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Questions and Answers
What is one of the primary goals of pediatric nutrition?
What is one of the primary goals of pediatric nutrition?
Which of the following is NOT a goal of routine nutrition care for pediatrics?
Which of the following is NOT a goal of routine nutrition care for pediatrics?
Which step is first in the assessment of pediatric nutritional status?
Which step is first in the assessment of pediatric nutritional status?
What is a significant aspect of identifying patients for nutrition intervention?
What is a significant aspect of identifying patients for nutrition intervention?
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What method may be employed for those children who are critically ill in terms of nutrition support?
What method may be employed for those children who are critically ill in terms of nutrition support?
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What is the expected weight gain for infants aged 3 to 6 months?
What is the expected weight gain for infants aged 3 to 6 months?
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By what age should infants roughly double their birth weight?
By what age should infants roughly double their birth weight?
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What is the average length increase for infants during the first year of life?
What is the average length increase for infants during the first year of life?
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What percentage of birth weight can term neonates lose in the first few days of life?
What percentage of birth weight can term neonates lose in the first few days of life?
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What feeding method typically results in more rapid weight gain during the first 3 to 4 months?
What feeding method typically results in more rapid weight gain during the first 3 to 4 months?
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At what age do infants typically begin to exhibit slowed weight gain compared to earlier rates?
At what age do infants typically begin to exhibit slowed weight gain compared to earlier rates?
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What initial factors primarily influence an infant's growth parameters at birth?
What initial factors primarily influence an infant's growth parameters at birth?
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What is expected of an infant's weight by days 10 to 14 after birth?
What is expected of an infant's weight by days 10 to 14 after birth?
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Why is it important to correct growth parameters for gestational age in preterm infants?
Why is it important to correct growth parameters for gestational age in preterm infants?
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How much weight do children typically gain per year between age 2 years and puberty?
How much weight do children typically gain per year between age 2 years and puberty?
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Which of the following statements regarding growth during the second year of life is accurate?
Which of the following statements regarding growth during the second year of life is accurate?
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Which condition is NOT considered a high-risk diagnosis for nutrition assessment?
Which condition is NOT considered a high-risk diagnosis for nutrition assessment?
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What is a valid criterion for initiating a nutrition screening?
What is a valid criterion for initiating a nutrition screening?
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What percentage of adult height growth occurs during puberty?
What percentage of adult height growth occurs during puberty?
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At what average age do females typically experience their growth spurt during puberty?
At what average age do females typically experience their growth spurt during puberty?
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Which scenario indicates a patient may be in a catabolic state?
Which scenario indicates a patient may be in a catabolic state?
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Which statement best describes the growth patterns observed during adolescence?
Which statement best describes the growth patterns observed during adolescence?
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Which body measurement is essential for assessing nutritional status in children?
Which body measurement is essential for assessing nutritional status in children?
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What is a key reason for the normal deceleration of height velocity before the pubertal growth spurt?
What is a key reason for the normal deceleration of height velocity before the pubertal growth spurt?
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What duration of being NPO in previously malnourished children indicates inadequate intake?
What duration of being NPO in previously malnourished children indicates inadequate intake?
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Which type of diet is associated with a requirement for specialized nutrition assessment?
Which type of diet is associated with a requirement for specialized nutrition assessment?
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Why are accurate measurements of growth essential?
Why are accurate measurements of growth essential?
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Which of the following does NOT indicate poor nutritional status in children?
Which of the following does NOT indicate poor nutritional status in children?
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Which condition could potentially be misidentified as malnutrition?
Which condition could potentially be misidentified as malnutrition?
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What is an advisable action when deviations from a child's normal growth pattern are noted?
What is an advisable action when deviations from a child's normal growth pattern are noted?
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What percentage of children typically cross growth curves within the first 2 years of life due to genetic factors?
What percentage of children typically cross growth curves within the first 2 years of life due to genetic factors?
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Which of the following is NOT a component of a complete nutritional assessment?
