Pediatric Nutrition — MCQs

Pediatric Nutrition Indian Medical PG Practice Questions and MCQs

Question 421: A child of 8 kg has Bitot's spots in both eyes. Which of the following is the most appropriate schedule to prescribe vitamin A to this child?

A. 2 lakh units orally on day 0, 14
B. 2 lakh units orally on day 0, 1, 14 (Correct Answer)
C. 1 lakh units orally on day 0, 14
D. 1 lakh units orally on day 0, 1, 14

Explanation: ***2 lakh units orally on day 0, 1, 14*** - For a child weighing **8 kg** with **Bitot's spots (WHO classification X1B)**, the therapeutic dose is **200,000 IU** (2 lakh units) of vitamin A. - The standard WHO/IAP schedule for treating **vitamin A deficiency with ocular signs** is administration on **Day 0, Day 1, and Day 14** to rapidly replete stores and prevent progression. - The **oral route** is preferred for **Bitot's spots without corneal ulceration**, as it is effective, safe, and well-tolerated. - **IM route** is reserved for severe xerophthalmia (X2/X3 with corneal ulceration), persistent vomiting, or inability to take oral medications. *2 lakh units orally on day 0, 14* - Although the individual dose of **200,000 IU** is correct for this 8 kg child with **Bitot's spots**, this schedule misses the critical **Day 1 dose**. - The missing dose on Day 1 delays rapid **vitamin A replenishment**, which is crucial for preventing progression of **ocular damage** and achieving adequate tissue stores. *1 lakh units orally on day 0, 14* - This dose of **100,000 IU** is inadequate for a child weighing **8 kg or more** with clinical **vitamin A deficiency**. - WHO guidelines recommend **100,000 IU for children <8 kg** and **200,000 IU for children ≥8 kg**, making this dosage insufficient. - Additionally, the schedule is incomplete as it misses the **Day 1 dose**. *1 lakh units orally on day 0, 1, 14* - While the schedule of Day 0, Day 1, and Day 14 is appropriate, the **dose of 100,000 IU is inadequate** for a child weighing **8 kg**. - This lower dose may not provide sufficient **vitamin A replenishment** to reverse **Bitot's spots** and prevent progression to more severe xerophthalmia.

Question 422: In a scenario where a child is at the 50th percentile for weight and 75th percentile for height, and is otherwise healthy, what is the most appropriate action to take regarding their nutritional needs?

A. Vitamin rich tonic to be given
B. Forceful eating
C. Nothing should be done actively and assure the parent (Correct Answer)
D. Complete investigation for UTI

Explanation: ***Nothing should be done actively and assure the parent*** - A child at the 50th percentile for weight and 75th percentile for height is growing appropriately and **does not require intervention**, as these are healthy growth percentiles. - The child is **proportionally taller for their weight**, but these measurements are well within normal ranges, indicating good health and growth trajectory. *Vitamin rich tonic to be given* - Supplementation with a **vitamin tonic is unnecessary** in a healthy child with normal growth percentiles, as they are likely meeting their nutritional needs through a balanced diet. - Routine vitamin supplementation without a demonstrable deficiency or specific medical indication is **not recommended** and can sometimes lead to toxicity. *Forceful eating* - **Forceful feeding is detrimental** to a child's psychological and physical well-being, potentially leading to **feeding aversions** or unhealthy relationships with food. - A healthy child's appetite should be respected, and they should be allowed to eat according to their hunger cues, especially when growth is within normal parameters. *Complete investigation for UTI* - There are **no symptoms or signs presented** in the scenario (e.g., fever, dysuria, frequent urination) that would suggest a urinary tract infection (UTI). - Conducting an **extensive investigation for UTI** without any clinical indication would be an inappropriate and unnecessary medical intervention.

Question 423: What is the dosage of vitamin A for children between 1 and 3 years?

