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189 Cards in this Set
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infancy is:
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birth through 12 months
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ave birth wt in N. america?
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7-7.5#
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vlbw babies risk of dying in the first year of life is
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100 x greater than normal babies
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which race has higher incidence of lbw adn preterm infants?
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african american
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by what age does an infant double weight?
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4-6 months. when does it triple birth wt?
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1 year
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do infants grow continuously or in spurts?
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spurts
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body fat increases until what age in babies?
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9 months, than decreases
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when does brain growth peak?
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by birth
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brain is ___ adult size at age 1
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2/3
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neurodevelopment:
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term infant can fixate on objects and follow movement and by one year of age, becomes imitative and can play simple games
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cognitive
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little evidence of cognitive function in infant at birth. By end of one year, infant is playing with toys, exploring, and demonstrating anticipatory behavior
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at what age does the infant have repetitive vowel sounds?
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age 6.5 months
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psychological developments in infants:
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at 2 wks evidence they are more comfortable with familiar people
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infants recognize the voices of parents and siblings at what age?
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birth
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best ways to measure infant growth
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ht/wt/head circumference
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when should measurements be plotted?
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they should be repeated, plotted before infant leaves the room
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scales to measure baby:
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pan scale or electric
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kind of tape for measuring head circumference
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flexible, nonstretch
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are fat folds taken on babies?
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rarely except for over/underwt babies
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what biochemical levels do you screen for in infants?
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Fe
Lead at 6 months |
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how many bowel movements for good babies?
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initially: 4 per day until 4-6wks
after: 1 per day |
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Formula fed infants monitoring:
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monitor intake and wt gain
supplement foods: record amoutn offered and amount left at end |
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how many kcal per day for male infants:
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0-6months: 570
6-12months: 750 |
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Female kcal per day for infants:
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0-6month: 520
6-12 month:675 |
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when is metabolic rate highest in infants?
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at birth
b/c high muscle and growth |
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how much protein for babies
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1.5 g/kg
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do not limit fat for children under ___
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2 yrs old
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fat's purpose in infants?
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developing the brain
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how many g CHO for infants?
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60-100g/day
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Ca absorption is greatest for infants in
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breastmilk 66%
other milk: <50% |
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which babies need a vit D supplement?
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babies exclusively breastfeeding for first 6 months
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other babies who may need vit d supplement?>
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dark skinned babies
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what infants should receive flouride supplement?
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those 6 months - age 3-8yrs who don't have it in the water
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fe for babies?
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supplementation at 6 months after their iron stores are depleted
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water for babies?
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supplement not needed. offer water or other liquids when introducing solid foods.
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Na for babies?
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supplement not needed. Formula Na content is based on breastmilk content
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fiber for babies?
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no reccomendation
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colostrum compared to typical breastmilk?
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lower in fat
higher in protein transparent with yellow tinge after 3-6 days develops into transitional milk. By 14 days it is mature milk |
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color of mature breastmilk
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bluish and watery appearance
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protein in breastmilk:
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alpha lactoalbumin (contains all essential aa needed)
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which part of breastmilk is higher fat?
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hindmilk (2-3 x higher)
higher in long chain FA than formula nursing sessions of significant length to get hind milk Have baby only nurse one breast if it is small. |
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bifidus factor
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promotes friendly bacteriA
human milk and colostrum |
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breastmilk antibodies protect:
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-GI
-Respiratory -allergies |
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kcal of breastmilk?
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20kcal/oz
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CHO in breastmilk:
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a form of lactose
helps with Ca absorption |
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protein in formula
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usually from softened, smallened protein in cow milk
Can use soy protein |
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CHO in formula?
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lactose
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new formulas are adding
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long chain pUFA that are similar to breastmilk
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vit/minearls in formula?
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sufficient for normal growth until age 4-6 months. at which point additional nutrients are needed
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introduction of solid foods for infants should be based on:
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physiological maturation, nutrient needs and development of feeding skills.
These mean: |
physiological: kidney is more developed at 4-6months. Digestive system is improved and ability to digest fats is improved.
see other cards... |
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Feeding skills at 5 months:
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tongue extrusion reflex is gone.
Can move semi solid foods to back of mouth for swallowing |
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if infant can't sit up when eating foods...
