Pediatric Medicine: Exam 1 lec 3
what is the most common cause of both congenital and acquired GH deficiency?
idiopathic GH deficiency
when is the risk of undernutrition the greatest?
in utero through 2 years of age
what is the most common cause of anemia worldwide?
iron deficiency
what physical characteristics are a clue of endocrine causes of growth failure?
markedly reduced height velocity and usually marked by excessive weight for height
why does nutritional rehabilitation need to be initiated and advanced slowly?
minimize complications of refeeding syndrome *changes in serum electrolyte concentrations --> cardiac issues/ arrhythmias
what is the cornerstone of treating FTT?
nutritional management *children with FTT may require more than 1.5 times the expected calorie and protein intake for their age for catch-up growth: -increase caloric density of foods -high-calorie oral supplement -vitamin and mineral supplementation needed
what is the AAP's recommendation on giving parenteral vitamin K after birth?
recommends that parenteral vitamin K (0.5-1 mg) be given to all newborns shortly after birth
how do you treat "psychosocial short stature" (ie: deprivation dwarfism)?
remove the child from the adverse environment is of paramount importance
why should infants NOT receive fluoride supplements before 6 months of age?
risk of fluorosis
growth parameters should be measured _____________ and plotted on growth charts
serially *at one, two, four, six, nine, 12, 18 and 24 months
Growth failure denotes a slow growth rate regardless of _________________
stature
energy needs increase with _____________
stress
which infant is at higher risk of developing hemorrhagic disease - a breast fed infant or a formula fed infant?
the breast fed infant
what genetic disorders may cause short stature?
-Turner syndrome -Noonan syndrome -Down syndrome -Prader-Willi syndrome
how do you define failure to thrive (FTT)?
-Weight for height ratio less than 3rd- 5th percentile for age and gender or -Weight crossing 2 major percentiles on the growth curve
what does CBC of anemia look like?
-hypochromic -microcytic -serum iron low -serum ferritin low
if you see a child with a "cherub" (ie: chubby, immature) appearance, high pitched voice, sparse thin hair and delayed dentition suspect ...
GH deficiency
what is the most common cause of hypothyroidism in the US? worldwide?
Hashimoto thyroiditis (associated with other autoimmune conditions) iodine deficiency
what test do you use to screen for GH deficiency after you have ruled out chronic disease or familial short stature?
IGF-1 •If IGF-1 low, do two GH stimulatory tests- L-Arginine & Clonidine, and Glucagon stimulation
Inadequate protein intake in the presence of adequate caloric intake causes ...
Kwashiorkor -abdomen is distended with hypoactive bowel sounds -weight is near normal -pitting edema -marked atrophy of muscle mass -skin changes -moon facies
primary protein-energy malnutrition (PEM) vs. secondary PEM:
Primary PEM: a lack of food Secondary PEM: -increased caloric requirements -increased caloric loss -reduced caloric intake -or a combination of these three
when should children be referred to the dentist?
at their first birthday
how do you treat GH deficiency? what is the risk associated with this treatment?
biosynthetic recombinant DNA-derived GH (dosage is titrated to the growth rate, weight of the patient, and IGF-1 levels) slipped capital femoral epiphysis (SCFE) and pseudotumor cerebri
what 2 vital signs signify severe and life-threatening malnutrition?
bradycardia and hypothermia *know this
what is the most common cause of short stature?
constitutional (delayed bone age) *know this
what are signs of malnutrition on PE?
decreased subcutaneous fat, decreased muscle mass, dermatitis, hepatomegaly, cheilitis (vitamin B12 deficiency), or edema
Classic GH-deficient patients ___________ show an increase in serum GH levels after stimulation
do not
skin lesions associated with Kwashiorkor:
erosions and scaling
what are risk factors for vitamin D deficiency?
exclusive breast feeding, malabsorption, certain medications
what is the most common cause of Cushing's syndrome?
exogenous steroids for other medical conditions
T/F: Pure dietary iron deficiency is common especially in children 1-3 years of age
false *IDA is rare except in children 1-3 YO
T/F: iron supplements are recommended for all children during acute nutritional rehabilitation phase
false - iron supplements are not recommended during the acute rehabilitation phase, especially for children with kwashiorkor *associated with higher morbidity and mortality
what is the #1 cause of chronic disease in childhood?
fluoride deficiency *contributes to early childhood caries
what are the goals of treatment for malnutrition?
gain weight at greater than 50th percentile for age *≥150% or more of the recommended calories for an age-matched, well-nourished child
what is the flag sign?
hair is sparse, easily plucked, appears dull brown, red, or yellow-white *associated with Kwashiorkor
how do you define idiopathic short stature?
height below 2 standard deviations of the mean for age without any endocrine, metabolic, or other diagnosis
what is the best diagnostic study for iron deciency?
therapeutic trial of oral iron •Reticulocytosis (48-72 hours) •Increase in hemoglobin levels (4-30 days) •Repletion of iron stores (in 1-3 months) •The usual therapeutic dose of 4-6 mg/day of elemental iron induces an increase in hemoglobin of 0.25-0.4 g/dL per day
T/F: a normal linear growth pattern is good evidence of overall health
true
T/F: vitamin K deficiency in humans with normal intestinal function is rare
true
what needs to be ruled out in late-onset growth failure (ie: acquired GH deficiency)?
tumor of the hypothalamus or pituitary
what does constitutional delay of bone age usually lead to?
usually leads to a delay in secondary sexual development
if you see an irritable infant with a protruding belly, frequent respiratory infections, and Rickets suspect ...
vitamin D deficiency
what is one of the most common causes of bleeding in healthy infants?
vitamin K deficiency