Unit 2 (Lectures 11-14)

Question 1

What do centiles show?

Answer 1

number of children EXPECTED to be below that line
e.g. 50% below the 50th centile line and half above OR 91st centile: only 9% of children would be expected to be heavier/taller
- half fall between 75th and 25th centile - -1 and + 1 Z scores (=25th to 75th centile)

Question 2

Baby weight loss

Answer 2

• normal after birth (3-5 days)
• 80% will regain by 2 weeks of age (indicates feeding is effective and going well)
• > 10% weight loss may indicate feeding problem or illness
• regardless of % weight loss (consider overall picture to understnand baby health

Question 3

Hydrocephalus

Answer 3

fluid on the brain and rapid head growth in babies is a symptom

Question 4

BMI

Answer 4

Reflects how heavy a child is, relative to their height
- higher bmi = higher bmi in adulthood
- rapid growth and tracking 98th centile (>2) are at risk of LT health problems & more likely to be obese in childhood, adolescence and adulthood.

Question 5

How does Iron deficiency affect overall health?

Answer 5

• Delays/impairs growth
• Fatigue
• increased susceptibility to infection

Question 6

How does calcium deficiency affect overall health?

Answer 6

• Delays/impairs growth
• reduced blood clotting
• heart and nerve function
• reduced bone health

Question 7

How to measure growth of infants and children

Answer 7

Weight:
Clinical electronic scales
*if under 2 - mum can hold baby

Length:
Length board
Rounded to nearest 0.1cm (3 measurements)
under 2: lying
older than 2 : stand (standiometer)

Head circumference only taken up to 1 year of age

Question 8

When do we measure weight and length?

Answer 8

-Important in 1st week of life - gives estimate of good breastfeeding
-Concerns around weight gain or growth
-At routine checks

1,2,4,6,9,12,18,24 months

*Should measure more than 2 weeks apart after 6 months
(measure too often can be misleading)

Question 9

Growth reference

Answer 9

How certain children grew in a particular place and time
E.g. study

Question 10

Growth standard

Answer 10

How healthy children SHOULD grow under optimal environmental and health conditions

i.e. a single international standard representing the best physiological growth for children from birth to 5y and to establish the breastfed infant as the normative model for growth and development

Question 11

WHO childs growth standards:

Answer 11

Represent the best description of physiological growth and should be applied to all children everywhere, regardless of ethnicity, socio-economic status and type of feeding

Attained for:
- Weight for age
- Length/height for age
- Weight for length/height
- Body mass index for age

Question 12

When should additional measurements be taken?

Answer 12

If weight is below the 0.4th centile or above the 99.6th centile.
very rapid weight gain or loss (>10%)

Question 13

Discuss the general guidelines for growth over this newborn period.

Answer 13

• Most babies lose weight after birth (in the first 3-5 days)
• but 80% will regain by 2 weeks of age
• Infants recover birth weight usually by 10 to 14 days which indicates feeding is effective and going well

Question 14

“Growing normally”

Answer 14

Growth ‘tracks’ parallell to one of the centile lines (with little deviation)

Question 15

Further investigation required to identify the cause if…

Answer 15

Growth ‘tracks’ up or down signifficantly
Consistent changes in centile position
Height: 1 or more centile space
Weight: 2 or more centile spaces
Between Height & Weight: 2 or more centile spaces
Growing on 5th centile for weight
Growing on 95th centile for height

Question 16

How often should older children and adolecents be measured to track growth patterns?

Answer 16

once a year

Question 16

How often should infants&todlers be measured to track growth patterns?

Answer 16

1st week of like (0years old)
Month: 1,2,4,6,9,12 (1 year old), 18, 24 (2 years old)

Question 17

Why do the length/height percentiles change at 2 years of age and what is the important message to caregivers about this change?

Answer 17

<2 years are measured lying down (supine) on a length board
> 2 years are measured standing with stadiometer -> spine is compressed -> height is slightly less than their lying down length – the centile lines shift down slightly at age 2 to allow for this different type of measurement.

*What is the most important is to check, whether the child continues to FOLLOW THE SAME centile after this transition

Question 18

Concerns around delays in motor skill development.
Discuss milestone achievements

Answer 18

There are time widows of development that certian skills must be learned in order for subsequent learning to occur
however,
Wide and variable window of achievement for each milestone in young children.

If still concerned, refer to WHO guidelines of milestone achievement

Question 19

Pull-self to standing window

Answer 19

by 12 months
i.e. if stood at 11 months = normal

Question 20

Walking alone window

Answer 20

by 18 months
i.e. if walked at 16 months = normal

Question 21

Sit on chair - grasp object window

Answer 21

6 months

Question 22

Stand alone

Answer 22

14 months
(15 for walking)

Question 23

What is an allergy?

Answer 23

A reaction to harmless to environmental substances
E.g. dust mites, pets, pollen, insects, mould, medication, food

Question 24

What is the prevalence of allergies?