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ear infections and choking
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7 months feeding skill:
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can swallow small lumps of food
will try finger feeding |
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8 months eating skills
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cup drinking improves
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10 months eating skills
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pincer grasp
chewing motions |
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how to introduce food to baby:
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one ingredient at a time
wait 3-5 days before trying something new don't put cereal in a bottle |
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foods to avoid for babies
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corn
hotdogs nuts honey til after age 1 peanut butter popcorn whole grapes raisins seeds potato chips |
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breastfed vegan babies should receive what supplements?
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b12
zinc iron vit d |
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delay cow's milk until age:
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1.
Why? |
Fe anemia by increasing gastrointestinal blood loss
stressfull on kidneys as well |
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foods to avoid until age 1
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peanuts
cows milk egg whites |
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infants who have bulked up by age___ are ___ as likely to be obese:
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4 months
twice as likely |
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___ of adult of obesity is directly related to childhood
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1/3
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when does infant tooth decay occur?
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before 2 yrs old
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to avoid tooth decay:
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no juice in bottle, only cup (approx. 6 mon)
don't let child walk around with bottle all day no bottle in bed don't do prolonged inappropriate bottle feeding |
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failure to thrive definition:
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infant can't maintain wt or ht above 3rd%tile
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organic =
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disease related
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inorganic baby problem
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related to care taker, NOT disease
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factors related to failure to thrive:
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dysfuntional relationship
POVERTY education separation from caregiver family death |
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Fe deficiency affects
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25% of WORLDwide babies. are rates increasing?
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no, declining
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Fe deficiency common in what age kids:
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6 month- 3 yr
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how to treat baby fe deficiency?
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liquid supplements
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Fe deficiency associated with:
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anorexia
inhibited growth/development irritability apathy behavior and learning deficits even after problem is fixed |
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toddler is
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ages 1-3
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preschool age is
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age 3-5
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school age is
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5-10 yrs
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preadolescence is
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girls: 9-11 yrs
boys: 10-12 |
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when do you stop measuring head circ?
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36months
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patterns of bone growth n children?
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steady growth at epipheasyl plates
continually remodeled in response to weight/exercise |
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healthy child checks are:
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anual checkups to evaluate ht/age wt/age bmi/age until school starts
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anthropometry growth pattern evolves after what age?
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2 years
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when do you start measuring wt with clothes?
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after 2 years old
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when do you start measuring stature without a recumbent board?
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after 2 years old
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whenever recumbent length is taken, it should be compared to:
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CDC 0-36month growth chart.
When ht is taken standing, always compare it to: |
2-18 CDC growth chart
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wasting:
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below 5% in wt/ht
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stunting is:
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below 5% in ht/age
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shortterm malnutrition is measured how?
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wt/age
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chronic undernut is measured how?
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ht/age
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what do you screen for biochemically in children?"
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hct/hgb and when you suspect a need, lead also.
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clinical signs of advanced undernutrition:
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dull hair
rough skin cracked mouth corners spoon shaped nails |
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energy needs for kids is similar?
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no, widely varied based on size
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best to base energy needs in kids on:
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kcal/cm ht
or kcal/kg wt |
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eer IN children:
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based on kids who are NOT overweight
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TEE in kids:
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based on weight maintenance for overweight kids
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CHO for kids?
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130 g
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if on a vegetarian/vegan diet, monitor what?
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vit b12, vit d, calcium, eaa and iron
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we can get b12 from what in vegetarian diets?
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soy and fortified cereal
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protein recommendations for kids ages 1-13 are:
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1-3 yr: 13 g
4-8 yr: 19 g 9-13 yr: 34 g |
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fat % of kcal for ages 2 +
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limit sat fat
fat: 25-35% of kcal |
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lower fat intake is associated with
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lower risk of heart disease and cancer
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fiber recs ages 1-9"
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1-3: 19 g fiber
4-8: 25 g fiber |
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most common deficiencies in kids:
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Vit A, B6 and C
Calcium iron folate |
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Calcium recs in kids age 1 - 18 yr?
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1-3 yr: 500 mg
4-8: 800 mg 9-18: 1300 mg |
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when is flouride supplementation recommended
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when water supply of it is not adequate.