Which of the following is NOT a component of a complete nutritional assessment?
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Which method is recommended for obtaining dietary history in assessing nutritional intake?
Which method is recommended for obtaining dietary history in assessing nutritional intake?
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What classification may be used as a percent of the standard to assess malnutrition severity?
What classification may be used as a percent of the standard to assess malnutrition severity?
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Which chronic condition could impact a child's nutritional intake and should be evaluated during a nutritional assessment?
Which chronic condition could impact a child's nutritional intake and should be evaluated during a nutritional assessment?
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Why is growth velocity critical in adjusting nutrition goals for normal-term infants and children?
Why is growth velocity critical in adjusting nutrition goals for normal-term infants and children?
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Which factor is least likely to influence nutritional assessments in children?
Which factor is least likely to influence nutritional assessments in children?
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What is a primary reason for obtaining a child's past growth pattern through examination of growth charts?
What is a primary reason for obtaining a child's past growth pattern through examination of growth charts?
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What should a nutritional assessment include regarding medications?
What should a nutritional assessment include regarding medications?
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Study Notes
Pediatric Nutrition Goals
- Improving the health of pediatric patients through nutrition
- Decreasing morbidity and mortality in pediatric patients associated with nutritional problems
- Enhancing patient outcomes with timely, safe and cost-effective nutrition provided either orally or through feeding tubes or parenteral nutrition
- Identifying patients who would benefit from nutritional intervention
- Educating patients regarding specialized or therapeutic diets, or specialized enteral or parenteral nutrition support
Routine Nutrition Care Goals
- Maintaining body functions of growth and development
- Maintaining body activity
- Healing when needed
- Managing and treating diseases
Estimating Pediatric Nutritional Status
- Nutritional screening conducted by Registered Dietitians (RDs)
- A comprehensive nutritional assessment is then conducted
- Results are interpreted and interventions are implemented
- A follow-up plan is created
Nutrition Screening
- Conducted by RDs to determine those at nutritional risk
- The initial screening examines:
- Special diets or formulas
- Poor oral intake for over 5 days
- Pressure ulcers or poor wound healing
- Burns covering more than 15% of body surface area
- Difficulty chewing or swallowing
- Use of specialized nutrition support: enteral or parenteral
- Current diagnosis of malnutrition, cystic fibrosis, failure to thrive, or newly diagnosed diabetes mellitus
Comprehensive Nutrition Assessment
- Patients on nutrition support, and those with the following high-risk diagnoses or conditions are considered at high risk:
- Anemia
- Burns
- Cancer
- Congenital heart defects
- Cystic fibrosis
- Diabetes mellitus
- Failure to thrive
- Gastrointestinal disorders
- Inflammatory bowel disease
- Malabsorption syndromes
- Preterm infants
- Children with body weights:
- Below standards (weight for height < 3rd%-ile for age and disease-appropriate growth charts or > 95th-ile)
- Above standards (recent weight loss greater than 10% of usual body weight)
- Patients in catabolic state:
- Sustained fever
- Major organ failure
- Patients with inadequate diet order and intake for requirements:
- Not eating for three days or more in previously malnourished
- Not eating for five days or more in previously well-nourished
- Not eating for five or more days without parenteral or enteral nutrition
- Patients on clear or full liquid diets for more than five days
Nutritional Assessment of Pediatrics
- Nutritional status can be determined by assessing:
- Body weight
- Growth
- Adipose tissue
- Skeletal muscle
- Visceral protein stores
- Cellular immune function
Components of Nutritional Assessment
- Growth assessment and anthropometric measurements
- Medical, developmental, social, and personal history
- Nutritional intake history and history of food allergies
- Laboratory evaluation of biochemical and metabolic changes
- Review of nutrition-focused physical examination findings
- Educational needs and potential barriers to learning
Age Groups
- This covers nutritional assessment of infants, children, and adolescents
Infant Growth
- Maternal nutrition and the intrauterine environment are strongly reflected in growth parameters at birth and during the first months of life
- Genetic and environmental factors have a stronger influence after the first months of life
- Growth percentiles and z-scores for weight and length can change significantly in the first two years of life
- Term neonates can lose up to 10% of their birth weight in the first few days and should regain their birth weight by days 10-14
- Infants establish a weight gain pattern during their first year of life.
