Failure to thrive

Question 1

A 15-month present to the emergency department with cough and runny nose. You note that she is quite thin. her weight is well below the 3rd gentile, but her height and head circumference are on the 25th centile.

Answer 1

Impression
Given low weight centile measurement compared to height and head, I am concerned about failure to thrive in this 15 month old baby.

DDx to consider;
Non-pathological:
-
Pathological
- inadequate intake: malnutrition, restricted diet (ARFIDS), persistent diarrhoea/vomiting, neglect, poverty
- inadequate absorption: coeliac, food intolerances, other GI pathology (reflux, pyloric stenosis)
- excessive calorie consumption: congenital heart disease/lung disease, CF, hyperthyroidism

normal growth differences;
- ‘catch-up growth’; IUGR, SGA
- ‘catch-down growth’; LGA

Also need to consider if constitutional (mum + dad stature).

Question 2

FTT - History

Answer 2

History
- sx: irritable, flat, fatigue/lethargy, any vomits/diarrhoea
- feeding: type, volume, regularity
- REDS: developmental regression at any time
- general health and developmental milestones, review blue book, assess growth charts to see if crossing 2 or more lines.
- Paeds history, obstetric history
- RISKS: pre-term, fam hx, medical condition

Question 3

FTT - Examination

Answer 3

Examination
- General appearance + vitals
- hydrations status
- systems review: abdo pain, etc
- anthropometric measurements

Question 4

FTT - Investigations

Answer 4

Investigations
No investigations required for FTT.

• Bedside:
• Labs: FBC< iron studies, CRP/ESR, coeliac antibodies, TFTs, EUC/CMP/LFT
• imaging not indicated initialls

Question 5

FTT - Management

Answer 5

Management
- Dispositioning: inpatient vs outpatient. Most can be managed as outpatient with F/U in clinic, however if acute illness the admit under paeds

Supportive
- MDT approach with paeds, dietician, community nursing, etc
- aggressive dietary management: aim increase and catch up growth with concentrated formulas, supplements, high-energy shakes, multivitamins and mineral supplements
- hydration/electrolyte derangement corrections
- change/optimise feeding environment
- regular review and F/U

Definitive
- indicated if underlying cause evident, likely with referral to relevant paediatric sub specialist