Can help reduce dental caries up to 70%! |
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children esp at risk for iron deficiencie?
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age 1-3 b/c don't like meat and drink too much milk
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iron deficiency in kids is:
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defined as <5% of the distribution of hg or hct. (children 1-2 yrs, hg<11.0 g/dl; children 2-5, hg<11.1 g/dl)
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iron deficiency symptoms in kids? 4
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increased fatigue
decreased mental capacity increased lead toxicity risk decreased growth impaired resistance to infection |
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iron requirements in kids:
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1-3: 7 mg/day
4-8: 10 mg/day |
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things that help increase iron absorption:
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if you have low iron, you'll absorb it at a higher rate
eating heme (meat) iron gives your more absorption than non heme Ascorbic acid helps with non heme absorption as does meat |
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limit milk in children ages 1-5 to:
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24 oz or less per day
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children at risk for high lead poisoning:
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nonwhite, poverty, urban children
( lead pipes, paint and dust in the air) |
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diets deficient in four nutrients ____ increase risk of lead poisoning:
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phosphorus, iron, calcium and Vit C
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this deficiency and toxicity occur in the same children often:
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lead toxiticy, iron deficiency
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blood levels of lead represent:
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average levels in past 3-4 months
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most of lead is deposited where?
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in the bones
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supplements are only usually recommended for:
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flouride and vit d (bf infants)
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dental caries involve 3 things:
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tooth, bacteria in plaque, substrate (fermentable carbs)
enamel breaks down--> tooth decay |
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___ children at risk for hunger
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10 million
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___ children experience prolonged hunger
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4 million
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% of commericals promote food?
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60%
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who should eat smaller portions, but eat more frequently?
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preschool kids
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portion size for preschool kids?
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1 tbsp per year
(3 yr old = 3 tbsp food) |
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snacks for preschool kids at fixed or sporadic times?
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fixed
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neophobia:
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reluctance to try new foods
(takes 10 times) |
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responsive parenting:
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parents set limits and have a moderate amount of control over child's eating patterns
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can a child vegetarian/vegan be ok?
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yes, it can be.
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are all labels required to warn of choking?
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yes
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elevated blood sugar effect on learning?
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hleps with memory and cognitio
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when you don't eat breakfast, do you make up those nutrients later?
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not usually
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benefits of breakfast
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improved math and psychosocial, decreased tardiness/absent, decreased hyperactivity
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most prevalent pediatric nutritional problem:
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obesity
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weight loss for children age (2-7) with complications (and BMI greater than 95%)?
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lose 1 # per month at most
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children age 2-7 w/ no complications who are at risk for or overweight. What intervention?
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Weight maintenance. Try to get them to eat healthy and increase activity... will grow into healthier bmi with ht
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7+ yr old children who are at risk for overweight? what intervention?
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weight maintenance
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7+ yr old child who is at risk for over weight with complications. what intervention?
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weight loss. 1-2# per month
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overweight 7+ yr old with complications. intervention?
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weight loss 1-2# per month
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extremem overweight child 7+ yr old intervention?
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weight loss, 1-2# per week
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recommended changes to definition of childhood bmi's:
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85-95 = overweight
95+ = obese |
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what age is normal for decreased bmi?
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pre school. when is the lowest point?
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age 4- 6
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adiposity rebound?
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when you begin to increase in bmi after hitting your lowest bmi ages 4-6.
*rebounding earlier could mean obesity in later life |
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does modifying heart disease risk factors early in life have a big impact later?
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yes
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what blood work should be done for children at high risk for heart disease?
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HDL/LDL, total cholesterol, trig, glc
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early and frequent assessment is important in:
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special needs
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what kind of supplement may be esp needed in special needs?
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b vits
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developmental disabilities def:
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Group of physical, cognitive, psychologic, sensory and speech impairments that being anytime during development up to l8 years of age
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__% of pop have developmental disabilties
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5%
___% of kids under 18 have developmental disabilities: |
17%
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inherited disabilties
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pku, ms
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alterations during embryonic development disabilties:
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downs
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harmful interuterine exposure disabilties:
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FAS, drugs
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post natal event disabilties:
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shaken baby, accidents, lead
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disability definition:
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a severe chronic disability of a person 5 years of age or older, which is attributable to a mental physical impairment or combination of mental and physical impairments. Is manifested before the person attains age 22, is likely to continue indefinitely
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title 5 of social security
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authorizes Maternal and Child Health (MCH) Service Programs; stress prevention, early identification, intervention, treatment of disabilities
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child nut. program provisions for special needs?
