Growth and Nutrition
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- Percentage of growth during life
- foetal stage = 30% (nutrition, placenta) infant = 15% (nutrition, good health, happy) childhood = 40% (growth hormone, thyroid, nurtition, good health, happy) pubertal = 15% (growth hormone, testosterone, oestrogen)
- Female development
- - breast development begins 8.5-12yrs - public hair and rapid growth spurt following this - menarche at 2.5 yrs following start of pubery. Signal end of growth, only 25cm of height gain remains
- Male development
- - testicular enlargement to >4cm in volume is first sign of puberty - pubic hair growth follows testicular enlargement at 10-14yrs - height spurt when testicles volume 12-15ml after a delay of 18 months
- Why are kids vulnerable to poor nutrition
- - low nutritional stores - high nutritional demands for growth - rapid neuronal development, esp if <2yrs
- possible results of fat soluble vitamin deficiency
- Vitamins ADEK fat soluble rash, rickets, bruising, anaemia (megaloblastic B12)
- Failure to thrive
- - suboptimal weight gain/growth in infants/toddlers - demonstrated by trend across the centiles: mild = crosses 2 centile lines severe = crosses 3 centile lines - weight may fall in normal range, but most below 2nd centile
- Non-organic causes of FTT
- - feeding problems (decr. milk, poor technique) - maternl stress (inadequate food, how much to feed baby, munchausens)
- Organic causes of FTT
- - mechanical problems (cleft palate, poor coordination) - reflux, vomiting problems - chronic disease (CF, CHD, renal failure) - decr. absorption (coeliac, CF, food intolerance) - increased energy requirements (CF, cancer) - metabolic (thyroid) - chromosomal syndromes, infection
- Special factors in breast milk
- antibodies, lymphocytes, lactoferrin, lysozyme, bifidus factors, nucleotides, Fatty acids, amino acids, growth factors
- Components of formula
- protein, fat (veg oil), carbs (lactose), vitamins and minerals
- When to introduce cows milk and why
- Breast milk/formula ONLY for first 6 months!!! Because: - poorly available Fe - protein, Na, K, and calcium at very high levels for this age - high renal solute load - lack of vit C and essential fatty acids - risk of cows milk coilitis Can into cow's milk in small amounts at 6 months with custard and cheese. Wait until 12m to give full cream milk
- When to introduce solids and why
- - breast milk until 6 months, gradual solids from this point but milk major source until 12 months - at 6m child has improved motor abilities for eating and digestive system has matured (amylase esp). - first solids should be soft and smooth, eg Fe fortified infant cereal - chewing reflex begins at 7-9 months - into to veg and meat at 7 months - eating modified family meals by 12 months
- Lactose intolerance
- - lactose breaks down to glucose and galactose via lactast enzyme - lactase located superficially, thus can be lost in mucosal injury (eg.infection, coeliac) leading to osmotic diarrhoea
- Toddler diarrhoea
- - commonest cause of lose stools in toddlers - child well and thriving, no precipitating factors - aetiol: maturational delay in instestinal motility - stops by 5yrs
- Cow's milk protein intolerance
- - 1% of healthy infants, rare over 6months - Sx: fussiness, frequent mucoid stools with blood streaks - often a family hx of atopy - diagnosis confirmed upon resoultion with milk protein-free diet - older kids can present with a coeliac-like protein losing enteropathy, occult intestinal blood loss, oedema, anaemia and FTT - anaphylaxis rare but life threatening
- Steatorrhoea
- bad smell, difficult to flush, loose, oily CF pancreatic insufficiency, inadequate bile salts, inadequate absorptive surface area, enterocyte defect, lymphatic problems
- Carbohydrate malabsorption
- osmotically active nutrients in gut lumen (causes diarrhoea) Due to enzyme deficiency, excess intake of sugars
- Bloody diarrhoea
- infection, IBD, milk protein intolerance
- Crohns disease
- - transmural, mouth to anus (esp.distal ileum, proximal colon) - Sx: nausea, vomiting, bloody diarrhoea, abdo pain, anal skin tags Dx: barium follow through - narrows, fissuring, mural thickening, fistulae, decreased growth, anorexia, delayed puberty
- Ulcerative Colitis
- - mucosal inflammation with rectal bleeding, diarrhoea, colicky abdo pain, decrease in weight Rx: steroids, immunosuppressants
- What is Coeliac Diesease
- autoimmune response to gliaden (gluten) - cell mediated injury of intestinal mucosa, results in sub villous atrophy, inflammatory infiltrate (intra-epithelial lymphocytes)
- Presentation of coeliac
- - often 9-18 months - anorexia, decr. weight, abdo distension - chronic diarrhoea +/- anaemia - fat soluble vit def/decr.