Answer 24

1 in 5 will develop in their life time Eczema: 1 in 10 Food: 5-10% children, 2-4% adults

Question 25

Atopic disease

Answer 25

Genetic tendency to develop allergic disease. lgE antibodies are produced after exposure to environmental allergens Present with one or more of: asthma, allergic rhinitis (hayfeever, congunctivitis; nose/eyes) eczema or hives (urticaria/sskin) *If have one, more likely to develop another

Question 26

What is a food intolerance? vs food allergy

Answer 26

Intolerance: usually in older children and adults - delayed reaction after ingestion of large amount of the food - can be related to reduction in digestive enzymes i.e. lactase e.g. lactose, FODMAP foods, fructose caused by abdominal pain, bloating, gas, diarrhoea/constipation Food allergy: an immune mediated hypersensitivity reaction to a food. 40% increased risk of developing food allergy if have eczema (atopic disease)

Question 27

resources for families

Answer 27

- YUM cook book (DF, GF) - Ascia - Paediatrics society - Formula companies for videos and recipe books

Question 28

Adverse food reactions

Answer 28

can be food, chemicals in food Immune mediated or non-immune mediated

Question 29

Non-immune mediated adverse food reaction

Answer 29

Reactions to non-protien substances e.g. cho, chemicals, food additives, toxins, irritants Reactions are usually delayed (up to 20 hours after food is eaten) Symptoms: diarrhoa, nausea, cramping, headache Diagnosis: typically eliminaition and reintroduction DOES NOT INVOLVE THE IMMUNE SYSTEM DOES NOT PRODUCE IgE ANTIBODIES

Question 30

IgE mediated food allergy

Answer 30

Quick response (within 1h) - hives, swelling, breathing difficulty, vomiting, floppy/pale - associated with anaphalaxis Diagnosis: with clinical symptoms i.e. how quickly did it start and what were the sympyoms? and +ve SPT or seum IgE antibodies test (blood test) e.g. egg

Question 31

Most common food allergies (big 9)

Answer 31

responsible for 90% of food allergies milk, eggs, peanuts, tree nuts, milk, wheat, soy, fish, shellfish, sesame are Cows milk, egg, wheat, soy are grown out of by 5 years old Peanut and tree nuts, fish and shelfish usually persist (75-90%)

Question 32

Two ways to test IgE mediated food allergies

Answer 32

1. Skin prick test (SPT): IgE antibody specific response (weal diameter (< 3mm)) 2. Serum specific IgE blood test (measures IgE when mixed with allergens in laboratory)

Question 33

Non-IgE mediated food allergy

Answer 33

commonly due to cows milk or soy occur within first year of life then resolve in early childhood delayed onset (2-48h) gi system response e.g. reflux, diarrhoea, blood/muscus in stools, excessive crying and abdominal pain difficult to test becuase haven't build antiboties to the food diagnosis done on clinical symptoms

Question 34

Prevention of food allergy

Answer 34

From 6 months to 12 months all allergen foods should be introduced into the infants diet (one at a time , 1-2 days apart to detect problem foods) and offered regularly (once tolerated) Eating a healthy and balanced diet before pregnancy, while pregnant and breastfeeding. Keeping skin well moisturised

Question 35

What did the LEAP 2015 study show? (peanuts)

Answer 35

Earlier introduced peanut - lower the risk of peanut allergy continued exposure keeps tollerance to peanuts

Question 36

What did the PETIT 2017 and STAR 13 study show? (egg)

Answer 36

early introduction of egg from 4-5m to 12 months decrease egg allergies

Question 37

What did the health nuts study 2017 show? (cows milk)

Answer 37

Introduction to cows milk in first 3 months reduced risk of cows milk allergy and sensitivity

Question 38

What did the ABC study in 2020 show? (cows milk)

Answer 38

Introduction to cows milk within first 3 days of life (due to LBS) followed by exclusive breastfeeding = increased risk of cows milk protein allergy.

Question 39

Does being born on a farm increase or decrease risk of food allergy

Answer 39

decrease (less exposure to pullition)

Question 40

Extensively hydrolysed and amino acid formulas

Answer 40

Made with cows milk then extensively hydrolysed to brreakdown proteins into small peptides (via heat) *not suitable for infants with severe cow's milk PROTIEN allergy or anaphylaxis to cows milk AA: further broken down of peptides into singular amino acids *smaller molecules which are less reactive.

Question 41

Infant milks for IgE and Non-IgE mediated cows milk protein allergy

Answer 41

*if react to cows milk - will also react to other mammals milk (e.g. goat/sheep) lactose free is also not suitable as baby is reacting to PROTIEN in the milk (not the lactose) - lactose intollerance is RARE if react to cows milk - also react to soy - not given soy formula (esp under 6m old) extensivley hydrolised *not suitable for infants with severe cow's milk PROTIEN allergy or anaphylaxis to cows milk rice milk formula: good if have corn allergy as corn is in aa and extensively hydrolised formula Amino acid formula: needed when anaphilactic,

