DRAFT: This module has unpublished changes.

Pediatrics

 

Abbreviations/Definitions

 

•FTT: Children who gain significantly less weight or have a significantly lower weight when compared to children that are the same age and gender.

 

•Tetrology of Fallot (TOF): A congenital heart failure. 

 

•PKU: An inborn error of phenylalanine metabolism.

 

•Prader Willi Syndrome: A genetic disorder which causes a constant sense of hunger, low muscle tone, short stature, and incomplete sexual development.

 

•Cystic Fibrosis: A disease in which there are abnormally thick mucus secretions from the epithelial surfaces of various organ systems, including the respiratory tract, the gastrointestinal tract, the liver, the genitourinary system, and the sweat glands.

 

Anatomy/Physiology

 

Describe the typical pattern of growth and development of an infant during the first year of life.  (Include skills related to feeding/eating.)

 

After the first four months of life a baby should double their birth weight, be able to sit up straight if placed sitting up, reach for objects, anticipate feeding when able to see a bottle, and be able to place things in his mouth. By nine months an infant will gain weight at a slower rate, develop more regular bowel patterns, gain the ability to crawl, feed himself with fingers, and imitate speech sounds.

 

Describe the typical pattern of growth and development of toddlers and young school-age children.

 

Around 18 months infants will begin to experience a decrease in appetite compared to their first 18 months of life. Children at 18 months will start to gain the ability to feed themselves and will have developed most of their baby teeth. After 24 months children will grow at a steady rate of about 2 to 1/2 inches. 

 

Describe the typical pattern of growth and development during the adolescent period.

 

Girls will experience puberty at about age 11 and boys at about age 13. This period of increased growth will last about 2 years. During this period of growth nutrient needs are increased.

 

Pathophysiology

 

Discuss the incidence of iron deficiency anemia in the pediatric patient.

 

Iron deficiency anemia is the most common cause of anemia in children. Babies who are breast fed typically receive adequate amounts of iron up until 6 months. Around 6 months of age their iron stores and the amount of iron they receive from breast milk are not adequate to meet their needs. At 6 months infants should be fed iron fortified cereal which can include breast milk or formula. Infants who are not breast fed are at greater risk of developing iron deficiency anemia because iron in breast milk is absorbed at a greater rate.

 

Nutritional Management

 

Compare the composition of breast milk to commercial infant formulas.

 

Breast milk contains more highly bioavailable protein, vitamins and minerals compared to infant formula. Breast milk also contains DHA and ARA which are immune-enhancing polyunsaturated fatty acids. In addition breast milk contains antimicrobial substances. Most infant formula on the market today attempts to mask the composition of human milk. However, many of the immune-enhancing and antimicrobial properties of breast milk can not be duplicated. 

 

Discuss the sequence of food progression in infant diets.

 

Infants typically breast feed and/or receive iron-fortified infant formula until 6 months of age. Around 6-8 months infants are ready for pureed or mashed foods. Iron fortified serial should be introduced first followed by pureed or mashed vegetables, fruit, and then meats. By 7-10 months the infant is generally ready to begin feeding themselves with finger foods such as dry cereal. By 8-12 months most infants will be ready for soft or cooked table foods such as cheese and vegetables that are cut into small bite size manageable pieces.

 

What foods are responsible for the majority of food allergies in children under three years of age?

 

Milk and soy allergies along with allergies to peanuts, tree nuts, egg whites, honey, and shellfish. 

 

How are the nutritional needs of a pre-mature infant different from that of a full term infant?

 

Infants who are born premature are not able to directly feed from bottles or breasts until they have reached about 32-34 weeks of age. It is recommended that premature infants breast feed. When the premature infant begins to grow their nutritional needs will exceed those of a normal term infant for vitamins, sodium, magnesium, zing, phosphorus, calcium, and protein. 

 

Describe the recommended strategy for management of pediatric obesity.

 

Encourage parents to be role models: exercising together, stoping or minimizing fast food consumption, cooking and eating healthy, nutrient dense foods. Encourage family adoption of a healthy living environment: removing junk food and calorie dense food from the home. Encouraging consumption of regular meals with healthy snacking patterns. 

DRAFT: This module has unpublished changes.

Click here to view the pediatrics chart review.

 

INTERN’S NAME: Melissa Cannon

INSTITUTION: Coler-Goldwater

ROTATION AREA: Pediatrics

CHARTING TYPE: Not specified 

 

PRECEPTOR’S COMMENTS / CORRECTIONS OF CHARTING


INTERN’S COMMENTS ABOUT NUTRITIONAL INTERVENTION(S):

 There are no pediatric patients at Coler-Goldwater therefore I am attaching a nutrition assessment for a woman who is 23 (the youngest patient I was able to see). Her condition developed when she was 6 because of a fall.

 

WAS THE NUTRITION INTERVENTION SUCCESSFUL? WHY/WHY NOT?:

The nutrition intervention was a continuation of her current diet.

DRAFT: This module has unpublished changes.