PEDS EXAM 1: NUTRITION & CHILD ABUSE

breast milk

considered the best food for a newborn, with benefits including promoting high calcium absorption, protecting against renal stress, protecting the gut, and having a high biological value of protein

IgA antibodies & ILCs

breastmilk contains antibodies & cells which protect the baby's gut against bacterial invasion- give 2 examples

HIV+ or CMV+ mother, TB, malaria, typhoid fever, breast cancer

what are some major contraindications to breast feeding?

baby has cow's milk protein intolerance

(remember- breast milk has lactate, so technically most babies are not considered 'lactose intolerant')

What is an indication for the use of a soy- based milk?

baby is allergic to BOTH cow's milk and soy

What would be the indication for special milk formulas such as nutramigen, alimentum, neocate/pure amino, pregestimil, lactofree, isomil DF, etc....?

1 mg/kg/day (~15 mg/day)

What are the baby's iron requirements for the first year of life?

after six months

when should iron-containing food be added to a baby's diet? Essentially, an infant has adequate iron store up to this point.

150-200 cal/kg/24 hours

what is the daily caloric requirement for infants? (<1 year old)

60-100 cal/kg/24 hours

what is the daily caloric requirement for >1 year of age?

1000 calories + [age in years x 100 calories]

what is the daily caloric requirement for older children? (roughly)

4 months

When should babies start being introduced to common allergens (peanuts, eggs)?

marasmus

severe state of caloric deprivation; will look like: emaciation, distended or flat abdomen, visible intestinal pattern, muscle atrophy, hypotonia, edema, hypothermia

Kwashiorkor Disease

protein deficiency with appropriate caloric intake- "deposed child" being weened from breast

s/s similar to marasmus but also skin rash, anemia, immunodeficient

Rickets

Vitamin D deficiency in children; enlarged distorted bones, muscle weakness, growth failure, 'ping pong ball' skull, 'rachitic rosary' ribs

obese

children with a BMI >95 percentile for gender/age are considered....

TV in the bedroom

what is the greatest factor correlating with obesity in children?

endocannabinoids

Among one of the causes of obesity in children is sleep disturbance, as this leads to an increased secretion of .....

NAFLD (non-alcoholic fatty liver disease)

caused by obesity, this can lead to CVD, PCOS, sleep apnea, chronic kidney disease, hyperuricemia

hypotonic

sodium & osmolarity < serum (Na <130 mEq/L)

hypertonic

sodium & osmolarity > serum (Na >145 mEq/L)

mild dehydration (3-5%)

symptoms: pulse rate is normal or increased, increased thirst, decreased urine output, some loss of weight, normal physical exam

moderate dehydration (7-10%)

symptoms: tachycardia, little or no urine output, irritable, lethargic, depressed anterior fontanelle, decreased tears, mild loss of skin turgor, skin cool and pale

severe dehydration (10-15%)

symptoms: pulse rapid and weak, decreased BP, no urine output, markedly sunken anterior fontanelle, skin cold & mottled

shock

when dehydration is >15%

100 mL/kg/day

body weight: 0-10 kg

fluid requirements?

1000 mL + 50 mL/kg for each kg>10 kg

body weight: 11-20 kg

fluid requirements?

1500 mL + 20 mL/kg for each kg>20kg

body weight: >20 kg

fluid requirements?

Administer 20 mL/kg of saline over 20 minutes + repeat until IV volume is restored

If the patient is in shock or severely hydrated, what must you do first (before using the calculations) in order to restore intravascular volume?

when patient will eat within 24 hours

when is K+ replacement not required?

remember risks are greater with inc K+ when compared to decreased

hyponatremia

recommendations in fluid replacement are based of trying to avoid ________ which affects 30% of hospitalized patients

0.9% normal saline

the standard isotonic fluid

ADH

excess of what hormone can contribute to hyponatremia?

(this hormone increases in certain acutely ill patients)

emotional abuse

verbal abuse and the constant denigration of child by parent

results in low self esteem & sense of incompetence for life

emotional neglect

lack of loving interaction between parent and child

results in child feeling unlovable, worthless

physical neglect

the inability of unwillingness to provide a child with adequate food, shelter, clothing, or hygiene

medical care neglect

noncompliance for immunizations, dental care, illness follow-up; frequent visits to ER without follow-up

supervision neglect

latch key kids - associated with truancy and delinquency

bruises

_______ on the skin, scalp, fontanel, mouth, oral cavity, ears, genitalia can be a sign of abuse

TEN = Torso, Ears, Neck

FACES = Frenulum, Angle of jaw, Cheek, Eyelid, Subconjunctiva

p = Patterned bruising

what is the TEN-4-FACESp rule? helps pick out abuse in children

Chicken pox rarely occurs on the soles or palms

How can you tell the difference between abusive, punched-out lesions (ex- cig burns) and things like chicken pox?

Accidental burns will have a withdrawal pattern

How can you tell the difference between an accidental hot water immersion and one of abusive nature?

<1 year

Skull fractures at this age are almost always abuse.

<5 years

Fractures at this age point to probable abuse and definite if there are multiple fractures with no history of trauma

non-abusive

exclusive breast feeding, vegan diet, hypocalcemia, and vitamin D deficiency leading to fractures would be considered...

shaken baby syndrome

combination of subdural hematoma + retinal hemorrhage without evidence of blunt trauma may indicate ....

attempted toilet training

you may see genital trauma in cases of....

forced feeding

you may see oral trauma in cases of...

hair pulling

you may see subgaleal hematomas in cases of....

abdominal trauma

rupture of liver or spleen, intramural hematoma of bowel, pancreatic pseuo cyst

Rumpel-Leede Phenomenon

mechanical cause of lower extremity petechia and purpura- can happen when dad uses infant carrier fitted for mother

respiratory distress

what is the most common chief complaint in babies with shaken baby syndrome?

if playing takes on shame, secrecy, obsession

when does "playing doctor" become a red flag for sexual abuse?

if there is a clear focus on sexual intercourse

when does 3-4 year olds taking an interest in where babies come from become a "red flag" for sexual abuse?

when it becomes chronic/obsessive

when is masturbation considered a "red flag" for sexual abuse?

If sex play is with children of different ages (ex- a 7 /o and 2 y/o)

When does same sex exploration/playing doctor in 5-9 year olds become a "red flag" for sexual abuse?

pregnancy or STDs before age 15

Although more difficult to detect, what is a possible "red flag" for sexual abuse in adolescents?

over-sexualized or sexually-repressed families

what are two harmful family situations in which there is not necessarily explicit sexual abuse going on?

Vulnerable Child Syndrome

parents perceive the child as especially susceptible to illness or injury; usually follows a serious illness or life-threatening event, can result in missed school, overuse of medical services, altered child cognitive and behavioral development

medical child abuse

a child experiencing unnecessary and potentially harmful medical care at the instigation of a caretaker (fabricated illness, Munchausen's by proxy, etc...)