CDR CSP Board Certified Specialist in Pediatric Nutrition

Which growth chart should be used for a 14-month-old infant in routine well-child clinic?

• ACDC growth chart for ages 0-20 years
• BWHO growth standards for ages 0-24 months
• CFenton preterm growth chart
• DOlsen preterm growth chart

A 30-week gestation preterm infant on full enteral feeds is gaining 12 g/kg/day. What is the MOST appropriate response?

• AContinue current feeds; growth is appropriate
• BIncrease calories to target 15-20 g/kg/day weight gain
• CDecrease feeds because gain exceeds intrauterine rate
• DSwitch from human milk to standard term formula

An ELBW infant on parenteral nutrition should receive how much protein per day to support optimal growth?

• A1.5-2.0 g/kg/day
• B2.0-2.5 g/kg/day
• C3.5-4.0 g/kg/day
• D5.0-6.0 g/kg/day

Which formula is MOST appropriate for an infant with confirmed IgE-mediated cow's milk protein allergy who failed an extensively hydrolyzed formula?

• AStandard cow's-milk-based formula
• BSoy-based formula
• CAmino acid-based (elemental) formula
• DPartially hydrolyzed (HA) formula

A 10-year-old with cystic fibrosis weighs 28 kg. What is the appropriate dose range of pancreatic enzyme replacement therapy (PERT) per meal?

• A100-500 units lipase/kg/meal
• B500-2,500 units lipase/kg/meal
• C3,000-5,000 units lipase/kg/meal
• D10,000 units lipase/kg/meal fixed dose

According to AAP 2023 obesity guidelines, intensive health behavior and lifestyle treatment (IHBLT) for children with obesity should include at least how many contact hours over what time frame?

• A10 contact hours over 6 months
• B15 contact hours over 6 months
• C26 contact hours over 3-12 months
• D52 contact hours over 2 years

A 4-year-old with refractory epilepsy is started on the classic ketogenic diet. What is the standard ratio of fat to (protein + carbohydrate) by weight?

• A1:1
• B2:1
• C3:1
• D4:1

A 7-year-old with classic PKU has a phenylalanine level of 600 μmol/L. What is the BEST nutrition recommendation?

• AIncrease intact protein from natural foods
• BRestrict phenylalanine and provide medical food (Phe-free formula)
• CProvide a high-tyrosine, low-leucine diet
• DEliminate all dietary protein for 48 hours

Which classification reflects severe acute malnutrition in a 3-year-old per WHO criteria?

• AWeight-for-height Z-score between -1 and -2
• BWeight-for-height Z-score < -3 OR MUAC < 11.5 cm OR bilateral edema
• CBMI-for-age 5th to 15th percentile
• DHeight-for-age Z-score < -1

Per the 2014 ASPEN/AND consensus statement, which combination identifies pediatric malnutrition based on a single data point?

• AWeight-for-height Z-score, BMI-for-age Z-score, length/height-for-age Z-score, MUAC Z-sco…
• BSerum albumin and prealbumin
• CCaloric intake percent of estimated needs only
• DTriceps skinfold percentile only

A 6-month-old exclusively breastfed infant is at risk for which micronutrient deficiency, requiring supplementation per AAP?

• AVitamin C
• BVitamin D 400 IU/day
• CCalcium 200 mg/day
• DMagnesium 30 mg/day

A 2-year-old ex-30-week preterm has a head circumference at the 3rd percentile on the WHO chart but at the 25th percentile when corrected for prematurity. What is the BEST interpretation?

• AMicrocephaly requiring neurology referral
• BNormal corrected growth; continue routine monitoring
• CStop using corrected age immediately
• DInitiate aggressive catch-up nutrition

Which statement about calculating energy needs in critically ill children is MOST accurate per ASPEN/SCCM 2017 guidelines?

• AUse Harris-Benedict with stress factors of 1.5-2.0
• BUse indirect calorimetry when feasible; otherwise Schofield or WHO equations without stre…
• CRoutinely add 50% to RDA to account for stress
• DUse predictive equations multiplied by injury and activity factors

What is the recommended energy distribution for an infant 0-12 months old?

• ACarbohydrate 45-65%, fat 30-40%, protein 5-20%
• BCarbohydrate 50-60%, fat 40-55%, protein 5-15%
• CCarbohydrate 30%, fat 60%, protein 10%
• DCarbohydrate 55%, fat 25%, protein 20%

Which lab finding is MOST consistent with refeeding syndrome in a malnourished adolescent with anorexia nervosa starting nutritional rehabilitation?

• AHyperphosphatemia, hyperkalemia, hypermagnesemia
• BHypophosphatemia, hypokalemia, hypomagnesemia
• CHypernatremia and hyperglycemia
• DElevated BUN and creatinine

A 2-month-old former 28-week preterm infant develops PN-associated cholestasis (direct bilirubin 3.5 mg/dL). What is the BEST lipid emulsion strategy?

• AContinue 100% soybean oil emulsion (Intralipid) at 3 g/kg/day
• BSwitch to or use a fish-oil-containing or mixed-oil lipid emulsion (SMOF or Omegaven)
• CStop lipids entirely until bilirubin normalizes
• DIncrease Intralipid to 4 g/kg/day

A child receiving central PN has a target glucose infusion rate (GIR) of 12 mg/kg/min. For a 10 kg child, what is the dextrose infusion in g/day?

• A86 g/day
• B144 g/day
• C173 g/day
• D200 g/day

Which BMI percentile range defines obesity in a 10-year-old per CDC/AAP criteria?

