Nutrition and GI Flashcards
The average weight gain in the first and second year of life are, respectively:
A) 10kg, 2kg
B) 10kg, 5kg
C) 7kg, 2kg
D) 7kg, 5kg
C
During what age range does weight gain slow and appetite decrease?
A) 1-2 years
B) 2-3 years
C) 2-5 years
D) 5-7 years
C
Which of the following depicts the eating patterns of the toddler and pre-school age group?
A) Erratic and variable
B) Consistent with predictable likes and dislikes
C) Inadequate intake without coaxing
D) Increased appetite compared to infancy
A
Which of the following statements is false?
A) Young children are neophobic
B) The majority of children described by their parents as picky eaters have appetites appropriate for their age and rate of growth
C) Toddlers assert their autonomy by preferring to self-feed and by being selective about their food choices
D) “Grazing” throughout the day helps provide adequate nutrition to the picky eater
D
The following situations may provoke picky eating habits, except:
A) Bribing, coercing or threatening a child to eat
B) Allowing the child to choose how much they eat
C) Dysfunctional family environment
D) Excessive milk or juice intake
B
List 4 reasons why a child may develop food refusal behaviours.
Excessive juice/milk intake, grazing throughout the day, attention-seeking strategy in a dysfunctional family environment, negative approach to feeding (threats, bribes, coercion, punishment), familial refusal of certain foods, distracted or chaotic mealtime environment, insistence on mealtime manners inappropriate to child’s level of development
List 3 key features a food diary should include:
Foods eaten, portion sizes eaten, 3-7 days in length, time taken to finish a meal, mealtime atmosphere
List 5 recommendations regarding food refusal when the parents have unrealistic expectations.
- Reassurance that decreased appetite in this age is normal
- Parents are responsible for what children eat (ie healthy food options); children are responsible for how much they eat
- Food intake may fluctuate from day to day, but growth should be preserved
- Give small portions initially (1 tbsp of each food per year of child’s age), then offer more if desired
- Snacks midway between meals, avoid grazing, don’t offer juice
- Make eating enjoyable with no negative consequences to eating
- 20 minutes eating time, then food removed until next mealtime.
- Warning times 10-15 min before a meal for child to prepare
- Avoid distractions during mealtime
- Only insist on age-appropriate table manners
- Families should eat together
- No appetite stimulants, no vitamins needed, toddler formulas not substitute for healthy foods
What percentage of toddlers and preschoolers are described by parents as picky eaters?
a) 10%
b) 25%
c) 50%
d) 75%
b
List the members who should be involved in a multidisciplinary team providing nutritional support to a child with cerebral palsy.
- MD
- RN
- RD
- OT
- SLP
- psychologist
What measures are useful in assessing the nutritional status of a child with neurodevelopmental disability?
- height
- weight
- weight-for-height
- triceps skin fold thickness
- mid-arm circumference
List 3 predictors of poor nutritional status in a child with neurological impairment
1) Longer duration of neuro impairment
2) Severity of neuro impairment
3) Oromotor dysfunction
List causes of inadequate intake in neurologically impaired children.
- lack of hand-mouth coordination leading to inadequate intake
- eat more slowly and don’t have enough time to intake adequate amount
- inability to communicate hunger and satiety to caregiver
List causes of malnutrition in children with neurological impairment
- inadequate intake
- increased loses
- altered metabolism
- Oromotor dysfunction
What factors might increase the caloric needs of a patient with CP?
- increased muscle tone
- choreoathetoid movements
- ability to ambulate
Give examples of Oromotor dysfunction that might be seen on patients with neurological impairment.
- inadequate sucking
- dysfunctional swallowing
- persistent tongue extrusion
- drooling due to inadequate lip closure
- inability to chew adequately
What are examples on non-nutritional factors affecting growth of patients with neurological impairment?
- impact of neurological disease itself
- syndromes
- endocrine dysfunction
- ethnicity
- genetic potential
- pubertal status
What types of questions shod be included in a nutritional history?
- type & amount of food
- degree of dependency on caregiver
- amount of spilling
- Oromotor dysfunctions symptoms: drooling, persistent extrusion reflex, delayed swallowing, symptoms of aspiration (cough, choking)
- stress associated with mealtime
List signs of malnutrition on physical exam
- low weight, low height, low weight-for-height
- low tricep skinfold thickness
- mid arm circumference
- decubitus ulcers
- peripheral edema
What investigations would be helpful in assessing a patient’s nutritional status?
- albumin
- CBC (? Iron deficiency)
- PO4, Ca, ALP, Vit D levels
- BMD
What treatment options can be considered in neurologically impaired children with gastroesphageal reflux?
- PPI
- H2-blocker
- prokinetic agents
- surgical anti-reflux procedures
List the factors that contribute to poor bone health in patients with neurological impairment
- decreased ambulate on and weight-beating activities
- malnutrition
- limited sun exposure
- anticonvulsant meds (alter vitamin d metabolism)
How could a physician improve the oral intake of a patient with CP?
- change feed consistency
- optimize feeding position
- optimize caloric density
Gastrostomies have been proven to have which positive impacts?
- improved quality of life
- decrease time spent feeding the child
- improve nutritional status of the child
List the benefits of human breast milk
- optimum growth
- immune function
- development
- minimal cost to family
- improved health and development of child and mother
