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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
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

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