Question 42

Advice

Answer 42

- Continue breastfeeding - Inform on milk free diet, food substitutes - How to read food labels for allergens - Encourage and explain introduction of other allergens (introduce early to reduce the risk if allergy) - Add formula to foods to get used to flavor when mum returns to work - Vitamin D supplementation (oral drops) (may benefit if EB and live south of nelson and in winter) - Eczema management e.g. creaming, hydrocortisone Closely monitor growth

Question 43

How to read food labels for allergens

Answer 43

Contains = avoid May contain: may be okay, depends on severity of allergy

Question 44

Advice in todler years

Answer 44

- Continue to breastfeed until around 2 years - Continue on formula when mum working, but add calcium with FORTIFIED soy/oat milk - Advice on managing daycare and anaphylaxis plan from specialsit - Advice on family meals - meals to be dairy, egg, peanut, GF due to other family members Monitor growth

Question 45

Alternative milks and yoghurts

Answer 45

Milk: *Check calcium 120mg/100ml - Soy (good protien, fat, energy) - Oat (good energy, some protien) - Rice (good energy, 300ml/day max) - Almond/coconut/cashew (low wenegy, protien, fat = last resort) Yoghurt: soy, coconut, cashew

Question 46

Alternative Cheese and egg

Answer 46

DF cheese: none have calcium - useful for social activities e.g. pizza night Eggs: chia or linseeds & water mashed banana or apple sauce

Question 47

When should complementary feeding begin?

Answer 47

Introduce soil foods around 6 months - not before 4 months and preferably while still breastfeeding And in age-appropriate form e.g. smooth peanut butter and cooked egg BEOFRE 12 months old (incl high risk infants)

Question 48

Eczema skin treament

Answer 48

Apply moisturiser at least twice a day Avoid products containing food protiens and products (Smearing food on skin with eczema may increase risk of developing allergy to that food) 3 serves of Omega-3 fatty acids (oily fish) per week possible reduce eczema in early life during pregnancy and breastfeeding

Question 49

Reintroduction to egg: The egg ladder

Answer 49

Step 1: well cooked e.g. biscuts or egg pasta Step 2: lightly cooked e.g. pancakes or scrambled egg Step 3: raw e.g. mayonaise or raw cake mix

Question 50

Genetic explinations for food allergies

Answer 50

If parent has an atopic disease, 40% of offspring will be affected (high risk infant if both parents)

Question 51

Environmental explanations for food allergies

Answer 51

- Hygiene hypothesis: less exposure to infections in early life, increases chance of allergies developing due to suppressed natural development of immune system (critical window utero-5y) - Food skin exposure: food-based skin products - Food processing methods: roast vs boiled peanuts - Delayed intro to allergenic foods: beyond 12 months old, egg, peanut, tree nuts

Question 52

Dual-allergen exposure hypotheses

Answer 52

becoming allergic by skin exposure (in the absence of protective oral exposure as oral is more protective to form a tolerance Skin exposure = failure to establish tolerance

Question 53

If breast feeding is not possible what is the recommended formula?

Answer 53

cows milk

Question 54

Baby lead weaning

Answer 54

Alternative approach to introducing complementary foods. - Finger foods (not puree) as first foods - Babies feed themselves (not -spoon fed) - not reccomended by MOH

Question 55

How to safely practice baby-led weaning

Answer 55

- Ensure baby can sit up unassisted, pick up food and bring to their mouth - Offer soft foods which are able to be squashed to the roof of mouth with tongue For reducing of BLW concerns, offer iron-rich foods daily, follow advice on reducing choking risk

Question 56

What did the BLISS study show for baby-lead weaning?

Answer 56

Positive: Lower food fussiness and greater enjoyment of food no difference in choking or iron status

Question 57

Discretionary foods

Answer 57

High in energy, saturated fat, salt, sugar little nutirional value contributes to 13% of todlers total energy intake and 9/10 consumed dicretionary foods

Question 58

MOH servings for todlers

Answer 58

Vege: 2-3 Fruit: 1/2 Grains: 4 Legumes, nuts(unsaturated oils/spreads) , fish, egg, meat: 1 milk products: 1-1.5

Question 59

Should toddlers drink whole blue cows milk or 'toddler milk' (cows milk based formula, fortified with iron, iodine, Vit D and C)

Answer 59

whole blue cows milk - important as provides energy, protien, calcium, riboflavin, and vit B12 (Not reccomended to use reduced fat milk as have high energy requirements) *no more than 350ml / day as it is low in iron and displaces nutrient-rich foods in the diet 'Toddler formula': Not recommended by MOH because it adds to their preference towards milk over nutrient rich foods. Optimal nutrition from a variety of healthy foods is important to set up healthy eating behaviors. *22% of total energy intake is from toddler milk Problematic as consumption of veg becomes lower Fruit juice allowance: 120ml / day However, Clinical setting: e.g. iron concerns it is short term beneficial to boost iron status

Question 60

Issues around toddlers and 1/3 consuming above upper limit (1000mg/d)

Answer 60

May influence preferences for salty foods into adulthood. High sodium intake is a risk factor for cardiovascular disease

Question 61

What does the 'Atopic March' reffer to?

Answer 61

Excema Progression of atopic diseases (i.e. excema) to other atopic diseases.