Development - Failure To Thrive Flashcards
What is failure to thrive?
Poor physical growth and development
What is faltering growth?
Fall in birth weight across:
- One or more centile spaces if they were below 9th
- Two or more centile spaces if between 9th and 91st
- Three or more centile spaces if above 91st centile
What is a centile space?
Distance between two centile lines on a growth chart e.g. distance between 75th and 50th centile lines
What are the general causes of failure to thrive?
Inadequate nutritional intake
Feeding difficulty
Malabsorption
Increased energy requirements
Inability to process nutrition e.g. T1DM
What are the causes of inadequate nutritional intake?
Maternal malabsorption if breastfeeding
IDA
Family or parental problems
Neglect
Food availability (poverty)
What are some causes of feeding difficulties?
Poor suck (due to cerebral palsy)
Cleft lip or palate
Pyloric stenosis
What are some causes of malabsorption?
Cystic fibrosis
Coeliac disease
Cows milk intolerance
Chronic diarrhoea
IBD
What can cause an increased energy requirement?
Hyperthyroidism
Chronic disease e.g. CF and congenital heart disease
Malignancy
Chronic infections e.g. HIV
What needs to be assessed in failure to thrive?
- Pregnancy, birth, developmental and social history
- Feeding or eating history
- Observe feeding
- Mum physical and mental health
- Parent child interactions
- Height, weight and BMI
- Calculate mid-parental height centile
What does a feeding history involve?
Breast or bottle feeding
Feeding times
Volume and frequency
Difficulties feeding
What does eating history involve?
Food choices
Food aversion
Meal time routines
Appetite in children
What can be useful for parents to do after a feeding history?
Food diary
What outcomes from assessment suggest inadequate nutrition or growth disorder?
Height more than 2 centile spaces below mid-parental height centile
BMI below 2nd centile
What initial investigations should be done for faltering growth?
Urine dip -UTI
Coeliac screen - anti-TTG or anti-EMA
Other investigations considered when symptoms suggest underlying diagnosis e.g. CF or pyloric stenosis
What happens if faltering growth reviews are too frequent?
Increases parental anxiety
What can be done when there is difficulty with breastfeeding?
Midwife support
Health visitor support
Lactation consultants
Supplementing with formula milk
What can supplementation with formula milk sometimes lead to?
Results in reduced or stopped breastfeeding
Why should mothers be encouraged to express when not breastfeeding?
To encourage lactation to continue
What can be done for inadequate nutrition?
Encouraging regular structured mealtimes and snacks
Reduce milk consumption to improve appetite for other foods
Review by a dietician
Energy dense foods
Nutritional supplement drinks
What is a last-line measure for inadequate nutrition?
Enteral tube feeding
