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Flashcards in Pediatrics Deck (346)
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1

What are the 4 unusual patterns of growth?

1. Plateauing: child has stopped growing; usually a sign of chronic malnutrition
2. Sharp decline: weight loss; usually an acute malnutrition: insult; trauma, new diagnosis, stopped eating etc.
3. Falling off 50th %ile: Still growing but at a slower velocity than normal
4. Incline in BMI: making an obese/overweight child; probably need to adjust intervention

2

What is failure to thrive?

o Weight (or weight for height) is less than 2 SDs below the mean for sex and age
o Weight curve has crossed more than 2 percentile lines after having previously achieved stable growth

3

What are the possible causes of FTT?

Infant Characteristics
- Chronic medical conditions (e.g. Inadequate intake (swallowing dysfunction, anorexia, etc.), Increased metabolic rate (Bronchopulmonary dysplasia, congenital heart disease, fevers, etc.), Breathing, heart beat is so difficult that they need more energy to do it,
Malabsorption (CF, short gut, IBD, celiac disease))
--> Usually children grow well within first few months, and suddenly start to fall off the curve
- Premature birth or IUGR
- Developmental delay
- Congenital abnormalities
- Intrauterine toxin exposure
Family characteristics
- Poverty
- Unusual health and nutritional beliefs
- Social isolation
- Disordered feeding technique
- Substance abuse
- Violence or abuse

4

What is short stature? How can we determine which child will probably have short stature?

Familial/genetic
Growth is parallel to the normal centile, usually below the 5th percentile
Final adult stature is short; does not change if child is fed more.
Use mid-parental height equation to get an estimation of the height of the child around 18-19 years old

5

What are the calculations for mid-parental height?

Girls: ((father' s height-13 cm)+(mother' s height))/2

Boys: ((mother^' s height+13 cm)+(father's height))/2

6

What is constitutional growth delay?

Child might be growing at the lower end for height and weight, but their mid-parental height is higher.
Some children will not grow as early and have their growth spurt later on: normal
Usually, parents will have had the same kind of pattern of growth when they were young

7

What is stunting/nutritional dwarfism in regards to growth charts?

Fall in length
– 2 SD below the height for age curves; not necessarily associated with emaciation; short stature or poor growth may be the sole manifestations of nutritional inadequacy
Typical pattern in stunting: Weight starts to fall first, and length is maintained (body will always protect brain growth and linear growth first) - first aspect affected is weight. Can see that malnutrition is a problem if weight falls first. Then, as weight continues to fall, height will start to fall later on.

8

How much time does it take to correct a stunting?

3x as long as the stunting/malnutrition period

9

For young children, how often do you monitor weight? length? stature? HC? mid upper arm circumference?

Weight: 7 days
Length: 4 weeks
Stature: 8 weeks
HC: 7 days (infants, 4 weeks up to 2 years of age)
Mid-upper arm circumference: 4 weeks

10

What are normal growth velocity charts based on for normal children? For ICU children?

Normal: Based on age
ICU and IUGR: Based on age and weight-for-age percentile

11

What defines a baby from 0-2 years old to be underweight?

Weight for age < 3rd %ils
Severely underweight < 0.1 %ile

12

What defines a baby from 0-2 years old as stunted?

Length for age < 3rd %ile
Severely stunted < 0.1 %ile

13

What defines a baby from 0-2 years old as wasted?

Weight for length < 3rd %ile
Severely wasted < 0.1 %ile

14

What defines a baby from 0-2 years old as at risk of being overweight?

Weight for length > 85th %ile

15

What defines a baby from 0-2 years old as overweight?

Weight for length > 97th %ile

16

What defines a baby from 0-2 years old as obese?

Weight for length > 99.9th %ile

17

What defines a child from 2-19 years old as underweight?

Weight for age < 3rd %ile
Severely underweight < 0.1 %ile

18

What defines a child from 2-19 years old as stunted?

Height for age < 3rd %ile
Severely stunted < 0.1 %ile

19

What defines a child from 2-19 years old as wasted?

BMI for age < 3rd %ile
Severely wasted < 0.1 %ile

20

What defines a child from 2-19 years old as obese?

Age 2-5: BMI for age > 99.9th %ile
Age 5-19: BMI for age > 97th %ile

21

What defines a child from 2-19 years old as severely obese?

Age 2-5: N/A
Age 5-19: BMI for age > 99.9th %ile

22

What defines a child from 2-19 years old as overweight?

Age 2-5: BMI for age > 97th %ile
Age 5-19: BMI for age > 85th %ile

23

What do Hgb, Hct, TIBC, and ferritin assess?

Iron, B12 and folate status (anemia)

24

What do albumin, transferrin and prealbumin assess?

Indicator of visceral protein status (if no inflammation), poor nutrition status, slow growth, edema

25

What does CRP assess?

Inflammatory marker, increased with infection

26

What does WBC assess?

Immune system marker, increased with infection

27

What does sodium assess?

Indicator of hydration and kidney function

28

What do urea and creat assess?

Indicator of kidney function, hydration, protein catabolism and intake

29

What do serum Ca and PO4 assess?

Indicator of bone osteopenia, RS

30

What does serum Mg assess?

Indicator of RS, GI losses