Growth and Nutrition in Infants and Children

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Questions and Answers

What is one of the benefits of beginning enteral nutrition (EN) early?

Increases complications

Reduces disease severity (correct)

Decreases patient outcomes

Increases ICU length of stay

Which screening tool is used to assess malnutrition risk based on a scoring system that includes illness severity?

Nutritional Risk Score (NRS-2002) (correct)

Malnutrition Screening Tool (MST)

Short Nutritional Assessment Questionnaire (SNAQ)

Mini Nutritional Assessment (MNA)

What classification of malnutrition risk corresponds to a score between 6 and 10 when using the NUTRIC tool?

Moderate risk

High risk (correct)

No risk

Low risk

Which parameter is NOT typically included in a comprehensive nutritional assessment?

Environmental factors Signup and view all the answers

In the Malnutrition Universal Screening Tool (MUST), a total score of 0-5 indicates what level of risk?

Low risk Signup and view all the answers

What is the ideal goal for nitrogen retention to effectively retain protein?

+3 to +5 grams Signup and view all the answers

What is the significance of C-Reactive Protein (CRP) levels in assessing protein status?

An increase in CRP suggests inflammation, affecting prealbumin measurements. Signup and view all the answers

Which protein is represented by the normal range of 3.5 – 5 gm/dL?

Albumin Signup and view all the answers

What does a nitrogen balance study primarily assess?

The adequacy of protein repletion. Signup and view all the answers

What common non-urinary sources can contribute to nitrogen loss?

Sweat and respiration. Signup and view all the answers

How is nitrogen balance calculated?

Nitrogen Balance = (N in) – (N out). Signup and view all the answers

Which of the following statements about prealbumin is true?

Prealbumin levels decrease as CRP levels rise. Signup and view all the answers

How much does an infant's length typically increase by the age of 12 months?

50% Signup and view all the answers

What begins to happen to adipose tissue distribution after age two?

Increased fat storage Signup and view all the answers

What is the normal range for transferrin in mg/dL?

250 – 300 mg/dL Signup and view all the answers

What is the primary issue associated with malnutrition in children?

Imbalance of essential nutrients Signup and view all the answers

During middle childhood, which statement is true regarding growth patterns?

Growth is steady and constant. Signup and view all the answers

What is a potential risk for chronically undernourished children during refeeding?

Refeeding Syndrome Signup and view all the answers

What happens to the rate of weight gain during adolescence?

It increases rapidly. Signup and view all the answers

What does a Z-score in growth assessment indicate?

Distance from the population mean in standard deviations. Signup and view all the answers

In which period do males generally grow taller than females?

Adolescence Signup and view all the answers

What factors may lead to an increased caloric requirement in children?

Growth spurts and underlying medical conditions Signup and view all the answers

What is indicated by a Z-score of -4.2 for weight in an assessment?

Severely underweight Signup and view all the answers

What is a benefit of intact protein for burn patients?

Reduces mortality rates Signup and view all the answers

When using partially digested protein, what is the recommended dosage?

0.3 – 0.5 g/kg/day Signup and view all the answers

What is a potential effect of medium-chain fatty acids?

Are more water-soluble than long-chain fatty acids Signup and view all the answers

What is a possible side effect of using simple glucose in oral supplements?

Higher osmolality Signup and view all the answers

Which statement is true regarding probiotics?

They may inhibit pathogenic bacterial growth Signup and view all the answers

Which vitamin is commonly associated with antioxidant effects?

Vitamin C Signup and view all the answers

What should be avoided when supplementing with glutamine?

Using immune-modulating formulas Signup and view all the answers

What is the primary use of modular supplements in clinical settings?

To provide specific nutrient needs or deficiencies Signup and view all the answers

Why should viscous formulations be avoided in patients with acute renal failure?

They can cause tube clogging. Signup and view all the answers

What is the maximum protein requirement for a patient undergoing continuous renal replacement therapy (CRRT)?

2.5 g/kg/day Signup and view all the answers

What should be done when using oral dosage forms for patients with renal failure?

Crush tablets to a fine powder and mix with water. Signup and view all the answers

Which types of medications should never be crushed for patients with renal failure?

Delayed or extended-release tablets Signup and view all the answers

What is a significant factor affecting nutritional assessment in patients with hepatic failure?

Presence of ascites Signup and view all the answers

What is recommended for patients with hepatic encephalopathy who do not respond to other treatments?

Branched-chain amino acids (BCAA) Signup and view all the answers

For patients with pulmonary failure, what dietary formulation is suggested?

Calorically dense formulations Signup and view all the answers

Which micronutrients are at risk of being lost in patients with acute renal failure?

Selenium and Zinc Signup and view all the answers

Study Notes

Infant Growth

Infants increase in length by 50% within the first year of life.

Childhood & Adolescent Growth

Growth is slow but constant during the preschool years (Ages 2-6).
Adipose tissue distribution begins around the age of 2.
Steady growth occurs during middle childhood (Ages 7-10).
Females are generally taller and heavier than males in height and weight during middle childhood.
Adolescence (Ages 11-18) involves rapid growth in height and weight.
Males are generally taller and heavier than females in height and weight during adolescence.

Nutritional Assessment

Risk Factors: Used to identify potential malnutrition.
History: Medical and dietary history are crucial.
Anthropometrics: Measurements like height, weight, and head circumference are used to assess growth.
Classification of Malnutrition: Determines the severity of malnutrition.
Nitrogen Balance: Assesses protein intake and utilization through a 24-hour urine collection.

Visceral Protein Status

Albumin: Normal range is 3.5-5 g/dL.
Transferrin: Normal range is 250-300 mg/dL.
Transthyretin (Pre-albumin): Normal range is 15-40 mg/dL.
Retinol-binding protein: Normal range is 2.5-7.5 mg/dL.
C-Reactive Protein (CRP): A positive acute phase reactant (increased by at least 25% during inflammation).
- Normal range is <1 mg/dL.
- Used to assess the accuracy of pre-albumin measurement.
- Pre-albumin levels can be falsely low due to inflammation.

Protein Requirements

Intact protein: Requires complete digestion into smaller peptides.
Partially digested (peptide-based): Easier for the body to utilize, beneficial for patients with mal-absorption and diarrhea.
Modular supplements: Provide customized nutritional support.

Glutamine

A conditionally essential amino acid that plays a critical role in gut health and immune function.

Probiotics

Live microorganisms that confer health benefits to the host.
May inhibit pathogenic bacterial growth, block pathogen attachment, eliminate toxins, and enhance the host inflammatory response.

Vitamin & Trace Elements

Used for antioxidant effects and repletion.
Vitamin E & C are important for immune function.

Acute Renal Failure

Adjust enteral formula based on electrolyte profile.
Avoid viscous formulations like syrups, mineral oil, and granules due to the risk of tube clogging.
Crush tablets or open capsules and dilute in 15-30mL of sterile water.

Hepatic Failure

Traditional nutritional assessment tools may be inaccurate.
Branched-chain amino acids (BCAAs) may be beneficial for patients with encephalopathy refractory to other treatments.

Pulmonary Failure

Fluid-restriction and calorically dense formulations are often employed (1.5-2.0 kcal/mL).

References

ISMP: Institute for Safe Medication Practices

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Description

This quiz explores the stages of growth from infancy through adolescence, highlighting key growth patterns and nutritional assessments critical for child development. It covers both the physical changes and the importance of nutritional factors that influence growth throughout different childhood stages.