CERTIFIED SPECIALIST IN PEDIATRICS
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Acute malnutrition (undernutrition) refers to changes in weight in relation to height. -
ANSWER% of IBW @ 50%Wt/Ln
>90% Grade 0 (normal)
80%-89% Grade 1 (mild)
70% -79% Grade Il (moderate)
<70 rade lIl (severe)
Chronic malnutrition (stunting) refers to a reduction in the rate of linear growth -
Waterlow Criteria - ANSWER%IBW of Wt/Ln, age 1-3
>95% Grade 0 (normal)
90%-94% Grade I (mild)
85%-89% Grade II (moderate)
<85 % Grade III (severe)
Subcutaneous fat loss can be seen in: - ANSWERFacial cheeks (buccal pads) -hallow,
narrow, flat for moderate
Biceps and triceps - little space when skin pinched
Ribs Lower back Mid-axillary line- depressions very apparent
Buttocks- wasted, flat, baggy skin, wrinkled
Muscle Wasting can be seen in: - ANSWERClavicle Shoulder (deltoid muscles) -
protruding/prominennt
Scapula - As the muscle groups around the scapula waste, bone becomes more
prominent
Thigh (quadriceps muscle) (Note: lower body is less sensitive to change)
Knee - square, proninent, no muscle
Calf (gastrocnemius muscle)- definite tissue reduction
In average infant, weight doubles by: - ANSWERThe time they reach 6 months old
In average infant, weight triples by: - ANSWEROne year of age
Infant nutritional history, assess: - ANSWER1. Current method of feeding
2. Type of milk/formula per feed
3. Number of times per day, child is breastfed or takes bottle
4. Duration of feed and abnormal symptoms (including sweating, increased work of
breathing, choking or coughing)
5. Method for preparation (i.e. ratio of formula to water and source of water)
6. Special formula including rationale for modification
7. Number of meals/snacks per day (assess meal content)
8. Assess for developmental delay, oral aversions
9. Frequency of wet diapers and stooling patterns, stool consistency and frequency
10. Feeding history to include milestones, texture, progression, and variety
11. Food allergies/intolerances
12. Vitamins minerals herbal and/or food supplements (quantity, frequency, and
duration)
13. Review social, economic and environmental factors
Protein Needs in the Critically III Child - ANSWER0 - 2 years 2 - 3g /kg/day
2-13 years 1.5 -2g /kg/day
13 - 18 years 1.5g /kg/day
According to the American Academy of Pediatrics, energy and protein needs during
adolescence should be based on rather than .-
ANSWERHeight, Weight
Athetoid Cerebral Palsy energy needs: - ANSWERup to 6000 kcals/day (adolescence)
Down Syndrome2 Boys (5-12 yr) Girls (5-12 yr), energy needs - ANSWERBoys (5-12
yr) 16.1 kcal/cm height
Girls (5-12 yr) 14.3 kcal/cm height
Myelomeningocele (Spina Bifida) energy needs: - ANSWERApproximately 50% of
recommended daily allowances for age after infancy
May need as little as 7 kcal/cm height
, Prader-Willi Syndrome energy needs: - ANSWER10-11 kcal/cm height for maintenance
8-9 kcal/cm height for weight loss
individual diets may be as low as 800 - 1000 calories, under medical supervision.
Vitmain D conversion from mcg to IUs: - ANSWER/0.025
Vitmain D conversion from IUs to mcg: - ANSWERx 0.025
Vitamin D requirements for infants 0-12months - ANSWER10mcg (400IUs)
Vitamin D requirements for 1 year and up to 70y: - ANSWER600 IUs
Calcium requirements for 0-12mo - ANSWER260 mg
Calcium requirements 1-3years - ANSWER700mg
Calcium requirements 4-8 years - ANSWER1000mgs
Calcium requirements 9-30yrs - ANSWER1300mgs
Iron requirements 7-12months - ANSWER11mg
Iron requirements 1-3 yrs - ANSWER7 mgs
Iron requirements 4-8 yrs - ANSWER10mgs
Iron requirements increase for males at , for females at
. - ANSWERMales Ages 14-18
Females ages 14-18, then also increases further from 19-51 (menses)
Hunger cues 0-4 months - ANSWER
Birth to 4 Months feeding cues - ANSWERCries or fusses Gazes at caregiver, opens
mouth during feeding to indicate desire to continue, brings hand to mouth
4-6 Months Hunger Cues - ANSWERCries or fusses Gazes at caregiver, opens mouth
during feeding to indicate desire to continue
Birth to 4 Months Fullness Cues - ANSWERSpits out nipple or falls asleep Stops
sucking
4 months to 6mo fullness cues - ANSWERTUrns head away from nipple, stops sucking,
distracted noticing surroundings more
6-8 months hunger cues - ANSWERReaches for food or spoon, points to food.
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