Pediatric Nutrition - Van Hoorn & Crouse

Question 1

What distribution of macronutrients (% CHO, % protein, & % fat) is recommended for a pregnant woman as opposed to a non-pregnant woman?

What about straight caloric intake between pregnant and non-pregnant women?

Answer 1

Macronutrient distribution is essentially the same between pregnant and non-pregnant women:

• 50-60% CHO
• 15-20% protein
• 25-30% fat

However, pregnant women are advised to increase their calorie level overall.

Question 2

How many calories should a pregnant woman eat per day if she weighs:

1. Ideal (normal) Body Weight
2. >120% IBW
3. <90% IBW

Answer 2

1. 30 kcal/kg
2. 24 kcal/kg
3. 36-40 kcal/kg

Recall: One dietary calorie (_C_alorie) = one kcal.

Question 3

When are prenatal vitamins recommended for a pregnant woman?

Answer 3

Always!

Question 4

Why is sufficient iron intake important for a pregnant woman?

Answer 4

• Prevents anemia
• Supports fetal growth
• Allows production of additional blood

Question 5

What sources of iron are recommended for a pregnant woman?

Answer 5

• Lean beef / pork
• Whole grains
• Dark leafy greens

Question 6

Name two notable micronutrients that influence iron absorption.

Answer 6

• Vitamin C improves absorption
• Calcium can block absorption

[OJ seems like a double-edged sword…]

Question 7

Why is folic acid important for a pregnant woman?

What are recommended sources of folic acid for a pregnant woman?

Answer 7

Decreased risk of birth defects

Sources:

• Fortified grains
• Beans
• Dark leafy greens

Question 8

Why is calcium important for a pregnant woman?

Answer 8

• Prevents bone loss (in mother)
• Improves fetal bone growth

Question 9

What are recommended sources of calcium for pregnant women?

Answer 9

• Dairy products
• Fortified orange juice
• Fish with bones

Question 10

What is the recommended weight gain for a mother with a baseline BMI of:

1. <18.5
2. 18.5-24.9
3. 25-29.9
4. >30

Answer 10

1. 28-40 lb
2. 25-35 lb
3. 15-25 lb
4. 15 lb

Question 11

What are three complications related to overweight or obesity during pregnancy?

Answer 11

1. Gestational diabetes
2. Macrosomia (excessive birth weight of the newborn)
3. Eclampsia

Question 12

What is a notable eating disorder seen in some pregnant women?

Answer 12

Pica

An eating disorder characterized by an appettie for non-food materials, such as dirt, paper, clay, sand, glass [yikes], etc.

Question 13

Why are pregnant women recommended to limit fish consumption?

Which fish as especially cautioned against?

Answer 13

Want to limit mercury ingestion - teratogenic

Especially avoid **large, predatory **fish (biomagnification of mercury levels in the higher levels of the food chain)

• Shark
• Swordfish
• King mackerel
• Tilefish
• Albacore tuna

Question 14

Which foods should be avoided by pregnant women to reduce the risk of listeriosis?

Answer 14

• Soft cheeses
• Raw fish (sushi)
• Deli meats
• Unpasteurized milk
• Smoked seafood

Question 15

Name some benefits of breastfeeding over formula.

Answer 15

• Abs in milk aid the baby’s immune system
• Better digested, less gas & constipation
• Linked to decreased risk for ovarian & breast cancer
  
  • (In the mother, I assume?)
• Less expensive
• Improves mother/child bonding
• Burns calories

Question 16

What macronutrient recommendations are given to a woman who is breastfeeding?

Answer 16

• Breastfeeding burns 200-500 kcal/day
  
  • Keep in mind for daily caloric intake
• Eat wide variety of foods
  
  • Focus on protein sources
• Additional fluids are necessary - dehydration risk

Question 17

What micronutrient recommendations are given to breastfeeding women?

Answer 17

Continue taking a prenatal vitamin!

• Calcium: 1,000 mg/day
• Folic acid: 500 µg/day

Question 18

What growth chart should be used for premature infants?

Answer 18

Fenton 2003

Question 19

What growth chart should be used from birth to 24 months for a generally healthy infant?

Answer 19

WHO growth charts

Question 20

What growth chart should be used from 2-20 years old for generally healthy children?

Answer 20

CDC growth charts

Question 21

What specific metric is followed using the CDC growth chart?

What percentile is defined as overweight?

Obese?

Answer 21

Metric: BMI

Overweight: 85-95%ile BMI-for-age

Obese: >95%ile BMI-for-age

Question 22

When is the Down Syndrome growth chart recommended?

