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What is the difference between static and dynamic measurements of growth?
What does a single assessment of growth tell you? What doesn't it tell you?
Static - measuring once. Dynamic - tracking over time.
Single assessment tells you about attained size, but doesn't tell you if child is growing at appropriate rate.
What does adequate growth monitoring require? To determine what? Specifically what 4?
Adequate growth monitoring requires repeated growth measurements to determine growth rates.
Whether child is faltering, "tracking", catching up, or accelerating excessively.
What is an easy way to visually assess child's growth rate?
By plotting child's measurements on a growth chart.
If looking at graphs of serial growth measurements, how do you differentiate tall growth vs. obesity?
- Obesity will increase past percentile lines, while tall growth will start on the 95th percentile (or another high one) and stay on that curve.
What measurements are generally used to assess growth rate? What is a better measurement for catching disease early?
Height and weight.
What must you keep in mind about using BMI for children? 3
What could differences be caused by? (4)
- 1. BMI changes drastically with age, so must use appropriate measurements
- 2. BMI is a sensitive, nonspecific measurement - cannot differentiate overweight (extra lean muscle) and overfat.
- 3. Same BMI could be associated w. different levels of body fat (differences due to race/ethnicity/sex/maturation status!!)
What are the challenges in defining obesity?
1. Give definition
2. What is challenge (2)
3. Does body weight always relate to fatness? Why or why not?
4. What can cause variation of up to 20% around mean weight for children of same sex, height, and fatness based on tricep skinfold thickness?
- 1. Obesity = excess adipose tissue
- 2. (1) How to determine how much fat & what level is unhealthy (2) In childern, how to distinguish overweight from overfat?
- 3. No, body weight is not consistently related to fatness during chldhood bc body comp changes w/ age and maturation.
- 4. Frame size!!!!
What are concerns with obesity? (6)
- 1. Tracking of obesity
- 2. Health risks & consequences
- 3. Social risks & consequences
- 4. Higher risks in minority pops
- 5. Global trends
- 6. Numbers affected
What is obesity tracking?
2. What is the general rule? (2)
3. What proportion of adult obesity is attributable to childhood ranges? In US?
4. After 6 years old, what percentage of obese children remain obese into adulthood?
5. After puberty, what percent of obese children with at least one obese parent remained obese?
- 1. Tracking to see if child obesity leads to adult obesity.
- 2. 8-22%. In US: 42-63%
- 3. 50% of obese children after age 6
- 4. 80% of obese children with at least one obese parent -->obese into adulthood.
What are the health risks & consequences of obesity? (7)
Social risks & consequences? (2)
- Health risks:
- - Skin disorders
- - Orthopedic problems
- - Respiratory disorders
- - Elevated blood pressure
- - Altered serum lipid profiles
- Prediabetes, 70% have at least one risk factor for CVD
Social consequences: poor self esteem, social isolation (2)
How is obesity reflected in minority populations?
- Higher risk.
Blacks > Mexicans>Whites in all age groups for BMI>=95th percentile.
In males, mexican-americans are the most obese, while in females, blacks are the most obes.
What are global trends of obesity?
Brazil vs. US?
In most countries, adult obesity is growing more rapidly than child obesity, except in australia.
In Brazil, child obesity has caught up with adult obesity (which has stayed pretty consistent), however, in the US, both groups have gotten more obese.
(1) Overweight lower in Central/Eastern Europe whose economies suffered recession during economic/political transition in 90s. (2) Prevalence of overweight higher in southern countries of Europe, esp outside of eastern block.
What are the numbers of children affected by obesity?
In US, tripled over past 30 years (5%-18%)
How do you clinically assess childhood OW? (4 steps)
- 1. Calculate BMI
- 2. Family history (obesity of 1st degree rels and CVD, etc of 1st and 2nd degree rels)
- 3. Diet (identify caregivers, get rid of high cal foods, evaluate time in play, PE, after school, screen time, TVs in bedrooms)
- 4. Evaluate for obesity associated complications - diabetes, abnormal lipid panels, CVD risk factors
How do you behaviorally assess obesity?
1. Assess eating behaviors? (7)
- 1. Fruit & veggie consumption
- 2. Breakfast consumption
- 3. Frequency of family meals prepared at home
- 4. Frequency of eating food bought away from home (esp fast food)
- 5. Sugarsweetened beverage intake (sodas, energy drinks, tea, juice)
- 6. Portion sizes of meals and snacks
- 7. Atypical eating/nutrition behaviors
How much juice is okay? 2 What type?