A. 1667 IU
B. 2333 IU
C. 1333 IU (Correct Answer)
D. 1250 IU

Explanation: ***1333 IU*** - The recommended daily allowance (RDA) for **vitamin A** in children aged 1 to 3 years is **400 mcg RAE** (Retinol Activity Equivalents) as per **ICMR guidelines**. - Using the conversion factor of **1 mcg RAE = 3.33 IU**, this equals approximately **1333 International Units (IU)** (400 × 3.33 = 1332 IU). - This dosage supports normal **growth, vision, immune function**, and epithelial tissue maintenance. *1250 IU* - This value is slightly lower than the recommended daily allowance for vitamin A in this age group. - While not deficient, it provides about 94% of the RDA and may be insufficient for optimal growth and development over prolonged periods. *1667 IU* - This dosage moderately exceeds the RDA for children aged 1 to 3 years (approximately 125% of RDA). - While occasional intake at this level is generally safe, consistent consumption may increase the risk of **hypervitaminosis A**, causing symptoms such as irritability, bone pain, and hepatotoxicity. *2333 IU* - This amount represents a substantial excess of vitamin A for toddlers (approximately 175% of RDA). - Chronic intake at such high doses can lead to **vitamin A toxicity**, manifesting as increased intracranial pressure, hepatomegaly, bone abnormalities, and growth retardation.

Question 424: What is the Na+ content of ReSoMal (rehydration solution for malnourished children)?

A. 30 mmol/L
B. 45 mmol/L (Correct Answer)
C. 60 mmol/L
D. 90 mmol/L

Explanation: ***45 mmol/L*** - ReSoMal is specifically formulated for **severely malnourished children** and contains a lower sodium concentration (45 mmol/L) than standard oral rehydration solutions (ORS). - This reduced sodium content helps to prevent **hypernatremia**, a common complication in severely malnourished children due to impaired renal function and reduced thirst sensation. *30 mmol/L* - This sodium concentration is **lower** than the recommended amount for ReSoMal. - Using a solution with such a low sodium content would be insufficient to replace **necessary electrolytes** and could lead to **hyponatremia** and other complications in malnourished children. *60 mmol/L* - This sodium concentration is **higher** than the recommended amount for ReSoMal. - A 60 mmol/L sodium concentration, while lower than standard ORS, would still carry an increased risk of **hypernatremia** in severely malnourished children, whose regulatory mechanisms are compromised. *90 mmol/L* - This is the sodium concentration found in **standard WHO ORS**, which is used for rehydration in children who are not severely malnourished. - For severely malnourished children, this concentration is too high and would significantly increase the risk of **hypernatremia** and cerebral edema due to their altered physiological state.

Question 425: A 3-year-old girl is brought for diarrhoea of 2 weeks' duration. She weighs 8 kg and her height is 93 cm. Her nutritional status can be described as what?

A. Mild malnutrition
B. Moderate malnutrition
C. Severe malnutrition (Correct Answer)
D. Very severe malnutrition

Explanation: ***Severe malnutrition*** - This 3-year-old child weighing 8 kg with height 93 cm has a **weight-for-height Z-score of approximately -3 to -4 SD**, indicating **severe acute malnutrition (SAM)**. - Normal weight for a 3-year-old is approximately 12-16 kg; 8 kg represents profound wasting with relatively preserved height (stunting less severe than wasting). - According to **WHO classification**, SAM is defined as weight-for-height < -3 SD, MUAC < 115 mm, or bilateral pitting edema. - The 2-week history of diarrhea contributes to acute nutritional deterioration, making this severe malnutrition. *Mild malnutrition* - Mild acute malnutrition would have weight-for-height between -1 to -2 SD. - This child's anthropometric deficit (8 kg at 3 years) is far too severe to be classified as mild. - Children with mild malnutrition typically maintain better growth parameters and clinical status. *Moderate malnutrition* - Moderate acute malnutrition (MAM) is defined as weight-for-height between -2 to -3 SD or MUAC 115-125 mm. - This child's weight of 8 kg for height 93 cm falls well below the -3 SD threshold. - The degree of wasting here exceeds the moderate malnutrition category. *Very severe malnutrition* - **"Very severe malnutrition" is not a standard WHO classification category** for pediatric malnutrition. - WHO uses a three-tier system: **mild, moderate, and severe** acute malnutrition, with severe being the most critical category. - Severe acute malnutrition encompasses what might colloquially be called "very severe" - including marasmus (severe wasting) and kwashiorkor (edematous malnutrition).