Answer 22

Apparantly, this growth chart has fallen out of favor.

It is no longer recommended for use.

Question 23

When should the Brooks specialty growth charts be used?

Answer 23

For a child with cerebral palsy.

Question 24

What are the macronutrient requirements of infants?

(% CHO, % protein, % fat)

Answer 24

Needs are reflected in the composition of breastmilk:

• 40-50% CHO
• 40-50% fat
• 10% protein

N.B. Formula is made to mimic the components of breastmilk.

Question 25

What supplementary micronutrients are given **directly ****to infants**, and when?

Answer 25

* **Vitamin K** * Single prophylactic dose given shortly after birth (intramuscular) * **Iron** * For breastfed infants, give a supplement by 6mo of age (can be in the form of iron-rich food) * **Vitamin D** * For breastfed infants, start a supplement shortly after birth

Question 26

Compare the cause and the general pathology of **Kwashiorkor** with that of **Marasmus**.

Answer 26

**Kwashiorkor** * Muscle wasting masked by edema * Caused by lack of adaquate protein in the diet **Marasmus:** * Wasted appearance and diminished subQ fat stores * Caused by overal lack of adaquate energy intake

Question 27

How long should breast milk and/or formula be the sole source of nutrition for an infant?

Answer 27

For the first 6 months of life

Question 28

What is the most common cause of dental caries (cavities / tooth decay) in infants?

Answer 28

* Cavities: * Use of a bottle or sippy cup while sleeping * Unchecked intake while awake with liquids other than water (esp. juice!)

Question 29

What condition is: * **Common** in newborns * Usually **resolves** with lower volume/more frequent feedings, position changes, and maturation of infant's GI tract * **Painless** and does **not** affect the infant's growth? When is this condition actually considered **harmful**?

Answer 29

GER (Gastroesophageal reflux) Only considered GERD (**_D_**isease) if the reflux is accompanied by **symptoms** and **complications** (i.e., **inadequate growth**).

Question 30

How should an infant's first food be chosen?

Answer 30

* Foods that help to meet both energy and micronutrient needs * Iron-fortified cereals * Pureed meats

Question 31

How quickly should foods be introduced?

Answer 31

Introduce new, **single-ingredient** foods no sooner than **2-3 days apart** to watch for possible allergic reactions. (Remember: Introduce first foods around 6mo of age)

Question 32

What recommendations are given for drinking **juice** in infants?

Answer 32

* Only after 6 months of age! * Limit to 4oz or less per day * Only in an open cup * Helps to limit drinking - bottle or sippy cup is too easy to drink from

Question 33

What recommendations are given for **milk** drinking in infants?

Answer 33

* Not before **12** months of age * Only **whole cow's milk** should be offered

Question 34

What stooling pattern is typical for breastfed infants? For formula-fed infants?

Answer 34

* Breastfed: * 3-4 per day * Soft * Medium-sized * Yellow * Formula fed: * Less frequent * Firmer * Tan-colored

Question 35

How does stooling pattern change with age?

Answer 35

As the infant ages, the **volume** of stools **increases** as the **frequency** **decreases**.

Question 36

What are some **red flags** to watch for in terms of infant **feeding** **problems**?

Answer 36

* Consume too little or too much * Feeding too quickly or too long * Feeding not on a typical schedule * Having difficulty successfully transitioning to new / appropriate textures for age

Question 37

What macronutrient distribution is recommended for toddlers through adolescence? (% CHO, % fat, % protein)

Answer 37

* 50-60% CHO * 10-15% protein * 25-30% fat Similar to adult distribution, with ~5% more fat & ~5% less protein.

Question 38

In terms of children and adolescents, which four populations are at the most risk of protein deficiency?

Answer 38

* Dieters * Athletes who restrict intake * Vegetarians * Those with food allergies

Question 39

1. What are two benefits of adequate dietary fiber? 2. How much dietary fiber is needed for a 6-12mo old? 3. How much is needed for children older than 2 years?

Answer 39

1. Benefits: * Prevents constipation * Protects against heart disease 2. 6-12 months: gradually increase to **5g/day** by 1st birthday 3. \>2 years: (child's age + 5g) per day

Question 40

Calcium is critical during adolescence to achieve peak bone mass. Name three eating habits in adolescents that present a risk for inadequate calcium intake.

Answer 40

1. Low milk intake 2. High soda intake 3. Low vitamin D

Question 41

What are benefits of adequate Vitamin D intake?

Answer 41

* Bone health * Disease prevention * Cancer * Autoimmune * Infectious

Question 42

How much Vitamin D is required early in life? After that? At what point does the amount switch?

