessary for sucking) needs to disappear
• Ability to swallow solid foods
• Sit unsupported in high chair

Question 3

Introducing Solids to infants

Answer 3

• Rice or oatmeal infant cereal first
• Start with a thinner consistency
• New food every 4 to 7 days (allergies)
• No salt, sugar or seasonings should be added

Question 4

Solid foods for 6 to 8 months

Answer 4

• Soft table foods can be added
• Cheerios
• Avoid hard food pieces
• Use of a cup

Solid foods do not substitute for breastmilk or formula which should still be their primary source of nutrients until 12 months

Question 5

Infants – Foods to Avoid

Until 12 months

Answer 5

• Honey
• Peanuts, popcorn, hard foods, grapes and hot dogs
• Strawberries
• Cow’s milk
• Peanut butter

Question 6

Toddlers food needs

Answer 6

• DONT reduce fat intake of a child less than 2 years of age
• calcium daily (but limit milk intake, too much calcium not enough iron)
• 19 grams of fiber daily
• limit juice - offer water between meals
• 3 meals and 2 snacks daily

Question 7

Toddlers – Promoting self feeding

Many be hungrier during growth spurt

Answer 7

• Use child size utensils
• Do not force feed or utilize the “clean plate” rule
• Keep toddler in a secure chair at a comfortable height
• Never leave the toddler unattended at meal times
• Promote a family meal time
• Minimize distractions during meals ( avoid just sitting in front of tv)

Constipation can decrease appetite

Question 8

Preschoolers

Answer 8

• Continue the principles discussed for toddlers
• By age 5, can understand the social context of meal time
• More likely than toddler to try new foods
• Will enjoy helping with food preparation and clean-up
• Promote a family meal time

Question 9

Obesity – Toddlers and Preschoolers

What causes it and what can be done to prevent?

Answer 9

•More prone to obesity if a parent is obese

• Unlimited 🧃 and 🥛 consumption
• Do use the “Clean your plate” rule
• Offering high sugar “junk food” just so child will eat
• Not starting healthy eating habit from birth (ranch for 🥕 or 🧀 for 🥦 will help them eat healthy)
• Offer new choices multiple times
• Do not use food as a reward or punishment
• Use a structured meal time

Question 10

School age

Answer 10

Needs vary by size, age, gender and activity level
•Appetite⬆️ but caloric needs⬇️
•Diet choices established earlier will continue
•More influenced by parents, peers and social media
•Offer a high quality PROTEIN with each meal
•Increased CALCIUM needs
•Still benefits from a family meal time

Question 11

School Age - Obesity is caused by

Answer 11

• Lack of exercise and time outside
• More “screen” time
• Unstructured meal time
• Increased consumption of sugar laden beverages
• Peer influence

Question 12

Adolescents needs

And what to avoid and encourage

Answer 12

•Higher caloric needs
- May appear to be constantly hungry
•Higher calcium and protein needs

• avoid “specialty” diets
• Habits will continue as adult
• Encourage physical activity daily
• Family meal times are still very important

Question 13

Adolescents - Obesity

What to encourage to prevent obesity?

Answer 13

•Encourage healthy eating habits
   - less fast food 
   - fruits and vegetables 
•Include adolescent in meal planning with family
•Exercising with peers and family

• Obesity as an adolescent is a direct link to obesity as an adult
• Influenced by peers

Question 14

Anemia

Answer 14

• Iron deficiency anemia is the most common cause of anemia in childhood.
• Often occurs when transitioning from formula to whole milk. Infant formulas are iron fortified. When formula is stopped the child is not receiving enough iron from other food sources.
• Cow’s milk actually makes it harder for the body to absorb iron. Toddlers can develop iron deficiency anemia if they drink too much cow’s milk (more than 24 ounces a day) and do not eat enough foods that are rich in iron such as green leafy vegetables and red meat.

Question 15

Anorexia

Answer 15

causes more complications and adolescent deaths, distorted body image; has social, psychologic, behavioral, cultural and physiologic components

Question 16

Bulimia

Answer 16

binge eating accompanied by purging, may be cyclic, may not change physical appearance, a psychologic disorder

Bulimics have a much higher recovery rate than anorexic adolescence

Question 17

Failure to thrive (FTT)

Answer 17

 Inadequate growth resulting from an inability to obtain or use calories required for growth.
 The deceleration of growth for both weight and height.
 Diagnosis is based on growth parameters that
1) drop more than 2 percentiles from baseline,
2) are persistently below the third to fifth percentiles.