• ABMI 85th to <95th percentile
• BBMI ≥95th percentile
• CBMI ≥99th percentile
• DBMI ≥120% of the 95th percentile

A 3-year-old with short bowel syndrome has 25 cm of small bowel and an intact ileocecal valve. Which adaptation strategy is MOST important?

• AContinuous enteral feeds with elemental formula to maximize absorption
• BBolus feeds only, regardless of tolerance
• CStrict NPO with PN only for 6 months
• DHigh-fiber, lactose-rich diet to encourage adaptation

Which is FIRST-line nutrition therapy for active mild-to-moderate pediatric Crohn disease?

• ALong-term low-fiber diet
• BExclusive enteral nutrition (EEN) for 6-8 weeks
• CTotal parenteral nutrition for 4 weeks
• DSpecific carbohydrate diet (SCD) only

A 6-month-old presents with vomiting, lethargy, and acidosis 2 hours after first introduction of cow's milk. Skin prick is negative. Most likely diagnosis?

• AIgE-mediated cow's milk allergy
• BFood protein-induced enterocolitis syndrome (FPIES)
• CLactose intolerance
• DEosinophilic esophagitis

What is the recommended sodium intake range for an infant on furosemide for chronic lung disease (BPD)?

• A1-2 mEq/kg/day
• B3-5 mEq/kg/day
• C6-8 mEq/kg/day
• D10 mEq/kg/day or more

Which feeding tube is MOST appropriate for a child with severe gastroesophageal reflux and recurrent aspiration who needs long-term enteral nutrition?

• ANasogastric (NG) tube
• BOrogastric (OG) tube
• CGastrostomy (G) tube
• DGastrojejunostomy (GJ) or jejunostomy (J) tube

A pediatric oncology patient on cisplatin develops persistent low magnesium. Which nutrition intervention is MOST appropriate?

• ARestrict magnesium-containing foods
• BSupplement oral magnesium and monitor renal losses
• CIncrease phosphorus intake
• DProvide a lactose-free formula

A 5-year-old with severe neutropenia post-chemotherapy is admitted. What dietary precaution is currently recommended per most pediatric oncology centers and AND guidance?

• AStrict sterile/low-microbial diet for all neutropenic patients
• BFDA Food Safety guidelines (safe food handling) without strict neutropenic diet
• CAll foods raw and unwashed
• DOnly liquid diet during neutropenia

Which feeding pattern is normal for a 6-month-old infant?

• A3 large bottle feeds per day, no solids
• BApproximately 24-32 oz breastmilk/formula plus introduction of complementary foods
• CWhole cow's milk as primary beverage
• DThree meals/day with 16 oz juice

When is allergenic food introduction (peanut, egg) recommended per AAP/NIAID 2017 guidance for high-risk infants (severe eczema and/or egg allergy)?

• AAvoid until age 3 years
• BIntroduce around 4-6 months after evaluation/testing as needed
• CAvoid until age 1 year
• DAvoid until age 5 years for peanut

Which screening tool is validated for pediatric malnutrition risk in the hospital setting?

• AMUST
• BSTAMP or STRONGkids
• CMNA-SF
• DSGA (adult)

A 2-year-old with cerebral palsy is non-ambulatory and tube-fed. Which method is MOST appropriate to estimate energy needs?

• ADRI for age and weight
• BUse of CP-specific equations or indirect calorimetry; expect 60-80% of DRI for non-ambula…
• CAlways use 150% of DRI
• DUse adult Harris-Benedict with stress factor

Which factor differentiates marasmus from kwashiorkor?

• AMarasmus: severe edema; kwashiorkor: wasting
• BMarasmus: wasting without edema; kwashiorkor: edema with relatively preserved weight
• CBoth have edema and wasting equally
• DNeither is associated with malnutrition

What is the role of MCT oil in pediatric nutrition?

• ARequires bile and pancreatic lipase for absorption
• BAbsorbed directly into the portal system without micelle formation; useful in fat malabso…
• CProvides essential fatty acids
• DShould be avoided in chylothorax

Which growth pattern is consistent with stunting?

• ALow weight-for-height Z-score
• BLow height/length-for-age Z-score (<-2)
• CLow BMI-for-age Z-score
• DLow weight-for-age Z-score only

An 8-year-old with chronic kidney disease stage 4 (not on dialysis). Which protein recommendation is MOST appropriate?

• ADRI for age (1.0 g/kg/day) avoiding excess
• BHigh protein 2.5 g/kg/day to prevent malnutrition
• CStrict 0.5 g/kg/day to slow progression
• DVegetarian diet only, no animal protein

Which mineral does NOT typically need supplementation in formula-fed term infants?

• AIron
• BZinc
• CFluoride before 6 months
• DVitamin K

Which clinical sign suggests vitamin A deficiency in a child?

• ABitot spots and night blindness
• BCheilosis and glossitis
• CBowed legs and rachitic rosary
• DBleeding gums and petechiae

A pediatric patient with sickle cell disease has lower height and weight than peers. What nutrient is commonly deficient?

• AFolate, vitamin D, zinc
• BVitamin K only
• CSodium
• DSelenium only

Which describes appropriate fluid management for a 12 kg child by Holliday-Segar?

• A100 mL/kg for first 10 kg + 50 mL/kg for next 10 kg = 1100 mL/day
• B100 mL/kg for first 10 kg + 50 mL/kg for next 2 kg = 1100 mL/day
• C150 mL/kg for first 10 kg = 1500 mL
• D60 mL/kg for entire weight = 720 mL

Per ASPEN, when should enteral nutrition be initiated in critically ill children?

• AAfter 7 days of NPO
• BWithin 24-48 hours of admission if hemodynamically stable
• COnly after extubation
• DAfter parenteral nutrition has been given for 5 days