4.2 Failure To Thrive

Question 1

Failure to thrive general definition

Answer 1

Kids less than 5, poor weight gain

Question 2

Take home messages:

Answer 2

• Manage only what you measure
• energy in/out/utilisation
• Hx and Exam
• look at other family members
• non-organic/organic causes
• consult

Question 3

What do you measure?

Answer 3

Weight
Length: Height if >2yrs
-plot on centile chart
-include previous measurements

Question 4

What is normal weight gain in 0-3 month baby?

Answer 4

150-180g/week:

-double the weight in first 3/12

Question 5

What is normal weight gain in 3-6 month baby?

Answer 5

120g/week

Question 6

What is normal weight gain in 6-9 month baby?

Answer 6

80g/week

Question 7

What is normal weight gain in 9-12 month baby?

Answer 7

70g/week

Question 8

What is catch up growth?

Answer 8

Babies with IUGR or small for gestation age

Catch up from <3percentile to p50 at 12m

Question 9

What is catch down growth?

Answer 9

Large babies of diabetic mothers

>p97 at birth, on p50 at 12m

Question 10

Definition of failure to thrive?

Answer 10

• Weight below p3 or p5 on two measurements
• downward crossing of>2 percentiles on a chart
• BMI less than p5 for age
• weight <75% of median weight for length
• weight velocity <5 for age

Question 11

Risk factors for FFT?

Answer 11

• Poverty/socioeconomic
• poor parental knowledge
• parental mental health
• young mother
• child abuse

Question 12

Most FFT are organic of non-organic?

Answer 12

Non-organic

Question 13

Initial approach to FFTY non-organic causes?

Answer 13

Energy in: foods?
Energy out:stool/vomit
Increased utilization: ?disease

Question 14

Types of FFT-insufficient caloric intake?

Answer 14

-not enough
Milk, breast milk, formula
-poor feeding: cleft palate
-lack of parental knowledge
-parental mental health
-parental non-orthodox beliefs
-poverty/socioeconomic

Question 15

FTT excessive loss of calories examples?

Answer 15

1. Excessive vomiting
   - Reflux, pyloric stenosis
   - non GIT - CNS/metabolic
2. Malabsorption/excessive stool
   - coaeliac disease
   - CF
   - Chronic liver disease
   - Giardiasis

Question 16

Examples of FTT excessive caloric utiliztation

Answer 16

Congenital heart disease
UTIs
Thyroid: hyper
Chronic lung
Immunodeficiency
Recurrent infections
Metabolic disorders

Question 17

Non-FTT, other factors?

Answer 17

1. parents reports no eating but normal growth
2. Too much and only milk
3. meal times battle ground
4. Stats: 3% of normal children are

Question 18

FFT history includes?

Answer 18

Caloric intake
-specific and detailed facts
-babies need 150ml/kg day milk
-parental knowledge/recall of diet
Observe mother-child interaction

Question 19

Other FFT history (2)

Answer 19

• Child’s Medical Hx - other doctors and tests
• Preg and perinatal Hx
• developmental Hx
• family Hx
• parents and sibling heights and weights
• social Hx

Question 20

FFT examination?

Answer 20

1. Well/not well
2. Dysmorphic
3. Centiles
4. Muscle bulk: thighs, buttocks
5. Malabsorption/nutrient deficiency

Question 21

In FFT what is impacted the earliest and most?

Answer 21

Weight

Question 22

InFFT what is spared?

Answer 22

Head growth

Question 23

What gets affected after weight in FFT?

Answer 23

Linear growth/height

Question 24

Bloods for FFT?

Answer 24

UECs, LFTs, BGLs, CMP
FBE, Iron studies, B12, Folate, Coags
TTG Antibodies, Total IgA
Thyroid

Question 25

FFT urine and stool?

Answer 25

urine MCS

Stool MCS,fat globules

Question 26

FFT investigations, consider checking past investigations?

Answer 26

Newborn Screening Test for CF

Question 27

Non-organic FFT Mx?

Answer 27

• Ensure weight gain, 1-2/52
• assess mother child dead
• multidisciplinary team
• home/foster
• long term follow up

Question 28

Seeing a baby with growth problem, don’t forget?

Answer 28

To check glucose