Answer 42

* **400** IU/day for **first** **12** **months** of life * Remember: Starts with the **first** **day** of life * **600** IU/day after 12 months

Question 43

What eating habits in childhood / adolescence present a risk for iron deficiency? What are possible effects of iron deficiency?

Answer 43

Habits: * High milk volume (recall: calcium limits absorption) * Poor intake of solids * Dieting Effects: * Poorer cognitive performance * Delayed psychomotor development

Question 44

Disregarding raw amount, why are sources of iron like meat, fish, and poultry **better** than sources like vegetables or grains?

Answer 44

**Heme**-iron sources are better absorbed than non-heme sources.

Question 45

What groups of children / adolescents are at risk of micronutrient deficiencies, and may require vitamin-mineral supplementation?

Answer 45

* Anorexia, poor diet, fad diets * Chronic disease (CF, IBD, liver disease) * Deprived, abused, or neglected children * Diet restriction to manage obesity * Failure to Thrive * Food allergies * Omit food groups

Question 46

What is the rule of thumb regarding the amount of food to give to toddlers / preschoolers? How often do children in this age group need to eat?

Answer 46

* Offer **1 tablespoon** of **each** food for **every** **year** of age * May need to eat **4-6** times per day

Question 47

Fussy eater problem solving time! What are some possible solutions to a child that: **Refuses meat**

Answer 47

* Offer smaller pieces * Include with other foods * Offer legumes, eggs, cheese, tuna

Question 48

Fussy eater problem solving time! What are some possible solutions to a child that: **Drinks too LITTLE milk**

Answer 48

* Offer cheese and yogurt * Use a straw! * [Bonus points for crazy straws]

Question 49

Fussy eater problem solving time! What are some possible solutions to a child that: **Drinks too MUCH milk**

Answer 49

* Offer water if thirsty * Wean from bottle * Limit milk to one serving per meal

Question 50

Fussy eater problem solving time! What are some possible solutions to a child that: **Refuses fruits / vegetables**

Answer 50

* Offer sauces and dips * Include in soups / casseroles * Prepare tender, but not overcooked * Continue to offer every other week

Question 51

Fussy eater problem solving time! What are some possible solutions to a child that: **Eats too many sweets**

Answer 51

* Limit availability in the home * Avoid using as bribes or reward * Incorporate small amounts with meals

Question 52

What are some potential food intake issues unique to school-aged children (6-12 years)?

Answer 52

* After-school snacks * Fewer family meals * Meals at friend's houses * Start to skip breakfast * Preparing their own convenience foods

Question 53

What are some potential food intake issues unique to adolescents?

Answer 53

* Frequent meal skipping (breakfast, lunch) * Regular snacking * High fast food intake * There is potential for disordered eating with: * Vegetarianism * Athletes * Eating disorders

Question 54

What does "lacto-ovo" specifiy as far as diets go?

Answer 54

Lacto-ovo means a person (say a vegetarian) includes dairy and eggs (and typically fish as well) in their diet.

Question 55

What micronutrients are important to assure adaquate intake of for a adolescent following a restrictive vegetarian diet?

Answer 55

* Vit B12 * Vit D * Calcium * Zinc * Iron * Long-chain omega-3 fatty acids * Riboflavin Consider vitamin and/or mineral supplements (though expanding the diet to include these micronutrients naturally is typically preferred.)

Question 56

Name six medical complications that can result from ## Footnote **anorexia nervosa**

Answer 56

* Amenorrhea * Bradycardia * Abnormal EKG * Fatigue * Dizziness * Hypercholesterolemia

Question 57

What are four medical complications that can result from **bulimia nervosa**?

Answer 57

* Constipation & laxative dependency * Dehydration * Electrolyte abnormalities * GI complications from frequent vomiting * Esophagitis * Reflux * Gastritis

Question 58

What special considerations should be made for adolescent athlete in terms of: 1. Caloric intake? 2. Vitamin/mineral supplementation?

Answer 58

1. Likely need more calories than average adolescent 2. The normal RDA should be sufficient, even for athletes

Question 59

What special considerations are there for adolescent athletes regarding **protein** **intake**?

Answer 59

* May require **50-150% more than** the RDA * Discourage protein supplements * Dehydrations * Weight gain * Ca²⁺ loss * Kidney & Liver stress

Question 60

What special considerations are there for adolescent athletes regarding **water** **intake**?

Answer 60

* Need 16oz. water for each pound of weight lost * Sports drinks are not needed for workouts less than 60min