Pediatrics Week 4: GI Dysfunction, Endocrine Dysfunction, and Nutrition
Book14, 25, 30; ATI Chapters 22, 23, 33, 34
Portion Control Key for All Ages **Class notes: Amount of serving in kids increases by age. Nutrition by age group
Infant: ìFluids 160ml/kg/day
ìAt one month requires 100-115 kcal/kg/day
ìFats to absorb Vitamins A,D,E,K
ìDHA and ARA help to develop spinal cord, visual acuity, cognitive and behavioral functions
ì400 IU/day of vitamin D is recommended for breastfeeding babies.
ìBreast milk formula birth to 4-6 months
ì4-6 months incorporate rice cereal 2-3 T daily fortified rice cereal ì6-8 months add fruits and vegetables 2-3 T three times daily avoid carrots, beets, squash, beans, and spinach before 6mn. ì8-10 months soft finger foods three times daily
ì10-12 months most soft table foods three times daily
Toddler: ìPhysiologic anorexia
ìQuality over quantity ì16-24 oz milk
ìNo more risk for iron deficiency anemia ìLimited juice consumption- dental caries ìSliced meats, cheese, tofu, fruits, vegetables, yogurt, PB with bread- healthy snacks. Preschool: ìSimilar to toddler; eating as social event
ìInvolve in prep
ìFood jags-only eats few food items.
ìThree meals, two to three snacks as routine norm
ìJuice 8-12 oz daily
ì5-a-day program with fruits/vegetable servings -routine diet. ìDecreased snacks “structure food plan”, leaner and taller. ìFast food 1x week, brush teeth. ìProtein: chicken, beans, peanut butter on spread. School-Age: ìGrowth spurt 10-12 years -prefers food eaten at home. ìIncreased nutritional needs ìTeach to choose nutritious foods : pictures, sample food, handouts, etc. Adolescent: oNeed >2000 calories daily, some may require 3000 calories daily -puberty/ growing. oNeed to instill healthy diet habits
oIncorporate calcium, Vitamins A and C, fiber Lacking in fast food and unhealthy food choices that are high in fats and sodium
Increased calories r/t sports
** Class notes Fat is important for infants for spinal cord, vision, vitamin adek, and cognitive development. Start with breastmilk or formula. Introduce food one at time for 3-5 days for allergies. 8-9 months can have soft finger foods. 10-12 months sit with family at table. School age: lots of nutrition teach about healthy diet and healthy foods because adolescents won’t listen. Adolescent: same calories as adult. Fast food lacks incorporate components in vitamins and fiber they will have deficiency. High concentration of sodium and fat from fast food watch bp. Nutritional Assessment
Physical/Behavioral Measurement: ìUse of growth charts
ìBMI (accuracy based on steady growth, culture, and other variations)
Do not fixate on this because it’s not fully accurate Negative sign of obesity in adolescent Low carb-decreased energy Low iron: lethargy, slow g/d, pallor. Dietary Intake: ìSee tables 14-4 to 14-6
ì24 hours recall of intake assesses adequacy of diet
ìDietary questionnaires and Food diaries (1-7 days) help to track intake and visual necessary modifications
Seeing what their overall habits are in a journal
Sudden GI upset- rule out lactose intolerance and gluten intolerance (celiac) A: night vision, dry skin
C: skin problem, bleeding, joint tender
D: rib deformity B: weak, decreased DTR
P: edema TABLE 14–4 Dietary Screening History for Infants Overview Questions What was the infant’s birth weight?
At what age did the birth weight double and triple? Was the infant premature? Does the infant have any feeding problems such as difficulty sucking and swallowing, spitting up, fatigue, or fussiness? If Infant Is Breastfed How long does the baby nurse at each breast? What is the usual schedule for breastfeeding? Does the baby also take any milk or formula? Amount and fre- quency? What type? If Infant Is Formula-Fed What formula is used? Is it iron fortified? How is it prepared?
Do you hold or prop the bottle for feedings? How much formula is taken at each feeding? How many bottles are taken each day? Does the baby take a bottle to bed for naps or nighttime? What is in the bottle? If Infant Is Fed Other Foods At what age did the baby start eating other foods? Cereal Fruit/juices Vegetables Finger foods
Meats
Other protein sources Do you use commercial baby food or make your own? Does the baby eat any table foods?
How often does the baby take solid foods?
How is the baby’s appetite? Do you have any concerns about the baby’s feeding habits? Does the baby take a vitamin supplement? Fluoride?
Have there been any allergic reactions to foods? Which ones? Does the baby spit up frequently? Have there been any rashes?
What types of stools does the baby have? Frequency? Consistency? TABLE 14–5 Dietary Screening History for Children What types of food or beverage does the child especially like? What foods or beverages does the child dislike
What is the child’s typical eating schedule? Meals and snacks? Does the child eat with the family or at separate times? Where does the child eat each meal? Who prepares the food for the family? What methods of cooking are used? Baking? Frying? Broiling? Grilling? What ethnic foods are commonly eaten?
Does the family eat in a restaurant frequently? What type? What type of food does the child usually order? Is the child on a special diet? Does the child need to be fed, feed himself or herself, need assistance eating, or need any adaptive devices for eating? What is the child’s appetite like?
Does the child take any vitamin supplements (iron, fluoride)? Does the child have any allergies? What types of symptoms? What types of regular exercise does the child get?
Are there any concerns about the child’s eating habits? TABLE 14–6 Food Insecurity Screening 1.Does your household ever run out of money to buy food to make a meal? 2.Do you or members of your household ever eat less than you feel you should because there is not enough money for food? 3.Do you or members of your household ever cut the size of meals or skip meals because there is not enough money for food? 4.Do your children ever eat less than you feel they should because there is not enough money for food? 5.Do you ever cut the size of your children’s meals or do they skip meals because there is not enough money for
food? 6.Do your children ever say they are hungry because there is not enough food in the house? 7.Do you ever rely on a limited number of foods to feed your children because you are running out of money to buy foods for a meal? 8.Do any of your children ever go to bed hungry because there is not enough money to buy food? *** Class notes: Two different growth chart based on gender. Assess nutrition by asking 24-hour recall or 5-7 days. Common Concerns
Hunger: ìFood insecurity an issue
ì20% of US children experience this
ìLow socioeconomic families
ìUnable to consume adequate amount Obesity: ìType 2 diabetes
ìCVD, HTN, dyslipidemia ì17% of children at or above 95th percentile ìWhat can we do? Prevent new cases and support child ìRisk: Fast food, no exercise, sedentary lifestyle. Food Safety: ìFood borne illness
ìNorovirus, salmonella, staph aureus
ìCHIPOTLE!
Food Safety Guidelines: Teach clients to follow these four key food safety practices:
ìClean: Wash hands and surfaces often.