- Dx and Mx of Coeliac
- Dx: positive Ab screen - antigliadin/antiendomysial antibodies. Biopsy shows sub villous atrophy which recovers with dietary restriction Mx: no wheat, barley, rye or oats. Rice, maise, soya, potato and jam is fine. Minor lapses in diet can matter!! After 5 yrs may cautiously reintroduce gluten *** untreated coeliac linked to cancer, esp lymphoma!! **
- Anorexia Nervosa
- - intense fear of becoming fat/losing control of eating - relentless pursuit of thinness, fat perception held - secretive food refusal, excessive dieting and excercise - amenorrhoea, emaciated, dry brittle hair, cold, slow Hr, low BP, languo
- Bulimia Nervosa
- - binge eating with sense of loss of control - self induced vomiting (knuckle callous) - use of dieting, laxatives, diuretics, enemas, increased exercise - more common ED of 15-25 year olds
- obesity in kids
- Aetiol: availability of food, alteration of intake, decr. physical activity - i in 4 kids are overweight or obese
- BMI in kids
- BMI measured by age appropriate BMI charts. < 5th percentile = underweight 5-85 = healthy 85-95 = overweight >95th = obese
- complications of obesity in childhood
- - psychosocial: low self esteem, depression, eating disorders - resp: sleep apnoea, asthma/exercise intolerance - GI: gallstones - Renal: glomerulosclerosis - dyslipidaemia, HTN, coagulopathy, endothelial dysfunction - type two diabetes, precocious puberty, PCOS - slipped capital femoral epiphysis, flat feet - obesity in adolescents likely to persist into adulthood. - obesity in adolescent is a RF for CVD when an adult regardless of adult weight
- Primary prevention strategies for obesity in kids
- Home: healthy meals, less TV, more activity School: mandatory PE, healthy canteen food Urban: safe open spaces for exercise, bike lanes and paths Government: tax fast foods and soft drinks, subsidise healthy foods, more funding for public health Media: prohibit advertising in kids hours, public education campaigns
- Obesity Mx
- - assess and manage complications - dietary change - increase planned and lifestyle activity - modify behaviours and habits associated with eating - parents as agents of change
- Tanner stages - pubic hair
- I - no sexual hair II - sparse pigmented long straight, mainly along labia and base of penis III - darker, coarser, curlier hair IV - adult distribution but decreased in total quantity V - adult in quantity and type with spread to medial thighs
- Tanner stages - breast development
- I - only papilla elevated II - breast budding. Elevation of the breasts and papillae occur as small mounds along with small increase in diameter of areola III - breasts and areola continue to enlarge, no seperation of contour IV - areola and papillae elevate above the level of the breasts and form secondary mounds with further development of breast tissue V - mature female breasts. Papillae may extend slightly above the contour of the breasts
- Tanner stages - testicular development
- I - testes, scrotal sac, and pernis have size and proportion similar to that of early childhood II - enlargement of the scrotum and testes and change in texture of the scrotal skin. Scrotal skin may also be reddened. III - further growth of the penis, initially in length but also some increase in circumference. Also increased growth of testes and scrotum IV - penis significantly enlarged in length and circumference, with further developemnt of the glans penis. Testes and scrotum continue to enlarge, distinct darkening of scrotal skin. V - genitalia of adult size in regards to size and shape