Nutrition and GI Flashcards
(90 cards)
1
Q
Thyroxine needs to be check in which infants on soy formula?
A
Congenital hypothyroidism.
2
Q
Harm for soy-based formula in which 2 populations?
A
- Premature (not adequate for growth)
- Congenital hypothyroidism (can cause abN function)
+/- non-IgE CMPA (due to high rate of coincident soy allergies)
3
Q
Best choice for newborn baby feed?
A
Breast feed
4
Q
T or F: soy based formula support normal growth + nutrition for 1st year of life
A
True UNLESS PREM
5
Q
CMPA formula recommendation
A
Protein Hydrolysate
6
Q
Types of Fats
A
- Saturated= double bone btw carbon replaced by H
- Unsaturated= min. 1 double bonds between two atoms of carbon
- > Cis vs. Trans based on arrangement of carbon across double bones
7
Q
T or F: there is a safe level of dietary trans level
A
FALSE.
Trans= negative health effects.
8
Q
Infantile Colic Criteria (Rome 3)
A
- infant < 4 mo.
- paroxysmal irritable/ fussy/ crying w/out clear cause
- episode last min. 3h + 3d/week x 1 wk
- no FTT
9
Q
Should you change diet if colic?
A
- IF severe and CMPA concern empiric time limited (max 2 wk) hypoallergenic diet
- otherwise small # infants actually reduce symptoms
10
Q
T or F: soy based form should be used to reduce colic
A
False.
Soy only if galactossemia or can’t take dairy.
11
Q
T or F: lactose-free helps colic
A
FALSE.
Congenital lactase deficiency are.
12
Q
T or F: pro/pre biotics help colic.
A
FALSE. Insufficient evidence for conclusion.
13
Q
DDX for FTT may include=
A
- Nutrition (intake, ED)
- Energy Loss (emesis, pancreatic dx, liver dx, RTA)
- Energy Needs up (chronic condition, CHF, tumour)
- Endo problem/Other (low thyroid, GH deficiency)
14
Q
Basic W/U for FTT may include:
A
CBC ESR or CRP lytes, gas, BG, BUN, Cr protein, albumin Fe, TIBC, sat, ferritin Ca, P, alk-phos AST, ALT, GGT serum immunoglobulins tTG, IgA TSH U/A
Step 2= sweat chloride, vitamin level, fecal elastase, bone age
15
Q
Adequate Caloric Needs Calc=
A
calorie for age (cal/kg/day) x ideal wt for ht (kg) / actual wt (kg)
16
Q
When do you use appetite stimulants in FTT
A
After expert R/A and refractory cases.
17
Q
First steps in toddler FTT
A
- Verify accuracy
- Plot on growth curve
- Calc. mid-parental ht
- Hx + P/E
- Caloric intake using food diary
- Basic W/U
- Optimize oral caloric intake
18
Q
How much wt and ht do you gain from 2-5 y.o.?
A
1-2 kg/year
6-8 cm/year
19
Q
How do you manage unrealistic expectations for picky eaters
A
- Reassure (decreased appetite normal in this age)
- Parents choose nutritious food and structure and child decide how much
- Small portion to start
- Snacks best mid-day
- Enjoyable time
- Limit table 20 min
- Ensure not tired or overstimulated
- No distractions
- No discipline then
- Eat together
- No indication for IV, formula, stimulants.
20
Q
What is the BFI (Baby Friendly Initiative)?
A
operational traget for hospital to get child-feeding ideal. get designation when follow all 1- steps x min. 80% of all F.
21
Q
List any steps in BFI (Baby Friendly Initiative)?
A
- written BF policy
- all HCP have skills + info to implement policy
- inform preg F and families about imp of BF
- place babies in uninterrupted skin-to-skin contact after birth min. 1 hr or until first feed done
- assist BF and lactation
- support exclusive BF x 6 month
- facilitate 24h rooming for all mother-infant
- encourage baby-led or cue-based BF
- support feed + care for BF without pacifiers
- provide transition among host to community services
22
Q
Dx Contraindications to BF
A
- HIV (+) mother (even if ART)
- Herpes lesion on both BF
- Untreated Infectious TB (within first 2 wk of tx)
- Cytotoxic chemo
- Radioactive isotopes or radiation therapy.
- Classic galactossemia
No contraindication if…. Hep B, Hep C
23
Q
T or F: you should stop BF for physiologic or milk jaundice
A
FALSE
24
Q
T or F: should not BF if PKU
A
FALSE. Now encourage BF w/ supplement low-phenyl formula w/ strict monitoring for phenylalanine levels.
