1: Endocrine - Growth Faltering (FTT) Flashcards
What is failure to thrive now known as
Growth faltering
What is FTT
Failure to grow at expected rate
What is weight-faltering
Crossing down-centiles for weight
What is growth-faltering
Crossing down centiles for weight or height (length)
When is weight a batter indicator for growth
Weight is a better indicator in infants and small children
When is height a better indicator for growth
Height is a better indictor for children
What is the main cause of FTT
Insufficient food-intake
How can causes of FTT be divided
- Organic
2. Non-organic
What are the 4 categories of ‘organic’ FTT
- Impaired intake
- Malabsorption
- Increased energy requirement
- Inability to use nutrients
What are 4 causes of impaired intake
- Impaired suck - cleft palate
- Oromotor dysfunction
- Chronic illness causing anorexia
- Vomiting - GORD
What can cause impaired suck
Cleft palate
What can cause oromotor dysfunction
Cerebral palsy
What are 3 causes of increased energy expenditure
- Malignancy
- HF
- Cystic Fibrosis
What are two causes of malabsorption
- Coeliac disease
- Cystic fibrosis
What are 2 causes of failure to utilise nutrients
- Chromosomal disorders
- Congenital anomalies (eg. hypoT)
- Congenital infections
How can non-organic causes of FTT be divided
Inadequate intake
Psychosocial
What are causes of decreased food availability
- Poor breast feeding technique
- Poor timing of bottle-feeds
What are psychosocial causes of FTT
Poor bonding
Maternal depression
Abuse and Neglect
Explain weight change in neonates post-delivery
Following delivery, it is common for neonates to loose weight, which usually stops by day 3-4. Neonates then gain their birth-weight by 3W
When is it abnormal neonatal weight loss
> 10%
If infant looses more than 10% of their brith weight, what should be done
- Feeding History
- Observe breast-feeding
- Clinical exam
- May require other investigations
Define growth-faltering in infants/children
- Crossing down 3 centiles for weight in more than the 91st centile
- Crossing down 2 centiles for weight, if 9-91st centile
- Crossing down 1 centile for weight, if less than 9th centile
What determines growth in-utero
Placenta
What determines infantile growth
Nutrition
TH
What determines childhood growth
GH
Thyroid
Genetics
What determines adolescent growth
Androgens
GH
How often should growth be measured in 0-1 years
5-recordings
How often should growth be measured in 1-2 years
3-recordings
How often should growth be measured in >2 years
Annually
How is weight and height plotted
On growth chart
When is child’s head circumference plotted
Until 2-years
When is child’s length plotted until and what takes over afterwards
2-year. Then use height
Explain how pre-terms are plotted on growth chart
Plot in pre-term section until 42W of age. When 42W plot on chart for correctional gestational age.
Correctional gestational age: plot weight for child’s actual age and then draw back to how many weeks child was pre-term
Continue this until 2-years
In investigating growth-faltering what is first-thing to do
Plot values on growth chart
What should be calculated for growth concerns
Mid-parental height
Explain how mid-parental height is calculated for a girl
[(Dad’s height - 14) + (Mum’s height + 8.5)]/2
Explain how mid-parental height is calculated for a boy
[(Mums height + 14) + (Dad’s height + 10)]/2
What type of history is taken in FTT
- Detailed Feeding history including weaning
What bedside tests should be ordered for FTT
Urinalysis
Urine MC+S
Why is MC and S ordered
Renal dysfunction
What blood-test is ordered for most cases of FTT
anti-TTG (coeliac screen)
What do other investigations depend on
History
What should be kept for all patients
Food diary
When should a child be referred to paediatrics for FTT
- Suspect NAI
- Failure to respond to primary care interventions
- Unexplained short-stature
- Rapid weight loss
What does management of FTT generally depend on
Cause
How are neonates with FTT generally managed
Formula supplements
How is child with FTT managed
Oral nutritional supplements
If FTT in 1m, how often should they be weighed
Daily
If FTT in 1-6m, how often should they be weighed
1W
If FTT in 6-12m, how often should they be weighed
2W
If FTT in >1 year, how often should they be weighed
Monthly