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can't make them pay extra for any dietary restrictions or special feeding equipment that they are required to provide
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disability def:
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those children with congenital or acquired conditions that affect physical and/or cognitive growth and development and who require more than the usual pediatric health care
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__% of special needs kids are at risk for nut problems
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40%
*for some improved nut is critical for survival |
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improved nut in special needs can result in:
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Increase the level of independence
Improve the child’s perception of self Improve the care provider’s perception of their ability to meet the child’s needs Mutual reinforcement and support can be achieved across disciplines |
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how much longer might feedings take in special needs?
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2-12 when eating pureed
15 x when eating solid |
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constipation may result from
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cerebral palsy muscle tone
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pica in
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autism
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prader willi is caused by
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DNA mutation of 15 chromosome
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prader willi symptoms:
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poor muscle tone
small sex gonads small stature mental retardation obesity small hands/feet FTT if can't suck as infant can't control their appetite |
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Myelomeningocele
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A form of spina bifida: one of the most severe forms of birth defects of the brain and spinal cord
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characteristics of myelomenigocele:
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wheelchair
short overweight BMR down to 50% of usual b/c of paralysis scoliosis pressure ulcers |
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challenges of myelomenigocele:
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need alternative ways to measure growht
monitor for pressure ulcers constipation, obesity and uti's as well |
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downs syndrome characteristics
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Chromosomal disorder resulting in some degree of mental retardation
Reduced muscle tone, weak suck may result in inadequate food intake Heart disorders (50% of children) may result in higher kcal needs Excess wt/ht is usually present by age 3 Increased risk for obesity lower height |
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what to do for downs syndrome:
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supplement if on low cal diet
extra fluids for loses monitor constipation/gum disease 15% reduction in metabolism |
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what to do for cleft plate:
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teach to drink early on b/c can't suck
allow extra energy and protein after sugery |
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celiac disease characteristics
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diarrhea/digestive problems by age2
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Diarrhea in the absence of intestinal damage and wt loss is likely due to overconsumption of fruit juices and Celiac
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overconsumption of fruit juices and Celiac
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pulmonary problems: what do do nutritionally:
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increase nutritional needs
extra kcal needed for the extra energy expended in breathing small, frequent meals, concentrated in kcal easy to eat foods lower interest in eating can slow growth rate |
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seizrues nutritonal problems:
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can't feed when semi conscious
normal grwoth rate when on meds meds can change hunger/sleep ketogenic diet take supplement |
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inborn error of protein metabolism:
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PKU
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treating pku?
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80% of protein comes from phe free protein beverage
most nutrients in liquid form *Failure to keep diet = mental damage |
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pediatric HIV treating:
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keep food very safe
FTT common |
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3 things to consider that determine nutritional needs in special needs:
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1. altered physical size
2. altered activity patterns 3. altered feeding characteristics |
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what do you express energy needs in relation to?
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ht/length
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what percent of kcal in special needs should come from carbs?
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50%
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%kcal from protein in sn??
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15-20%
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%kcal from fat in sn?
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30-35%
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anticonvulsants increase risk for what deficiencies?
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calcium
vit d folate |
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difference in assessments for sn?
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more professionals involved
longer histories (should review from birth if possible) |
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things to evaluate in sn?
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sga, examine mouth, dysphagia?, reflux?, aspiration? elimination patterns?
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what to compare stature to in sn?
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cdc disease specific growth charts
*arm length is a reasonable sub *also sitting ht is ok |
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measure length until age
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2
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typically measure these in blood count in sn:
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hct, hgb, CBC, urinalysis
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additional nutrients to test for in kids on anticonvulsants:
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vit c, calcium, vit d, folate
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also test ___ in prader willi biochemical tests:
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oral gtt
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also test for __ inbiochemical in downs:
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thyroid tests
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wt management is indicated for any special needs Child who is above ___%ile
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75th
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constipation in sn due to:
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vomiting
low fluid low fiber decreased pa decreased muscle tone meds |
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