25
Key to Birth-6 mon. Nutrition
1. BF exclusive x 6 mo.
2. All BF= Vit D 400 IU
3. First complementary = Fe rich (meat, Fe cereals)
4. Monitor growth
26
T or F: colic typically resolve by 4 mon.
TRUE
27
6-24 months Nutrition Recommendations
1. Support BF up to 2 y.o. +
2. If not, start 3.25% pasteurized homo milk 9-12 mon. (max 20 ounces)
3. Skim milk after 2 y.o.
4. Vit D 400 IU if BF
5. Fe rich food few times/d
7. Responsive feeding key
8. 12 mon= reg snacks + meals
9. Ensure food prep, cook, stored well
28
T or F: New fluids best via bottle if after 6 month age
FALSE.
| Best through soppy cup.
29
Name things that support mothers BF after returning to work.
1. Child care nearby
2. Breast pump
3. Flexible schedule
4. Supportive fam
30
How often and frequent should you introduce new foods to BB?
- avoid > 1 new/d
| - wait 2 d before another common allergen
31
If no egg or milk in infant diet, watch:
1. Ca
2. Zinc
3. Fe
4. Vit D
5. Vit B12
32
True or False: Fluoride reduces dental caries
True
33
Fluoride decreases enamel solubility via
1) Inhibition of Plaque
2) Inhibition of De-mineralization
3) Enhanced Re-mineralizatio of enamel
34
What is dental fluorosis?
- abnormal enamel development from ++ ingested fluoride
- occurs ~0.7 ppm
- usually no symptoms
- if P/E (+)= pitting teeth, 'snow capped case', chalking teeth
35
How do cities know to add fluoride to natural water?
Natural Fluoride concentration < 0.3 ppm
36
how much toothpaste to use?
pea size portion
37
When do you give supplemental fluoride?
IF they are min. 6 mon AND...
drinking water < 0.3 ppm
+ child does NOT brush BID
+ and dentist/HCP say high risk for caries (community, geographic trends)
38
How much fluoride do you supplement for kids 0-6 months?
NONE.
No matter what the fluoride concentration is in envirn't
39
When you need topical fluoride?
Once teeth have erupted
40
What are sports drinks?
1. Flavoured beverage w/ sugars + lytes + vitamins
41
What proportion of high schools studies caffeinated energy drinks consume caffeinated energy drinks?
> 50%
42
What are caffeine side effects
- tachy HR
- HTN
- fast speech
- increased motor activity
- delayed gastric emptying
- diuresis
- hot
43
T or F: People who mix energy drinks w/ alcohol drink less alcohol than general.
False.
44
T or F: Health Canada prohibits the use of caffeinated energy drinks as ingredient in premixed alcohol beverages.
True.
45
Caffeine Recommended Max Daily Intake for ages.
- 4-6: 45 mg/d
- 7-9: 62.5 mg/d
- 10-12: 85 mg/d
- 13 y.o. +: 2.5 mg/kg/day
46
What should paediatricians do re: caffeinated energy drinks?
- ask about consumption
- ask about reason to consume and if they mix w/ EtOH
- educate re: AE
- counsel on sports drink replacement (water, sports beverage if long)
47
Which population have higher risk of caffeinated energy drinks?
- CVS
- Renal
- Liver dx
- Sz
- DM
- Mood, ADHD dx
48
What is oral rehydration therapy?
Glucose + electrolytes
49
Recommended WHO osmolarity of ORT?
245 mosm/L
50
What do you give if no dehydration present?
Regular age-appropriate diet.
51
What % is mild dehydration?
<5%
52
What % is moderate dehydration?
5-10%
53
What % is severe dehydration?
>10%
54
How do you treat mild dehydration? (<5%)
Rehydrate w/ ORS (50mL/kg) over 4 hour
Replace ongoing losses
Age appropriate diet after rehydration.
55
How do you treat mod-dehydration? (5-10%)
Rehydrate ORS 100mL/kg over 4 hour
Replace ongoing losses
age appropriate diet after dehydration
56
How do you treat severe dehydration (>10%)
```
IV resus with NS 20cc/kg
R/A and repeat as needed
ORT when stable
Replace ongoing losses with ORS
Age appropriate diet once rehydrated.
```
57
Which general clinical parameters do you look at for dehydration assessment?