- 100% fruit juice w/o added sugar.
- 4-6 oz under 7 years old. 8-12 oz for over 7
What would you assess for physical activity behaviors in an obese child? (3)
- 1. Amount of TV/screentime/sedentary activities
- 2. Amount of daily PA
- 3. Role of environmental barriers/accessibility
How would you assess motivatoin and attitudes?
- 1. Are you concerned about your weight?
- 2. On a scale from 0-10, how important is it that you lose or change weight?
- 3. On scale 0-10, how confident are you that you coudl succeed.
What is an important prevention message?
5-3-2-1 almost none
5 or more fruits & veggies daily
- 3 structured meals (eat breakfast, less fast food, more meals prepared at home).
- 2 hrs or less of TV/sedentary activity
- 1 hr or more of moderate-vigorous PA adaily
- Almostone - SSBs
What are the most critical nutrient needs for children? (growth maturation) aka foods & nutrients to increase? (8) foods to decrease (2)
To increase: iron, fiber, calcium, vit D, dairy (but not too much bc milk is poor source of iron), and fruits and veggies, n-3
To decrease: added sugar (SSBs) and saturated fat (fast food)
What are consequences of not getting enough iron? (4)
- 1. Decreased appetite
- 2. Slowed growth
- 3. Developmental/behavioral problems
- 4. Increased risk of lead poisoning and infections
What do you test to determine if someone has iron deficiency? (4)
- Serum ferritin < 10 ug/L
- Free RBC protoporphyrin > 1.25 umol/L
- Transferrin saturation <12%
- Hb: 2-4 <11.1 g/dL
- 5-7: <11.5
- 8-11: <11.9
When should children be screened for iron deficiency anemia?
1. Low-risk: if a child drinks more than 24 oz of milk/day (poor source of iron; displaces iron-rich foods in diet) OR documented low-iron diet.
2. High-risk children (lowincome/minority): 9-12 months of age, 6 months after first assessment, annually between 2-5 years
What are the benefits and consequences of fiber? (1,2)
- 1. Reduces constipation (common problem in young children)
- 2. May reduce energy density of diet impacting growth OR may reduce bioavailability of minerals (iron, calcium )
What are consequences of not getting enough calcium? Vitamin D? 2
- 1. Poorly mineralized, weak bones that can affect peak bone mass
- 2. Rickets (calcium + vit d)
What is fluoride used for? What is consequence of deficiency? Overdose? What should be encouraged? 3
Lays foundation for healthy teeth (enamel) and bones
- Def: dental cavities (52% of children 6-8 have this in primary/prermanent teeth)
- Overdose: fluorosis
Encourage less fermented carbs (juices, sodas, milk, starches) and to drink from a cup by first birthday (no more sippycup)
What do you need to know about fast food? What do children who consume fast food eat more of? (5) Less of? (4)
1/3 of children/adolescents consume fast food on a typical day.
Eat more total energy, total fat, total carbs, added sugars and SSBs.
Eat less fruits, non starch vegetables, fiber, milk
Eating >25% of calories from added sugars --> decreased veggies, fruits, dairy, vit A, calcium, and folate. .
How many children 6-11 consume SSBs on a typical day?What is the general trend? What are the recommendations? (3)
- Decrease milk consumption and increase fruit juice and soft drink cnosumption.
Recommendations: Drink little or no sodas, sports/energy drinks, fruit juices. Drink H2O, reduced fat milk, or 100% fruit juice (4-6 oz or 8-12) Encourage whole fruit insetad of juice.
What do you need to know about food marketings effects on children? (2)
Recs? (parents & policy makers)
Food marketing: Food marketing increases kids preference and consumption of both brand and category of food.
- Recs: Talk about advertising with children, monitor TV viewing, teach good nutrition, limit screentime
- Policy makers: ban junk food advertising, restrict interactive food advetising to children via digital media increase prosocial media platforms that encourage them to choose healthy foods.
Define food insecurity
Federal programs? (4)
Limited availability or ability to acquire of nutritionally adequate and safe foods in socially acceptable ways.
Behavioral, emotional, academic problems.
