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8 Steps Who: Residents, Medical Students, Faculty, Middle level providers When: Wednesday 1110, GME lecture Where: FM Conference Room What: Knowledge:

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Presentation on theme: "8 Steps Who: Residents, Medical Students, Faculty, Middle level providers When: Wednesday 1110, GME lecture Where: FM Conference Room What: Knowledge:"— Presentation transcript:

1 8 Steps Who: Residents, Medical Students, Faculty, Middle level providers When: Wednesday 1110, GME lecture Where: FM Conference Room What: Knowledge: Most common malnutrition syndromes, choose your plate, age based nutritional requirements 1.Diet related risks: chronic degenerative disease, cardiovascular disease, DM2, cancer, obesity, OA 2.Nutrient deficiencies – growth retardation, iron deficiency anemia, dental caries 3.Iron deficiency anemia - 4.Overweight/obesity 5.Food insecurity million chldren in 2005 – emotional, behavioral, cognitive development 6.Categories: less than 2, 2-11, special health care needs, 7.Problem areas: dietary saturated fat, inadequate calcium, fiber, vitamin E, folate, iron, magnesium, potassium 8.Macronutrients – Healthy Eating Index? 9.Choose your plate – replace SSB with H2O, 10.How do we assess our patients? Skills: Counseling parents about dietary choices Attitude: Health behavior is important to consider for any change, moderation is key Why: Pediatric nutrition is catalyst for many levels of public health impact, start good habits young or foster change in an entire family What: 1)Learn the guidelines from FDA 2)Reviewed most common pediatric malnutrition syndromes 3)Understand resources for nutrition support at Madigan and Fort Lewis 4)Explore your experience with nutrition health behavior and how that impacts your care of pediatric patients 5)Analyzed evidence based pediatric nutrition recommendations What for: 1)Biologic nutritional concerns 1)Malnutrition 2)Age based requirements 2) Psychologic nutrition concerns 3) Social nutrition concerns How: See 4 I’s So What: Learning, Transfer, Impact

2 4 I’s Inductive: Input: Top 10 malnutrition list, matching vitamin to Implementation: choose your plate exercise Integration: use choose your plate in practice for education of patients

3 Timeline : Concept diagrams, group discussion on their concerns about pediatric nutrition : Introduction, objectives : Matching common malnutrition syndromes PPT review : Choose your Plate and education : Conclusion, integration task

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5 It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity.

6 Task 1: Concept Diagram Why is nutrition in kids important? Groups of 4 Draw a concept diagram Consider the ADA position and AAP article excerpt provided Include possible consequences, causes, contributors Most circles = Prize

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8 Pediatric Nutrition Amanda Cuda, MD

9 Objectives Developed concept of pediatric nutrition Reviewed pediatric malnutrition syndromes Reviewed age specific recommendations Explored health behavior counseling Exposed to national and local resources

10 Take Home Inspiration Choose Your Plate

11 Task 2: Matching Malnutrition Syndromes Use worksheet Work alone Match the description to diagnosis or syndrome

12 Task 2: Answers  Marasmus  Kwashiorkor  Stunted  Underweight  Overweight/obese  Anemia  Rickets  Scurvy  Pellagra Starvation Protein energy malnutrition Low height for age Low weight for height High weight for height Iron deficiency Vitamin D deficiency Vitamin C deficiency Niacin deficiency

13 Age Specific Nutrition Prenatal –Primordial prevention –Iron supplementation if anemia –DHA = Evidence Grade C Birth – 2 years –Exclusive breastfeeding for first 6 months –Transition to other food sources at 4-6 months –Iron supplementation if anemia at 12 months –Fluoride supplementation if not in water supply and have teeth –Primordial prevention

14 Age Specific Nutrition 2-5 years –Brushing = may not need fluoride any more –Most do not need multivitamin –Calcium, vitamin D, fiber in diet –Vitamin A supplementation considered in developing countries –Primary prevention –DHA? 5-11 years, Adolescence –Primary prevention –Fiber

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17 Task 3: Choose Your Plate Groups of 4 Menu from Pediatric Inpatient Nutrition Care Bag of “food” Task 3a: Order 3 meals by circling choices Task 3b: Create a meal with food Take 10 minutes We will hear a sample

18 Low hanging fruit Replace SSB with H2O Avoid the “whites” Eat on a kid plate Eat together at home Take out or fast food 1/week Shop on outside of grocery store 1 fruit, 1 veggie at every meal

19 For Picky Kids Chocolate milk increased calcium Presweetened cereals increased calcium, folate, and iron SSB, sugars, sweets, and sweetened grains had a negative impact More sugar consumed = fewer vegetables, fruits, dairy, vitamin A, calcium, folate

20 Role of the RD Provide technical assistance and training to practitioners that provide nutrition-related services to children and adolescents in health and education settings.

21 Nutrition Consults Lisa Lumpkin: Janet Fabling: 4N/PICU Individual visits for kids Special needs over 18 years

22 Objectives Develop concept of pediatric nutrition Review pediatric malnutrition syndromes Review age specific recommendations Explore health behavior counseling Expose to national and local resources

23 Task 4: Take Home Challenge Apply 1 of the “low hanging fruit” health behaviors for 1 month

24 Questions?

25 References Stang J, Bayerl CT; American Dietetic Association. Position of the American Dietetic Association: child and adolescent nutrition assistance programs. J Am Diet Assoc May;110(5): Frary CD, Johnson RK, Wang MQ. Children and adolescents’ choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups. J Adolesc Health. 2004;34: Ponza M, Devaney B, Ziegler P, Reidy K, Squatritio C. Nutrient intakes and food choices of infants and toddlers participating in WIC. J Am Diet Assoc. 2004; 104(suppl 1):S71-S79. World Health Statistics 2012, World Health Organization. pdf pdf Gidding etal. Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics 2006;117;544 DOI: /peds


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