- VS: HR, BP (low= late), LOC, U/O
- AF
- sunken eyes
- MM
- Thirst
- Skin turgor
58
What level of dehydration is this: ++ HR, low or absent U/O, great thirst, very dry MM, decreased turgor?
Severe
59
Describe mild dehydration?
- Slight elevated HR
- Slightly decreased U/O
- slightly dry MM
- slightly increased thirst
- no skin turgor
60
T or F: ORT is as effective as IV for mild-moderately dehydrated child?
TRUE
| - as effective IF not better
61
T or F: ORT is as effective as IV for severe dehydration?
FALSE
| - want to use IV
62
List the ORS contraindications
- severe dehydration
- impaired LOC
- protracted vomiting despite small f feeds
- paralytic ileus
- monosaccharide malabsorption
63
T or F: you should stop diet when sick?
False- continue age appropriate diet (including BF, no need for lactose-free formula etc.)
64
T or F: it is safe to give plain water for acute gastro.
False
| - low Na and low glucose
65
What are probiotics?
live micro-organisms; non pathogenic
66
what are probiotics?
non-viable food components
| i.e. fructo-and galacto-oligosaccharides
67
What does baby gut flora look like adults?
once solid food introduced
| - colonization in general starts immediately after birth
68
How do intestinal bacteria contribute to gut function?
- compete with pathogenic bacteria
- increase mucus secretion
- decrease gut permeability
- modulate immune function
69
When should you consider recommending probiotics?
1. Prevent NEC if > 1 kg
2. Prevent Abx-associated diarrhea
3. Shorten viral diarrhea
4. Decrease symptoms of colic
5. Decrease symptoms of IBS
70
Do probiotics aid in prevention or tx of: atopic dx, allergic colitis, preventing infection?
No.
71
What are risk of probiotics?
- small risk of invasive infection if immunocompromised
72
Which growth charts does CPS recommend?
WHO
73
T or F: weight for length or % ideal body weight should be used for kids > 2 y.o.
False.
- if < 2 y.o.
- BMI may be more helpful screen if older
74
Define obesity on growth charts?
If < 2 y.o.= wt for length > 99.9th % tile
If 2-5 y.o.= BMI > 99.9th % tile
If 5-19 y.o.= BMI > 97th percentile
75
Define overweight on growth charts?
If < 2 y.o.= wt for length > 97th % tile
If 2-5 y.o.= BMI > 97th percentile
If 5-19 y.o.= BMI > 85th % tile
76
Define severe stunting for growth charts?
Length for age (if < 2) < 0.1% tile
Ht for age if > 2
Versus stunting in general= < 3rd percentile
77
Define severe underweight and underweight?
wt for age
Underweight: < 3rd % tile
Severe: < 0.1%
78
List the benefits of BM in prem:
- less severe infections
- less NEC
- reduced colonization with pathogenic organisms
- decreased NICU length of stay
79
What are barriers for a prem receiving mother's own BF?
- mother may not be able to supply (ill/stressed)
| - baby transported away from mother's hospital
80
T or F: donor milk reduces motivation for mother to express own milk.
False
81
What are the rules of donor milk banking?
- adhere to Health Canada regulations
- NO profit and supply NICU on cost-recovery basis
- altruistic donations
- rigorous screening (interview, serology, consent)
- milk batched from different mother but Always pasteurized to inactivate bacterial and viral contaminants and then re-cultured to ensure safe
82
T or F: Donor milk is excluded if meds, smoking, drinking.
True
83
T or F: Donor milk is tested for Hep A, B, C, and HIV only.
False
- Hep B
- Hep C
- HIV
- Human T cell leukaemia virus
84
What nutritional components are not altered via the donor milk process?
- Carb
- Fat
- Salt
85
What nutritional components are changed via donor milk process?
- Protein (13% denatured)
- Some vitamins denatured
- Some immunologic decreased
86
T or F: there is a higher risk of allergic reaction if used donor milk compared to formula?
False.
- risk of allergic rxn not higher than formula
87
T or F: Donor milk is preferred over own mother's milk.
False.
- Only offer when N/A or limited amount
88
T or F: can give pasteurized human donor milk without consent.
False.
-Always need consent.
89
T or F: milk banking is cost effective?
True.
- reduce Dx severity, reduce resources
90
T or F: CPS endorses sharing of unprocessed human milk?
False.
- CPS does NOT endorse sharing of unprocessed milk