WIC, head start/early head start, food stamps, school breakfast/lunch program.
What is the link between food security and weight? Trends in the US?
- Mississippi: high food insecurity --> high obesity
- Colorado: low " --> low "
Food insecurity is increasing over time in US
AAP recommends supplements for which 5 groups? Which supplements should not exceed DRI?
Low-income, abused/negletec kids, poor appetite/eating habits, fad diets, and vegans.
Vitamin A and D
But rich mothers (whit, older, educated, privately insured, higher income, took supplements during pregnancy are most likely to receive supplements). Basically, children who need supplements the most are less likely to receive them.
What two things are needed in a vegetarian/vegan diet to ensure meeting DRIs?
What might strict vegan diets be deficient in? (5)
How do lacto-ovo vegetarians differ from vegans?
What are recs? (4)
Adequate energy and variety of foods.
B12, vitamin D, zinc, omega 3s, and calcium (unless fortified foods are consumed)
Lower rates of growth in vegans, but lacto-ovo vegs have same rates of growth of non vegetarians.
Recs: Allow child to eat several times/day (3 meals 2 dense snacks), include energy dense foods (cheese/avocado), include enough fat/omega 3s, include sources of vit D, calcium in diet (or supplement)
What is important to know about lactose intolerance:
What is it?
Who does it affect the most? (4) Prevalence in US?
Status of most adult animals?
Who is it least common among?
- Inability to breakdown lactose (insufficient lactase), so undigested lactose builds up in colon.
Affects AAs, Native As, and Asian Americans and premature infants the most. 30-50% in US.
Symptoms: bloating, diarrhea, vomitting, cramping, etc.
Most adult animals are lactose intolerant/lactase deficient.
European descent (history of cheese)
How to diagnose lactose intolerance? If lactose intolerant, how does this affect calcium intake?
Difficult to diagnose based on symptoms alone (could be IBS)
Coudl do allergy test - remove all diary to see if symptoms resolve, but this is not always conclusive. Can also do hydrogen breath test or stool acidity!!
W/o dairy products, most adolescents would not be able to meet calcium needs - unless they consume calcium fortified foods! (spinach, kale, broccoli, tofu, legumes, orange juice, frozen waffles, soymilk, breakfast cereals)
What is important to know about kids w/ special healthcare needs?
how many can benefit; common nutrition concerns
- -40 to 70% of CSHCN can benefit from nutritions ervices.
- - Common nutrition concerns:
- - Delayed growth/underweight; feeding problems/oral motor problems; constipation/diarrhea; picky or problem eating.
What are condition associated with low calorie needs? (4)
- 1.Down syndrome
- 2. Spina Bifida
- 3. Prader-Willi (can be fixed with growth hormone treatment)
- 4. Nonambulatory children
What are conditions associated with high calorie needs? (4)
- 1. Cystic fibrosis
- 2. Renal disease
- 3. Peds AIDS
- 4. Bronchopulmonary dysplasia (BPD) Need 160cal/kg/day rather than 100.
What are nutritional consideration for cerebral palsy? (5)
3 has 3 due to medication
- 1. Feeding difficulties
- 2. Undernutrition
- 3. Alterations in vit D, calcium, and vitamin K metabolism due to anticonvulsant meds
- 4. Constipation - wheelchair
- 5. Pressure ulcers - wheelchair
What are nutritional considerations for autism? 2
- 1. Very picky (nutritionist should work with speech, OT, behavioral, and feeding therapist)
- 2. Pica
What are nutritional considerations for cystic fibrosis? (5) Most common cause of death? (1)
What is recommended? (3)
Insufficient pancreatic/intestinal digestive enzymes --> malabsorption,malnutrition, and poor growth, deficiencies in fat sol vitamins, and often diabetes.
Generally need supplementary digestive enzymes, high fat diet and REEX1.5 kcals.
How should you assess nutritional status of special needs children? 4 questions
- 1. Is child's growth on track?:
- 2. Is his/her diet adequate?: (24 hr recalls, food records, FFQ) Ask about medications to check for food/Tx interactions. Ask about supplements.
- 3. Are child's feeding and eating skills appropriate for child's age?: Motor skills, may need feeding therapist.
- 4. Does diagnosis affect nutritional status?: Prader willi requires less calories, cystic fibrosis needs more.