Self-Peds

Which of the following children is a greatest rick for iron deficiency anemia?

Iron deficiency anemia is the most common nutritional deficiency in childhood. While human milk is low in iron content, it is very efficiently absorbed. Infants exclusively fed human milk require an iron supplement starting at 4-6 months of age. Transitional infant formulas are fortified with sufficient iron to meet the needs of infants with a history of prematurity. The iron content of cow's milk is inadequate and not efficiently absorbed by infants. Cow's milk should not be introduced before 12 months of age. To avoid iron deficiency anemia, children should avoid excessive milk intake, which can displace the intake of food items with greater iron content.

• 4 month-old term infant exclusively fed human milk

• 4 month-old corrected gestational age, former preemie on a transitional formula

• 10 month-old switched from formula to whole milk

• 17 month-old "picky" eater

When used in assessment of critically ill children, how do predictive equations compare to indirect calorimetry?

Many methods of predicting energy expenditure in children are available. However, when compared with actual measurements using indirect calorimetry, most equations are significantly different (both overestimating and underestimating.)

• No consistent comparison can be found

• Equations typically overestimate needs

• Equations typically underestimate needs

• Equations correlate well with indirect calorimetry

• Hypothyroidism

• precocious puberty

• cushing syndrome`

• growth hormone deficiency

Which of the following preterm growth charts allows for comparison for preterm infants from 22 weeks gestational age up through 10 weeks post term age?

1: Fenton

2: Ehrenkranz

3: Dancis

4: Lubchenco

The Fenton growth chart, updated from data previously collected by Babson and Benda, has many benefits over other available growth charts. Data was collected from a large sample size and validation of the chart occurred by using data from the National Institute of Child Health and Human Neonatal Research Network; CDC growth charts; intrauterine growth data, and postnatal growth data. The data is cross sectional and is best used to assess growth over time. A major advantage is that it allows for tracking of growth from 22 weeks gestational age up through 10 weeks post term age.

• fenton

• ehrenkranz

• dancis

• lubchengo

How often does the American Academy of Pediatrics recommend screening for iron deficiency anemia?

1: Once between the age of 9 and 12 months for all infants

2: Once between the ages of 2 and 6 years in all children

3: Once a year in all adolescents

4: Yearly if a child drinks >24 ounces of milk per day

Iron deficiency anemia is important to identify in young infants and children because of its adverse effects on behavior and development. The American Academy of Pediatrics offers two options for screening. Universal screening, or measurement of hemoglobin or hematocrit for all full term infants between 9 and 12 months, is one option. An alternative option is Selective Screening, or screening only infants deemed to be at risk such as preterm infants, infants not receiving iron fortified formula, and infants fed human milk who are older than 6 months who are not consuming an iron rich diet. Selective screening may be a better option for communities with a historically low incidence of anemia and when there is lack of good infant dietary practices (iron-fortified cereals or foods not rich in iron).

• once between the age of 9 and 12 months for all infants

• once between the ages of 2 and 6 years in all children

• once a year in all adolescents

• yearly if a child drinks >24 ox milk per day

What is the recommended daily enteral iron dose for preterm infants, one month after birth?

1: 0.5-1 mg/kg/d

2: 1-2 mg/kg/d

3: 2-4 mg/kg/d

4: 5-6 mg/kg/d

The rate of growth and erythropoiesis are noted to slow down soon after birth. During such circumstances, iron requirements are lower. An exogenous source of 2-4 mg/kg/day of iron is recommended during the period of stable growth, beginning at 4-8 weeks and continuing until 12-15 months of age. The American Academy of Pediatrics recommends that infants not receiving human milk receive an iron-fortified formula and that preterm infants receive at least 2 mg/kg per day of elemental iron from 1-12 months of age.

• 0.5-1 mg/kg/d

• 2: 1-2 mg/kg/d

• 3: 2-4 mg/kg/d

• 4: 5-6 mg/kg/d

Which of the following is recommended to prevent vitamin D deficiency in a 1-month-old infant fed human milk?

1: Supplement with 100 IU vitamin D per day

2: Supplement with 200 IU vitamin D per day

3: Supplement with 300 IU vitamin D per day

4: Supplement with 400 IU vitamin D per day

There are limited natural dietary sources of vitamin D and adequate sunshine exposure for the cutaneous synthesis of vitamin D is not easily determined for a given individual and may increase risk of skin cancer. The recommendations to ensure adequate vitamin D status have been revised to include all infants, including those who are exclusively breastfed. It is now recommended that all infants have a minimum daily intake of 400 IU of vitamin D beginning soon after birth.

• 1: Supplement with 100 IU vitamin D per day

• 2: Supplement with 200 IU vitamin D per day

• 3: Supplement with 300 IU vitamin D per day

• 4: Supplement with 400 IU vitamin D per day

A seven month-old infant fed reconstituted infant formula and other age-appropriate complementary foods may be at risk of over-supplementation with which of the following?

1: Vitamin A

2: Fluoride

3: Vitamin E

4: Iron

During normal enamel maturation, the increased mineralization in the developing tooth is accompanied by the loss of matrix proteins that are secreted early in development. Sufficiently high levels of fluoride can disrupt this process and increase enamel porosity. The greater the amount of fluoride intake during development, the greater the prevalence of enamel fluorosis. The estimated risk of enamel fluorosis related to fluoride intake from reconstituted infant formula is positively associated with the fluoride concentration in tap water.

• vit A

• fluoride

• vit e

• iron

Which of the following is NOT a contraindication to nasogastric feedings in a pediatric patient with cystic fibrosis (CF)?

1: Chronic sinusitis

2: Chronic otitis

3: Pancreatic insufficiency

4: Need for long term nutrition support

While cystic fibrosis is associated with pancreatic insufficiency, pancreatic enzymes are given simultaneously to assist with adequate absorption of nutrients. Therefore, nasogastric (NG) feedings are not contraindicated in CF patients suffering from pancreatic insufficiency. Contraindications to NG feeding include upper airway secretions, nasal polyps, recurrent sinusitus or otitis. Patients who will require long term nutrition support should be evaluated for permanent enteral access placement.

• chronic sinusitis

• chonic ottis

• pancreatic insufficiency

• need for long term nutrition support

Which of the following is the BEST indication for use of a soy-based infant formula?

1: Diarrhea

2: Cow's milk protein allergy

3: Galactosemia

4: Regurgitation with feeds

Infants with acute diarrhea,usually associated with gastroenteritis, can develop secondary lactase deficiency, but a soy formula is not recommended in those instances. Since a high percentage of children who are allergic to cow's milk protein will also be allergic to soy protein, the American Academy of Pediatrics now recommends a trial use of either a hydrolyzed or free amino acid-containing formula. Galactosemia is an inborn error of metabolism that affects the body's ability to metabolize galactose. Currently, the only way to treat galactosemia is to eliminate galactose from the diet. Soy-based infant formulas are used as substitutes for milk in galactosemia. The galactose content (approximately 20mg/L) of lactose-free cow's milk infant formula is considerably higher than soy and hypoallergenic formulas; therefore lactose-free cow's milk formula is not recommended for treatment of galactosemia. Soy protein-based formulas have no role in preventing allergy or in management of non-specific gastrointestinal symptoms, e.g., infantile colic and regurgitation.

• diarrhea

• cows milk protein allergy

• galactosemia

• regurgitation with feeds