Nutrition

Question 0

Per unit body weight, the estimated energy requirement of an infant is __________ times that of an adult.

Answer 0

Two

Question 1

In the first year of life, weight increases ________ fold and length increases ________ fold.

Answer 1

Three; two

Question 2

Benefits of breastfeeding

Answer 2

Reduced incidence of GI and respiratory infections
Allergy prevention (especially for children at risk => i.e. Family Hx of atopy)
Emotional benefit
Inexpensive

???: enhanced cognitive development, benefit for chronic disease (obesity, CVD, diabetes)

Question 3

First choice formula for infants below 9-12 mo. (Examples)

Answer 3

Cow milk based, iron fortified

Ex. Similac, enfamil, good start

Question 4

Primary lactose intolerance is _______________ (rare/common); therefore there are ______________ (few/many) indications for lactose free formula.

Answer 4

Rare; very few

Question 5

Specialized formulas such as protein-hydrolysate may be considered for which indications (3). Examples of protein-hydrolysate include: (3)

Answer 5

Cow’s milk intolerance
Cystic fibrosis
Certain malabsorptive syndromes

Examples include: pregestamil, alimentum, nutramigen

Question 6

Elemental (amino acid based) formulas such as _________ and _________ could be considered for infants with __________ or ___________.

Answer 6

Neocate or PurAmino

Cow’s milk intolerance or short bowel syndrome

Question 7

Cow’s milk is NOT recommended before ____________. Why? (4)

Answer 7

Before age 9-12 months.

Higher protein and mineral load
Lower levels of essential fatty acids
Poor iron bioavilability

=> associated with occult blood loss in stools of infants less than 6 mo.

Question 8

When cow’s milk is introduced (after age 9-12 months), _________% milk should be given.

Answer 8

3.25%

Question 9

Can goat’s milk be used as an alternative to cow’s milk? What about soy milk?

Answer 9

Goat’s milk: No! Similar composition to cow’s milk and NOT fortified with Vitamin D; high incidence of cross reactivity with cow’s milk protein.

Soy milk, rice milk etc.: No! Suboptimal fat and protein composition.

Question 10

Preferred source of nutrition for premature infants? Why?

Answer 10

Breast milk! Yum! +/- human milk fortifier (vitamins, mineral, protein)
Lowers risk of NEC and sepsis

Question 11

Average number of feeds per day from birth to 2 weeks (avg volume per feed)

Answer 11

6-10 feeds/day; 60-90ml/feed

Question 12

Average number of feeds per day and average volume per feed from age 1-3 months.

Answer 12

5-6 feeds/days; 150-180 ml/feed

Question 13

Average number of feeds per day and average volume per feed from age 6-12 months.

Answer 13

3-4 feeds/day; 210-240ml/feed

Question 14

Complementary foods should be introduced at age __________. Start with __________. __________ should be introduced last. Most infants will take ________% of their calories from complementary foods by age 1 year.

Answer 14

Age 6 months; start with iron fortified cereals; meats and alternatives should be last; 50%

Question 15

Egg white is not usually given until after age __________.

Answer 15

1 year

Question 16

Head circumference should be tracked and plotted for all visits (under/over) age ___________.

Answer 16

Under 2 years.

Question 17

BMI should be tracked and plotted at all visits (under/over) age _________.

Answer 17

Over age 2 years.

Question 18

Current standard for growth charts

Answer 18

New WHO growth charts
Based on children from multiple countries who:
Raised under optimal conditions for growth
Breastfed for at least 3 months

Question 19

Assessment of underweight (based on growth charts)

Answer 19

<3rd percentile in weight-for-age (under 10 years) or BMI-for-age (10 years or older)

*wasting is defined in the same way but using BMI-for-age

Question 20

Expected weight gain for 0-3 months (g/day)

Answer 20

26-31 grams/day

Question 21

Expected weight gain for 3-6 months (g/day)

Answer 21

17-18 grams/day

Question 22

Expected weight gain for 12-36 months (g/day)

Answer 22

7-9 grams/day

Question 23

Definition(s) of Failure to Thrive (FTT)

Answer 23

NOT a Dx
Weight <80% ideal body weight

Look at growth velocity, adjusted weight for length if premature/IUGR etc.

Question 23

***Approach***to failure to thrive (aka. Inadequate weight gain) => three important things to consider

Answer 23

1. Inadequate intake? (What? How often? Difficulties feeding?) 2. Increased losses? 3. Increased requirements?

Question 24

Causes of poor intake (10)

Answer 24

``` Anatomic problems (ex. Cleft lip/palate) Neurologic disorders GERD Congenital heart disease Genetic syndrome Chronic renal disease Oral hypersensitivity Feeding aversion Lack of routine Psychosocial factors Neglect ```

Question 25

Sources of increased losses (10)

Answer 25

``` Malabsorption (celiac, cow's milk protein intolerance, short bowel) Pancreatic disease (cystic fibrosis) Liver disease Recurrent or chronic infection Inflammatory conditions (ex. IBD) Vomiting Severe GERD Malrotation/atresia Metabolic disease DM (polydipsia/polyuria) Hyperthyroidism Malignancy ```

Question 26

Useful tests in failure to thrive due to suspected increased losses

Answer 26

``` Three day fecal fat, fecal elastase => fat Stool alpha-1-antitrypsin => protein Reducing substances => CHO Stool cultures Fat soluble vitamin levels CBC, iron studies, albumin Celiac => TTG/IgA level Cystic fibrosis => sweat test ```

Question 27

Reasons for increased requirements (7)

Answer 27

``` Congenital heart disease Cystic fibrosis IBD Chronic renal disease Liver disease Prematurity Catch up growth ```

Question 28

Celiac disease (laboratory findings)

Answer 28

TTG >3 Low albumin Villous atrophy on upper endoscopy and duodenal biopsy Tx: gluten free diet!!!

Question 29

Risk groups for iron deficiency

Answer 29

``` Premature infants, lower SES, infants of iron deficient mothers Early introduction of cow's milk Medications Malabsorption Poor dietary sources of iron ```

Question 30

Tx iron deficiency

Answer 30

Treat the cause! | 3-4mg/kg/day of elemental iron for 3 months

Question 31

Age range when Vitamin D deficiency commonly presents

Answer 31

3 months to 3 years

Question 32

_______________ is the only supplement needed for term infants in the first 6 months of life.

Answer 32

``` Vitamin D 400 IU (or 800 IU if in Northern communities) should be given to all breastfed infants until the diet provides this amount or until 1 year of age ```

Question 33

Definition overweight and obesity

Answer 33

Overweight: BMI > 85th percentile for age and sex Obesity: BMI >95th percentile for age and sex

Question 34

Can obesity be "eyeballed"?

Answer 34

No! Need to take weight/height/BMI