CPN Certified Pediatric Nurse Exam

Nutritional needs vary significantly across pediatric age groups based on growth rates, metabolic demands, and developmental stages. Adequate nutrition supports physical growth, cognitive development, immune function, and overall health.

Caloric requirements per kilogram body weight decrease as children age. Infants require approximately 100 to 120 kcal/kg/day; toddlers need 90 to 100 kcal/kg/day; school-age children require 70 to 80 kcal/kg/day; adolescents need 40 to 55 kcal/kg/day depending on activity level and pubertal status.

Protein requirements support tissue building and repair. Infants require 1.5 to 2 g/kg/day; children need 1 to 1.2 g/kg/day; adolescents require 0.8 to 1 g/kg/day. Complete proteins containing all essential amino acids come from animal sources; plant proteins can be combined for completeness.

Carbohydrates should comprise 45% to 65% of total calories, emphasizing complex carbohydrates over simple sugars. Fiber intake recommendations are approximately age plus 5 grams daily for children over 2 years.

Fat requirements decrease from 50% of calories in infancy to 25% to 35% in older children. Essential fatty acids support brain development; omega-3 fatty acids are particularly important during early childhood.

Breast milk provides optimal nutrition for infants through the first 6 months exclusively and continuing through at least 12 months with complementary foods. Benefits include ideal nutrient composition, immunologic protection, enhanced bonding, decreased infection rates, and reduced allergy risk.

Colostrum, produced during the first few days postpartum, provides concentrated immunoglobulins and promotes meconium passage. Mature milk transitions by approximately 2 weeks postpartum.

Breastfeeding frequency averages 8 to 12 times daily during early weeks. Adequate intake indicators include 6 or more wet diapers daily, regular stooling, appropriate weight gain, and satisfied behavior between feedings.

Formula feeding provides appropriate nutrition when breastfeeding is contraindicated or not chosen. Iron-fortified formula is recommended. Standard formulas are cow-milk-based; soy formulas serve infants with galactosemia or cow-milk protein allergy confirmed by specific testing. Specialized formulas address various medical conditions.

Formula preparation requires precise measurement; over-dilution causes water intoxication and malnutrition; under-dilution causes dehydration and renal stress. Bottles require proper cleaning. Formula should not be microwaved due to uneven heating creating hot spots.

Solid food introduction begins around 6 months when developmental readiness indicators appear: sitting with support, head control, tongue thrust reflex diminishment, and interest in foods. Single-ingredient foods are introduced one at a time, waiting 3 to 5 days between new foods to identify allergies.

Iron-fortified cereals, pureed vegetables, fruits, and meats are appropriate first foods. Avoid honey until age 12 months due to botulism risk. Avoid choking hazards including whole grapes, hot dogs, nuts, popcorn, and hard candies.

Toddlers and preschoolers demonstrate physiologic anorexia related to decreased growth rates. Appetite fluctuations are normal; forcing food is counterproductive. Food jags (preferring limited foods) are developmentally typical and usually resolve spontaneously.

Whole milk is appropriate from 12 to 24 months, transitioning to low-fat or skim milk thereafter. Limit milk to 16 to 24 ounces daily to prevent iron deficiency from excessive dairy consumption.

Serve small, frequent meals and snacks. Finger foods promote self-feeding and independence. Avoid using food as reward or punishment. Offer variety without pressure; repeated exposure (10 to 15 times) may be necessary before acceptance.

Choking prevention remains crucial through preschool years. Cut foods into small pieces; supervise mealtimes; ensure seated eating.

School-age children develop increasing independence in food choices. Pack healthy lunches; discuss smart cafeteria choices. Limit processed foods, sugary beverages, and excessive snacking. Family meals promote healthy eating patterns and communication.

Adolescent nutritional needs increase dramatically during growth spurts. Calcium requirements peak at 1,300 mg daily to support bone development. Iron needs increase, particularly for menstruating females (15 mg daily) compared to males (11 mg daily). Many adolescents consume inadequate fruits, vegetables, and calcium while exceeding recommendations for sodium, saturated fat, and added sugars.

Adolescent eating patterns often include skipped meals, fast food consumption, and irregular schedules. Provide education about nutrition without inducing anxiety about food choices.

Fluid needs are proportionally higher in children due to greater body water composition, higher metabolic rates, and larger body surface area relative to weight. Maintenance fluid requirements follow the Holliday-Segar method: 100 mL/kg for the first 10 kg, plus 50 mL/kg for the next 10 kg, plus 20 mL/kg for each additional kilogram.

Infants obtain adequate fluids from breast milk or formula; supplemental water is unnecessary and potentially harmful before 6 months. Introduce small amounts of water with solid foods.

Encourage water as the primary beverage for children and adolescents. Limit juice to 4 ounces daily for children 1 to 3 years, 4 to 6 ounces for children 4 to 6 years, and 8 ounces for older children. Avoid sugar-sweetened beverages.

Signs of dehydration include decreased urine output, dark concentrated urine, dry mucous membranes, decreased skin turgor, sunken fontanel (infants), lethargy, and tachycardia. Severe dehydration produces hypotension, altered consciousness, and absent tears.

Iron deficiency represents the most common nutritional deficiency in children. Risk factors include excessive milk consumption, inadequate dietary iron, and rapid growth. Screen for anemia at 12 months and during adolescence.

Vitamin D supplementation (400 IU daily) is recommended for all breastfed infants and children with inadequate dietary intake or sun exposure. Deficiency causes rickets and impairs bone development.

Food allergies affect approximately 8% of children. Common allergens include milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, and soy. Symptoms range from mild (hives, GI upset) to severe (anaphylaxis). Management includes strict avoidance and emergency action plans with epinephrine availability.

Failure to thrive describes inadequate growth related to insufficient caloric intake, absorption problems, or increased metabolic demands. Evaluation addresses organic and nonorganic etiologies. Management focuses on nutritional rehabilitation and addressing underlying causes.