Question 18

Gastroesophageal Reflux (GER)

Answer 18

Passage of gastric contents into the esophagus
Most infants outgrow reflux by 12 months; particularly common in preemies

Sphincter is very lose- when burp may throw up a little, don’t shake after eating !

Will eventually tighten, standing and sitting up and more solid foods will help as well

Question 19

Gastroesophageal Reflux Disease (GERD)

What complications develop

Answer 19

most involve the airway and can be life threatening in infants:

 Esophagitis
 Anemia
 Recurrent pneumonia
 Asthma
 Bradycardia
 Apnea
 ALTE

Question 20

Therapeutic Management of GERD

Answer 20

 Depends on severity. No therapy is needed for infant who is thriving and has no respiratory complications.

 Keeping head elevated for at least 30 minutes after feedings.
 Prone position should NOT be used due to increased risk of sudden infant death syndrome (SIDS)
 Small frequent feedings, space between feedings should still be permitted to allow formula in stomach
time to digest.
 Burping infant frequently (after every 1 to 2 ounces) during feeding, and after
feeding.
 Using pre-thickened formulas such as Enfamil AR
 For older children, decrease foods that exacerbate acid reflux (caffeine,
citrus, tomatoes, peppermint, spicy or fried foods)

Question 21

Cleft Lip (CL) surgery

Answer 21

cheiloplasty: 10 – 12 weeks (approximate)

surgery for the lip can be done early, it needs no extra time for growth

Question 22

Cleft palate surgery

Answer 22

Repair/palatoplasty: 6 to 12 months (approximate)

has to wait to allow for more growth but needs to be done before it alters speech patterns

Question 23

Nursing Care Management for a child with a cleft lip, palate or both

Answer 23

 Interventions in assisting parents in accepting a birth defect
 Use of Haberman nipples for feeding, or a large syringe with soft, red rubber catheter
** More air will be taken in because of the cleft; so the infant will need burping often
 The infant with unrepaired cleft palate is at risk for aspiration with oral feeding

Question 24

Management of care: after cleft lip or palate surgery

Answer 24

 Promotion of surgical closure
 Prevention of complications
 Facilitate normal growth/development
 Speech issues are common with Cleft Palate even after initial repair

Question 25

Postoperative Care for Cheiloplasty

Answer 25

``` Monitor airway Protect the suture line pain management No suctioning Proper positioning ```

Question 26

Postoperative Care for Palatoplasty

Answer 26

Monitor airway | Protect the suture line ATC pain management Soft diet

Question 27

Complications of Cleft Lip/Palate

Answer 27

```  Feeding difficulties  Altered dentition  Delayed or altered speech development  Otitis media  Excessive air intake – gagging, choking, regurgitation ```

Question 28

Promoting Nutrition in infant with cleft lip or palate

Answer 28

 Encourage breastfeeding  Burping infant more often during feeding  Monitor for aspiration  Encourage Skin to Skin contact

Question 29

GERD signs

Answer 29

``` Vomiting Colic -intense crying or fussiness Wheezing Failure to thrive Ear infections Abnormal posture Pneumonia ```

Question 30

After cleft lip or palate repair

Answer 30

Prevent crying Logan bow Pain medication Elbow restraint ``` NO: Suctioning Pacifier Nipple Hard food or items ```

Question 31

Feeding after repair

Answer 31

Haberman Feeders Breck Feeders Spoon to lips only Syringes Pigeon Feeders

Question 32

Preschooler nutrition needs

Answer 32

``` Calcium daily Iron daily fiber daily Fat intake 1000 – 1600 calories per day Limit juice- Encourage water intake ```

Question 33

Infant nutrition needs

Answer 33

 Breast milk and formulas: 20 cal/oz  Requirements met with multiple feedings  Gain weight at rate of 1 oz per day for 1st 6 months On Demand  Hunger cues  Bottle feed every 3-4 hours  Breast feed every 2-3 hours, 10-20 min on each breast

Question 34

Weaning

Answer 34

 Individualized decision  Encourage stopping bottle feeding between 12 to 15 months  No spill sippy cups are not recommended for everyday use

Question 35

Diagnostic Evaluation of GERD

Answer 35

```  History and physical examination  Upper GI series  Esophageal pH monitoring  Esophagogastroduodenoscopy (EGD)  CBC and hemoccult ```