Failure to thrive

Question 1

Categories of causes of failure to thrive

Answer 1

Intake problem
Absorption problem
Increased output

Question 2

Intake problem causes of FTT

Answer 2

Ineffective suck
Feeding aversion
Problem with parent/carer-infant interaction
Picky eating
Poor appetite
Physical disorders that affect swallow, reduced availability of food (neglect)

Question 3

What questions to ask about intake problems causing FTT?

Answer 3

Detailed feeding history
Baby - volume and frequency feeds
Type milk
Weaning

Older -
Appetite
Dietary exclusions
What drink and how much

Question 4

Absorption problems causing FTT

Answer 4

IBD
Coeliac
Cystic fibrosis
Infection
Severe food allergies/intolerance

Question 5

What to ask about absorption problems causing FTT?

Answer 5

Rectal bleeding
jaundice
Mucus in stools
Frequency of stools
Steatorrhea
Ass with foods
Systems reciew - urinary symptoms, resp symtpoms, skin chnages

Question 6

Increased output causes of FTT

Answer 6

Vomitting - GORD, diarrhoea, rarer causes increased metabolic demand ie metabolic disorders, cardiac disease, cancers

Question 7

Questions to ask about increased output causing FTT

Answer 7

Breathless when feeding?
Sweating
Unusual smells
Vomitting
Lethargy

Question 8

What does coxsackie virus cause?

Answer 8

Hand foot and mouth disease

Question 9

What does parvovirus cause?

Answer 9

Slapped cheek syndrome

Question 10

What would bloating, loose stools, wasted buttocks suggest cause of FTT is?

Answer 10

Coeliac

Question 11

How investigate FTT and sus crohns?

Answer 11

FBC , U&E, CRP, ESR, LFT, bone panel, serological test for coeliac disease - total immunoglobulin (IgA) and IgA transglutaminase (tTG)
anti-TTG

Question 12

What is different about growth charts in Downs?

Answer 12

Generally shorter
Higher prevalence of obesity - lower threshold for intervention
Puberty growth spurts usually less marked than for general population