- Expected weight gain in infancy is approximately 30 g/day from age 0-3 months, 20 g/day from 3-6 months and 10 g/day from 6-12 months.
- Infants should double their birth weight by four months of age and triple their birth weight by twelve months of age
- Weight gain slows after the infant’s first birthday
- Normal linear growth in infants is approximately 10 inches during their first year of life
- Feeding methods impact growth: Breastfed infants gain weight more rapidly during the first 3-4 months of life than formula-fed infants
- By age 1-2 years, breastfed and formula-fed infants have similar weights
- It’s important to correct growth parameters for gestational age in preterm infants
- The World Health Organization suggests correcting weight, height, and head circumference until age 2-3 years for children born prematurely
Childhood Growth
- Children gain approximately 2 kg/year between age 2 years and puberty
- They typically gain approximately 4 inches in length or height during their second year of life, 3 inches during the third year of life, and 2 inches per year between age 4 years and puberty
- With increasing height and slowing weight gain, toddlers and preschoolers grow taller and leaner
- Growth during this period is pulsatile, consisting of periods of rapid growth separated by periods of minimal growth
- There is a normal deceleration of height velocity before puberty begins (during adolescence)
Adolescent Growth
- Puberty refers to the physical changes that occur during adolescence and includes significant growth in stature
- Onset occurs between 8-13 years in girls and 9.5-14 years in boys
- Approximately 20% of adult height growth occurs during puberty
- Pubertal growth patterns can vary; steady growth or periods of rapid growth followed by periods of slow growth.
- The typical pubertal growth pattern involves a phase of acceleration, followed by a phase of deceleration, and ending with the cessation of growth with the epiphyseal closure.
- The timing of the growth spurt varies by sex, occurring an average of 2 years earlier in females than in males
Measurement of Growth
- Accurate growth measurements are essential for growth assessment
- Growth velocity is a sensitive indicator that requires periodic evaluation
- Increases or decreases in a child's normal growth pattern should be noted, particularly when there is a change greater than two standard deviations or measurements fall below the 5th percentile or above the 95th percentile
- Approximately two-thirds of children cross growth curves in the first 2 years of life due to genetic reasons
- The growth velocity of normal-term infants and children is useful in adjusting nutrition goals
Assessment of Malnutrition
- Weight is a good indicator of acute and chronic nutritional status, and is used to assess malnutrition in pediatric patients
- Weight may be classified as a percent of the standard:
- The Waterlow criteria are used to assess the degree of both acute and chronic malnutrition
Medical History
- A complete nutritional assessment should include:
- Recent hospitalizations
- Review of systems and history of allergies
- Personal and social history
- Chronic illnesses such as congenital heart disease, cystic fibrosis, kidney disease, and short bowel syndrome
- Previous growth patterns reviewed from growth charts
Medical History (continued)
- Recent surgeries, other medical deterioration, or procedures impacting nutritional intake, status, and management
- Medications
- Gestational age (for children under three years)
- Identification of low and very low birth weight infants
- Achievement of developmental milestones
- Presence of congenital abnormalities or genetic errors
Nutritional Intake History
- Nutritional intake can be assessed using:
- Twenty-four-hour recall
- Three-day food intake
- Food frequency questionnaire
- General interview
Nutritional Intake History (continued)
- This section is blank in the text and should include further details on assessing nutritional intake
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Description
Explore the essential goals of pediatric nutrition aimed at improving health outcomes in young patients. This quiz covers topics such as nutritional assessment, intervention strategies, and routine care practices for managing growth, development, and diseases through effective nutrition.