Question 426: A child with protein-energy malnutrition is brought to the outpatient department. Which of the following statements about Gomez's classification of malnutrition in children is true?

A. It considers both height and weight for assessment.
B. Weight is compared with standard weights for age. (Correct Answer)
C. Weight is a primary parameter compared to age standards.
D. Height-for-age is the primary parameter used.

Explanation: ***Weight is compared with standard weights for age.*** - Gomez's classification is based primarily on **weight-for-age** as a percentage of a reference standard. - It categorizes malnutrition into **Grade I (75-90% of expected weight), Grade II (60-75%), and Grade III (<60%)** based on the severity of the weight deficit. - This is a **simple, early classification system** that uses only one anthropometric parameter. *Height-for-age is the primary parameter used.* - This is incorrect. Gomez's classification **does not use height** as a parameter. - Height-based classifications include **Waterlow's classification** (which uses height-for-age to assess stunting) and **WHO growth standards**. - The limitation of Gomez's system is its inability to differentiate **acute from chronic malnutrition** without height data. *It considers both height and weight for assessment.* - This is incorrect for Gomez's classification; this approach is characteristic of other classification systems like the **Waterlow classification** or the newer **WHO growth standards**, which use indices like weight-for-height and height-for-age. - Gomez's method uses a **single anthropometric measure** (weight-for-age) to classify malnutrition. *Weight is a primary parameter compared to age standards.* - While this statement correctly identifies weight as a primary parameter compared to age standards, **Option A is more precise and direct**. - Option A specifically states the comparison of "weight with standard weights for age," which clearly describes the methodology of Gomez's classification. - This option is less specific about what is being compared.

Question 427: What is the recommended oral dose of vitamin A to be given in a 10-month-old child on each of days 1, 2, and 28?

A. 50,000 IU
B. 100,000 IU (Correct Answer)
C. 200,000 IU
D. 600,000 IU

Explanation: ***100,000 IU*** - The recommended oral dose of Vitamin A for infants aged 6-11 months is **100,000 IU** on day 1, day 2, and day 28 for the treatment of severe vitamin A deficiency or in high-risk areas. - This dosage helps to rapidly replenish vitamin A stores and reduce the risk of associated complications like **xerophthalmia**. *50,000 IU* - This dose is lower than the recommended amount for treating vitamin A deficiency in infants aged 6-11 months. - A 50,000 IU dose is typically given to infants under 6 months of age. *200,000 IU* - This dose is recommended for children 12 months and older, or for pregnant women with severe deficiency who are not experiencing night blindness. - Administering 200,000 IU to a 10-month-old child could pose a risk of **hypervitaminosis A** due to their smaller body weight and developing metabolic systems. *600,000 IU* - This dose is excessively high and would lead to significant **vitamin A toxicity**, especially in an infant. - It is not a therapeutic dose recommended for any age group in the context of vitamin A supplementation programs.

Question 428: What is the true statement regarding an 'at-risk baby'?

A. Mild malnutrition with weight slightly below expected norms.
B. Socioeconomic risk due to high birth order (more than 3). (Correct Answer)
C. Normal birth weight above the critical threshold of 2.5 kg.
D. Severe malnutrition with weight significantly below expected norms.

