3 - Paeds - Gastro - Failure to Thrive Flashcards
define mild and severe FTT
what is essential in ?FTT children
what may be compromised by prolonged, inadequate weight gain
mild - fall across 2 centiles
severe - fall across 3 centiles
essential - repeated obs from child health record
height and development
what is “catch down weight”
infants weight falls from birth centile determined by intrauterine env to lower, genetically determined growth centile - Monitor closely
Small baby w/o FTT… how would they “present”? things to ask/look for? what may cause temporary FTT?
aSx, alert, happy, satisfactory development
?short parents, preterm infant or growth restricted at birth
intercurrent illness > temp FTT
Three categories of causes of FTT
organic, non-organic, others
Organic causes?
impaired suck/swallow due to neuro disorder/cleft palate
chronic illness eg CF, CD, ren failure, liver disease
Non-organic cause…broad spectrum of ?? 5-10% of FTT kids will be ?? what is an important contributing factor??
broad spec of psychosocial and env deprivation
on child protection register/subject to abuse/neglect
socioeconomic deprivation
non-organic cause for FTT - what may a mother of this child be like…
depressed, eating disorder, poor understanding of baby’s health,
undernutrition with organic and env factors
Causes of FTT other than organic/non-organic
inadequate retention eg vomiting, malabsorption eg coeliac, failure to utulise nutrients eg downs, increased requirements eg thyrotoxicosis
Important things to look for/ask about/get patient do to, for Hx
food diary feeding Hx Sx Birth Hx FHx growth problems/illness dev Hx psychosocial problems at home?
FTT - things to look for O/E
signs of organic disease
- dysmorphism (syndromes)
- signs of malabsorption eg distension
- signs of chronic resp disease eg clubbing
- signs of HF eg SOB, oedema
- signs of nutritional deficiencies
FTT - Ix - what to do? why ferritin?
FBC, Serum Ferritin
to look for IDA -> correcting inadequate iron may improve diet
MGMT principles - for organic? for non-organic?
when to admit?
organic -> treat organic cause
non-organic -> usually MDT in primary care
admit if <6m and severe FTT needing active refeeding - use hospital as demo that child can gain wt
who might be involved in mgmt of non-organic FTT
Health visitor - assessment + support with feeding
Paeds dietitian - assessment + recommendations of energy intake
SALT - feeding disorders
Clinical psychologist
Nursery placement to alleviate stress at home
Outcome for non-organic FTT kids
tend to continue undereating
lasting deficit in weight
impaired development is only short term
