Pediatric Nutrition

Question 1

What are some unique aspect of infant nutrition?

Answer 1

lack of caloric reserve
increased metabolic rate
high growth rate
icnreased demands from illness
dependence/independence

Question 2

What is used to determine pedatric malnutrition?

Answer 2

anthropometry: the scientific study of the measurements and proportions of the human body.

WHO charts for <2 yrs w z-scores, MUAC

Question 3

How much does an infant’s weight change in the first 4-6 months of life?

Answer 3

doubles

Question 4

How much does an infant weight change in the first year?

Answer 4

triples

Question 5

How much does the infant’s length change in the first year?

Answer 5

increases 50%

Question 6

Describe child growth for ages 2-6.

Answer 6

growth slows but is constant

adipose tissue distribution begins

Question 7

Describe child growth for ages 7-10.

Answer 7

steady growth

females > males in ht and wt

Question 8

Describe child growth for ages 11-18.

Answer 8

Begins before puberty and continues until growth is complete.
Rate of wt gain increases.

Question 9

What is the best tool for assessing a child’s growth?

Answer 9

grwoth charts for
length
wt
head circumference

Question 10

What is the goal for a child’s wt assessment?

Answer 10

stay at or above 50th percentile

Question 11

What is failure to thrive?

Answer 11

in pediatrics when a child’s growth falls 2 major percentiles or weight is <3-5th percentile

Question 12

How many kcal/kg/d are necessary for a pre-term infant?

Answer 12

100-120+

Question 13

How many kcal/kg/d are needed for a 0-6 mo infant?

Answer 13

100-110

Question 14

How many kcal/kg/d are needed for a infant 6-12 mos?

Answer 14

90-100

Question 15

How many kcal/kg/d are needed for a 1-7 yo?

Answer 15

60-80

Question 16

How many kcal/kg/d are needed for a 7-12 yo?

Answer 16

50-60

Question 17

How many kcal/kg/d are needed for a 12-18 yo?

Answer 17

30-50

Question 18

What are the AAP recommendations for breastfeeding?

Answer 18

exclusive for first 6 mos
optimal to continue for at least 1 yr
may extend beyond 1 yr if desired

Question 19

What are the adv of breastfeeding for a newborn?

Answer 19

optimal nutrients
decr risk of infx
decr risk of immune-related diseases
psychological and cognitive adv

Question 20

What are the adv of breastfeeding for a mother?

Answer 20

decr post partum bleeding
fasting time to attinment of pre-pregnancy wt 
decr risk of breast and ovarian cancer
incr child spacing
mother-infant bond

Question 21

Contraindiciation to breastfeeding.

Answer 21

material HIV pos-status
infectious TB
Human T-cell lymphotrophic virus type I or II
Untreated brucellosis

Certain drugs

Question 22

What types of drugs are avoided in breastfeeding?

Answer 22

immunosuppressants, chemotherapy, lithium, amphetamines, radioacive agents, etc.

drugs that reduce milk production: ergots, decongestants

Question 23

What drug characteristics make it less likely to be presnt in breast milk?

Answer 23

high MW
low lipid solubility
high protein binding
high volume of distribution 
short t1/2

Question 24

How many times will term, healthy infants feed a day?

Answer 24

6-9 ties

Question 25

What is the caloric density of breast milk? **

Answer 25

20 kcal/oz

Question 26

What are the components of breastmilk?

Answer 26

lipids are 50% of calories:long-chain FAs protein: 70/30 whey/casein carb: lactose

Question 27

What supplements are necessary for premature neonates?

Answer 27

Vitamin D: <1.5 kg: 200 U/d >1.5 kg: 200-400 U/d Iron: 2 mg/kg/day (elemental)

Question 28

What supplements are necessary for term infants?

Answer 28

Vitamin D: partially or fully breastfed: 400 IU daily iron: not indicated for breastfed, healthy infants

Question 29

What is the additional calori content added to human milk by fortifiers?

Answer 29

24 kcal/oz for 1 pk per 25 mL | 22 kcal/oz for 1 pk per 50 mL

Question 30

What are indications for formula feeding?

Answer 30

- substitute or supplement feeds for mother who do not or cannot breastfeed - human milk intolernace - maternal infection transmittable - maternal chemotherapy - failing to gain wt despite optimization of breastfeeding

Question 31

What are the nutrtional contents of term formulas?

Answer 31

20kcal/oz, 19 kcal/oz carb: lactose cow milk protein Vit D supp not needed -->all should get iron fortified

Question 32

Describe pre-term formulas.

Answer 32

more calorie dense: 24 kcal/oz available as ready-to-feed bottles $$

Question 33

Describe enriched formulas.

Answer 33

more calorie dense: 22kcal/oz | liq or pulv

Question 34

What are examples of specialty formulas?

Answer 34

soy-based lactose-free hypoallergenic or non-allergenic antireflex

Question 35

How are transitional formulas used?

Answer 35

for premature infants being discharged home from the hopsital - designed for initiation at 1800g or 34 weeks PCA - d/c at 52-56 weeks PCA - usually 22 kcal/oz

Question 36

when and how should formula be concentrated?

Answer 36

pre-term already conc'd for TERM formulas decr amt of water to incr caloric content--> families should not do this on their own

Question 37

When are complementary foods initated for infants?

Answer 37

btw 4-6 mo | introduce single ingredient foods first

Question 38

How should complementary foods be introduced to an infant?

Answer 38

introduce 1 new food q4-5 d increase serving size gradually emphasize all food groups

Question 39

What should not be done when iniating complementary foods in infants?

Answer 39

``` never put anything but breast milk or formula in a bottle -don't give <1 yr: honey cow's milk choking hazards potential allergens ```

Question 40

Describe the Holliday-Segar method of calculating child fluid requirements.

Answer 40

<10 kg: 100 mL/kg 10-20 kg: 1000mL + 50 ml/kg for kg>10 >20 kg: 1500 mL + 20 mL/kg for q kg >20

Question 41

What would be the amt of maintenance fluids for a 14 kg child?

Answer 41

1200 mL/24 hrs

Question 42

What would be 1.5x the mainteance fluids for a 25 kg child?

Answer 42

2400 mL/24hrs

Question 43

How should feeding reqs in a failture to thrive child be calculated?

Answer 43

use catch-up grwoth plan for caloric need use 50th percentile wt multiply desired wt by kcal/kg/d for age to get the new daily req

Question 44

Which ped pts are candidates for nutritional supplementation?

Answer 44

``` ability to eat but stunted growth/devo oral aversions/picky eaters -req specialized diet -delayed intro of oral feeding -unpleasant oral-tactile situations ```

Question 45

Define pre-term.

Answer 45

<37 wks gestational age.