Explanation: ***Socioeconomic risk due to high birth order (more than 3).*** - An **"at-risk baby"** is defined by specific criteria that identify infants vulnerable to adverse health outcomes during the neonatal and early infantile period. - **High birth order (>3)** is a recognized risk factor as per IAP (Indian Academy of Pediatrics) and WHO guidelines, primarily due to: - **Maternal depletion syndrome** (depleted maternal nutritional reserves from multiple pregnancies) - **Socioeconomic constraints** (limited resources spread across more children) - **Reduced parental attention** and care per child - Other criteria for "at-risk baby" include: birth weight <2.5 kg, preterm birth, birth asphyxia, congenital anomalies, and maternal risk factors. *Severe malnutrition with weight significantly below expected norms.* - This describes **severe acute malnutrition (SAM)** in an infant or child, which is a **nutritional disorder**, not a defining criterion of an "at-risk baby" at birth. - While malnutrition increases morbidity risk, the term "at-risk baby" specifically refers to **perinatal and neonatal risk factors** present at or around the time of birth. - SAM is a **consequence** that may develop later, rather than a defining characteristic of the "at-risk" classification. *Mild malnutrition with weight slightly below expected norms.* - **Mild malnutrition** is not a criterion for classifying a baby as "at-risk" in the standard pediatric definition. - The "at-risk baby" classification focuses on **specific measurable risk factors** (birth weight, gestational age, birth order, etc.) rather than mild nutritional deviations. *Normal birth weight above the critical threshold of 2.5 kg.* - A **normal birth weight (≥2.5 kg)** is actually a **protective factor** and indicates lower risk at birth. - This statement describes a baby who does **not meet the "at-risk" criteria** based on birth weight, though other risk factors could still be present. - Birth weight ≥2.5 kg is one indicator of adequate intrauterine growth and lower neonatal mortality risk.

Question 429: A child who is exclusively fed on cow's milk is likely to have a deficiency of which of the following?

A. Iron deficiency (Correct Answer)
B. Vitamin A deficiency
C. Thiamine deficiency
D. Riboflavin deficiency

Explanation: ***Iron deficiency*** - Cow's milk is **poor in bioavailable iron** and high in calcium, which can inhibit iron absorption. - Excessive cow's milk intake by infants can lead to **gastrointestinal blood loss** (due to protein-induced enteropathy), further exacerbating iron deficiency. *Vitamin A deficiency* - Cow's milk contains a significant amount of **Vitamin A**, making deficiency unlikely from exclusive feeding. - While processing can reduce some vitamin content, it's not a primary cause of **Vitamin A deficiency** in this context. *Thiamine deficiency* - Cow's milk is a **good source of Thiamine (Vitamin B1)**, especially whole milk. - **Thiamine deficiency** is more commonly seen in populations with limited access to fortified grains or those with chronic alcoholism. *Riboflavin deficiency* - Cow's milk is an excellent source of **Riboflavin (Vitamin B2)**, making deficiency improbable with exclusive feeding. - **Riboflavin deficiency** typically manifests with angular cheilosis and glossitis, and is rare in children consuming dairy.

Question 430: A boy who refuses to eat fruit presents with knee swelling and hematoma. Which vitamin deficiency is most likely suspected?

A. Vitamin D
B. Vitamin E
C. Vitamin B1
D. Vitamin C (Correct Answer)

Explanation: ***Vitamin C*** - A refusal to eat fruit, a primary source of **vitamin C**, is a significant risk factor for deficiency. - **Vitamin C** deficiency (scurvy) impairs **collagen synthesis**, leading to fragile capillaries, easy bruising (**hematoma**), and poor wound healing, which can manifest as **joint swelling**. *Vitamin D* - Deficiency typically causes **rickets** in children, characterized by **bone deformities**, bowing of the legs, and impaired growth. - It does not directly cause **hematomas** or acute **joint swelling** from capillary fragility. *Vitamin E* - Deficiency is rare and usually associated with **fat malabsorption disorders**. - It can lead to **neurological symptoms** like ataxia and peripheral neuropathy, not typically **hematomas** or **joint swelling**. *Vitamin B1* - Deficiency (beriberi) affects the **cardiovascular** and **nervous systems**, causing symptoms like heart failure, peripheral neuropathy, and muscle weakness. - It does not cause **hematomas** or **joint swelling** as primary manifestations.

Practice by Chapter

Breastfeeding

Practice Questions

Infant Formula Feeding

Practice Questions

Complementary Feeding

Practice Questions

Nutritional Requirements by Age

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Malnutrition and Failure to Thrive

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Obesity in Children

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Vitamin Deficiencies

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Mineral Deficiencies

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Food Allergies and Intolerances

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Nutritional Management of Chronic Diseases

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Eating Disorders

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Parenteral and Enteral Nutrition

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