Show:
Intake Uptake Mistakes
Malnutrition's Definitions
Ways and Means
Goals
100
3 questions to ask on HPI or ROS to assess for swallowing dysfunction in a 2 year old male with developmental delay and failure to thrive?
What are: HPI During feeds, any coughing/gagging/choking? During feeds, any fatigue or increased WOB? Delayed swallow? After feeds, any nasal regurgitation/congestion? ROS Chronic respiratory symptoms as above: wheeze, cough, apneas
100
1 of 2 common means of determining a patient's ideal body weight using growth curve
What are: - Height age (find age where they would be at the 50%ile for height or length, then use the weight at the 50%ile for that age) - Height percentile (e.g. if height is 25%ile for their age, IBW taken to be the same 25%ile for age) Limitations Crosses ages and puberty, or assumes symmetry (e.g. 50%ile weight are also 50%ile in height) Underestimates malnutrition in short person, overestimates malnutrition in tall person
100
According to CPS and NASPGHAN (North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition), the maximum duration of NG feeding before should consider gastrostomy tube placement.
What is 3 months?
100
The highest priority/goal of nutritional support for neurologically impaired child
What is improved quality of life (others: optimize health, function, maintain adequate growth and nutrient intake)
200
3 possible barriers to intake affecting the oral phase of feeding/swallowing in a 23 month old F with failure to thrive PMHx: spastic quadriplegic cerebral palsy, neonatal HSV encephalitis
What are: - drooling/inadequate lip closure - persistent extrusion reflex/tongue thrusting - uncoordinated tongue movements, rigid or contracted tongue (can't form bolus) - oral sensitivities (abnormal oral sensation - temperature, texture, etc.) - difficulties chewing (weakness, coordination) - aphthous ulcers - dental caries or abscesses - gingivitis associated with poor oral hygiene, anti epileptic meds, etc.
200
WHO Criterion used to determine chronic malnutrition, or stunting, in pediatrics
What is height (or length) for age more than 2 SD below median based on WHO/NCHS international reference (e.g. z-score less than -2)?
200
2 indications for an anti-reflux procedure in a 2 year old patient with polymicrogyria referred for a gastrostomy tube
What are: Reflux either non-responsive to maximal medical therapy or associated with pulmonary aspiration
200
A major growth parameter that may not be corrected completely by aggressive nutritional therapy
What is height/stature/length?
300
The most accurate way to estimate basal metabolic rate in NI child with difficulties ambulating, muscle atrophy, and indeterminate growth potential?
What is indirect calorimetry?
300
1 of the 3 most important predictors/risk factors for poor nutritional status in a neurologically impaired child
What is either - Duration of neurological impairment (NI) - Severity of NI - Oromotor dysfunction – major contributor to malnutrition in NI children
300
3 management options to discuss/suggest to parents of child with NI, FTT, insufficient oral intake
What are: Enteral tube feeding Oral supplements or modular products SLP/OT assessment of feeding/swallowing Optimize supportive care/disease mgmt Avoidance of aspiration Rule out current disease/endocrine dysfunction
300
Appropriate goal weight-for-height in older child who is wheelchair bound but capable of independent transfers
What is 25%ile (Others: bedridden is ~10%ile, normal activity ~50%ile)
400
A very important, high-yield screening question for NI child with failure to thrive who independently feeds
What is the duration of feeds/mealtimes? (If prolonged, then ask other Q's, such as: can they get all the food to the mouth? can they do this efficiently? Good evidence from literature suggests that caregivers often overestimate child's caloric intake if NI, especially if not observed the entire time)
400
The correct means of measuring mid upper arm circumference
What is - measurement in L arm (by convention, unless...) - mid-point (relaxed, elbow flexed, 1/2 way from acromion to olecranon processes) - Do not compress or alter contour of the arm with measuring tape, but snug
400
Feature of an adult formula that may make it inappropriate for paediatric use
What is an altered calorie/nutrient ratio? Adult formulas designed to meet micronutrient requirements of someone with minimum intake of 1500 kcal/day. If inadequate intake, consider Fe/Ca/PO4, vitamin deficiencies
400
Appropriate goal weight-for-height/length in < 3 y/o child with neurological impairment
What is the 25-50%ile (to ensure sufficient growth)
500
Expected changes in basal metabolic rate (BMR) and physical activity energy expenditure (PAEE) for a 5 y/o female with hemiparetic cerebral palsy with unilateral muscle atrophy relative to a similar sized girl with normal function
What are: Decreased BMR associated with lower lean body mass Likely increased PAEE because increased calories required for ADL
500
3 objective measures of nutritional status in a 8 y/o child who is non-ambulatory, with significant contractures
What are: - Mid upper arm circumference* - Triceps skin fat-fold thickness* - Subscapular skin fat-fold thickness (less affected in malnourished NI children) - Weight for age (wheelchair scale, someone holds patient) - Weight for length (using tibial/lower leg length or upper arm length to estimate stature) - Estimated Height for age (as above) - BMI (as above)
500
3 indications for percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) tube placement
What are: 1) severe reflux refractory to medical therapy/intolerance of gastric feeds (alternative to G-tube fundo) 2) reflux associated with aspiration (alternative to G-tube/fundo) 3) 1 or 2 + poor candidate for anti-reflux procedure (ARP) 4) 1 or 2 + previous failed ARP, high risk for repeat failure
500
3 of the potential benefits associated with nutritional support/rehabilitation in patients with neurodevelopmental disabilities
What are: Improved overall health Improved peripheral circulation Healing of decubitus ulcers Decreased spasticity Decreased irritability Improved gastroesophageal reflux Others listed (less evidence, but cited/plausible) - linear growth and weight restoration - quality of life - hospitalizations - alertness - developmental progress - decreased aspiration