CSP Pediatric Nutrition Disorders & Conditions 3 — Questions and Answers
Question 1: A 4-year-old with cystic fibrosis is not gaining weight adequately despite pancreatic enzyme replacement therapy. What is the most appropriate next step?
- Switch to a low-fat diet
- Add high-calorie oral supplements and reassess enzyme dosing (Correct answer)
- Initiate a protein-restricted diet
- Reduce dietary fiber intake only
Correct answer: Add high-calorie oral supplements and reassess enzyme dosing
Children with CF often require 110–200% of estimated energy needs; optimizing enzyme dosing and adding caloric supplements addresses inadequate weight gain.
Question 2: Which serum marker best reflects recent dietary protein intake (past 2–3 weeks) in a malnourished child?
- Albumin
- Prealbumin (transthyretin) (Correct answer)
- C-reactive protein
- Transferrin
Correct answer: Prealbumin (transthyretin)
Prealbumin has a half-life of 2–3 days, making it a more sensitive marker of recent nutritional status than albumin (half-life ~20 days).
Question 3: A 7-year-old with ARFID (Avoidant/Restrictive Food Intake Disorder) refuses most foods due to sensory sensitivity. Which approach is most nutrition-focused initially?
- Initiate nasogastric tube feeding immediately
- Force exposure to feared foods to overcome aversion
- Assess nutrient adequacy and supplement deficiencies while engaging feeding therapy (Correct answer)
- Restrict meals to one food group only
Correct answer: Assess nutrient adequacy and supplement deficiencies while engaging feeding therapy
Initial management of ARFID involves assessing and correcting nutritional deficiencies while concurrent feeding therapy addresses the behavioral component.
Question 4: Refeeding syndrome is most likely to occur in which pediatric patient?
- A well-nourished child starting oral iron supplementation
- A severely malnourished adolescent restarting nutrition support after prolonged starvation (Correct answer)
- An obese child beginning a calorie-restricted diet
- A healthy infant transitioning to solid foods
Correct answer: A severely malnourished adolescent restarting nutrition support after prolonged starvation
Refeeding syndrome occurs in severely malnourished individuals when nutrition is reintroduced, causing shifts in phosphate, potassium, and magnesium into cells.
Question 5: Which dietary fat modification is recommended for a child with chylothorax managed conservatively?
- High long-chain triglyceride diet
- Medium-chain triglyceride (MCT)-based formula or diet (Correct answer)
- Low-fat diet with fat-soluble vitamin supplementation only
- High saturated fat diet to boost lymph flow
Correct answer: Medium-chain triglyceride (MCT)-based formula or diet
MCT fats are absorbed directly into the portal circulation, bypassing lymphatics and reducing chyle production in chylothorax.
Question 6: An 8-year-old with Crohn's disease is started on exclusive enteral nutrition (EEN). What is the primary nutritional goal of EEN in pediatric Crohn's?
- Provide short-term parenteral nutrition backup
- Induce mucosal healing and remission while supporting growth (Correct answer)
- Maximize dietary fiber intake
- Reduce protein intake to rest the bowel
Correct answer: Induce mucosal healing and remission while supporting growth
EEN induces remission and promotes mucosal healing in pediatric Crohn's disease while simultaneously supporting catch-up growth.
Question 7: A toddler with cholestatic liver disease is at highest risk for deficiency of which group of vitamins?
- Water-soluble B vitamins
- Fat-soluble vitamins A, D, E, K (Correct answer)
- Vitamin C and folate
- Thiamine and riboflavin
Correct answer: Fat-soluble vitamins A, D, E, K
Cholestatic liver disease impairs bile flow needed for fat-soluble vitamin absorption, making A, D, E, and K deficiency common.
CSP Pediatric Nutrition Disorders & Conditions 3
A 4-year-old with cystic fibrosis is not gaining weight adequately despite pancreatic enzyme replacement therapy.
What is the most appropriate next step?