Failure To Thrive

Question 1

What is failure to thrive?

Answer 1

Poor physical growth + development in a child

Question 2

What is the NICE guidelines definition of failure to thrive? (3 things)

Answer 2

Fall in weight across:

• 1+ centile spaces if birthweight was below 9th centile
• 2+ centile spaces if birthweight was between 9th and 91st centile
• 3+ centile spaces if birthweight was above 91st centile

Question 3

What are the main causes of failure to thrive? (5 things)

Answer 3

1. Inadequate nutritional intake
2. Difficulty feeding
3. Malabs
4. Increased energy req
5. Inability to process nutrition

Question 4

What are the causes of Inadequate nutritional intake? (4 things)

Answer 4

1. Maternal malabs (if breastfeeding)
2. Iron deficiency anaemia
3. Family / paternal problems (Neglect)
4. Poverty (no food)

Question 5

What are the causes of Difficulty feeding? (4 things)

Answer 5

1. Poor suck (e.g in cerebral palsy)
2. Cleft lip / palate
3. Genetic conditions (–> abn facial structure)
4. Pyloric stenosis

Question 6

What are the causes of Malabs? (5 things)

Answer 6

1. Cystic fibrosis
2. Coeliac disease
3. Milk intolerance
4. Chronic diarrhoea
5. IBS

Question 7

What are the causes of Increased energy req? (4 things)

Answer 7

1. Hyperthyroidism
2. Chronic disease (e.g Congenital heart disease / Cystic fibrosis)
3. Malignancy
4. Chronic infections (e.g HIV / immunodeficiency)

Question 8

What are the causes of inability to process nutrients properly? (2 things)

Answer 8

1. Inborn errors of metabolism
2. T1DM

Question 9

What are the key areas of assessment of failure to thrive? (6 things)

Answer 9

1. Pregnancy / Birth / Dev Hx
2. Feeding / Eating Hx (food diary)
3. SHx
4. Mums health (physical + mental)
5. Height, weight, BMI (plot on growth chart)
6. Calculate mid-parental height centile

Question 10

How do you calculate the mid parental height?

Answer 10

(Mum height + Dad height) / 2

Question 11

What assessment outcomes would suggest inadeq nutrition / growth disorder? (2 things)

Answer 11

1. Height: 2+ centile spaces below mid parental height centile
2. BMI below 2nd centile

Question 12

What are the initial investigations for faltering growth recommended by NICE? (2 things)

Answer 12

1. Urine dip (check for UTI)
2. Anti-TTG / Anti-EMA (check for Coeliac disease)

Question 13

When should you do further focussed investigations for faltering growth?

Answer 13

When you sus other conditions from signs / symptoms (e.g cystic fibrosis / pyloric stenosis)

Question 14

If the cause of faltering growth is Difficulty breastfeeding, what are the Mx options? (2 things)

Answer 14

1. Support mother (midwives / health visitors / peer groups / lactation consultants)
2. Supplement w formula milk

Question 15

What is the disadvantage of supplementing breastfeeding w formula milk?

Answer 15

Often results in breastfeeding stopping

Question 16

If the cause of faltering growth is Inadeq nutrition, what are the Mx options? (5 things)

Answer 16

1. Regular structured mealtimes / snacks
2. Reduce milk consumption –> improve appetite for food
3. Dietician review
4. Additional energy dense food
5. Nutritional supplement drinks

Question 17

If Mx options for faltering growth fail, what should you consider?

Answer 17

Enteral tube feeding