Failure to Thrive Flashcards
What is failure to thrive?
a clinical diagnosis used in pediatrics
given when children are <3rd percentile on the WHO growth chart for their age
what growth measurements are important for children?
Head circumference until 24M
Height
Weight
What is ht growth estimation for children? how is it calculated?
the estimated ht a child will grow to based on parental height
Girls: (Dad’s height + Mom’s height – 13cm)/2
Boys: (Dad’s height + Mom’s height + 13cm)/2
What staging system do we use for sexual maturity?
Tanner’s staging
What are ddx for short stature?
Mnemonic: ABCDEFG
Alone
Bone dysplasia
Chromosomal
Delayed growth (constitutional)
Endocrine (low GH, Cushing, hypothyroid)
Familial
GI malabsorption (celiac, Crohn’s)
what are three general buckets for failure to thrive etiologies?
- inadequate caloric intake
- inefficient use of calories
- increased requirements/metabolic demand
what are some reasons within the “inadequate caloric intake” bucket for failure to thrive?
- environmental: food access/security
- feeding difficulty: feeding technique, physiologic deformities (cleft palate, cerebal palsy)
- social: parenting skills, alternative health beliefs, education, child abuse/neglect
what are some reasons within the “inefficient use of calories” bucket for failure to thrive?
- GI: enterocolitis, vomiting, diarrhea
- Endocrine: T1DM, hypothyroidism, adrenal insufficiency, inborn errors of metabolism, GH deficiency
- Genetics: chromosomal abnormality
- Immune: celiac, lactose intolerance, food allergy ➔ malabsorption
what are some reasons within the “increased requirements/metabolic demand” bucket for failure to thrive?
- malignancy
- congenital/acquired heart disease
- hyperthyroidism
- chronic infections (HIV, TB)
- respiratory illness: CF or severe asthma
- endocrine: T1DM
- trauma (burns, MVA, recurrent surgery)
explain how growth hormone deficiency can cause failure to thrive?
less GH, body cannot properly develop bones, muscles, and CNS
what condition would we be worried about with GH deficiency?
pituitary dwarfism ➔ abnormally short stature with normal body proportions
what is the most common form of dwarfism and patho of it
achondroplasia: short limbs and prominent forehead
error with fibroblast growth factor receptor ➔ issue with collagen
what are some causes of growth hormone deficiency?
Brain injury
Tumor
Genetics
Infection
Radiation/surgery
what s/s might we see with failure to thrive?
child is smaller/shorter vs peers ➔ growth chart
fussiness/crying
lethargy or sleepiness
constipation
physical delays (sitting, walking)
social delays (interacting, learning)
delayed puberty
malabsorption s/s: muscle wasting, fractures, minimal adiposity, dermatologic signs (thin, weak hair and skin)
how do we approach failure to thrive re: work-up?
we investigate s/s
hx is very important
bloodwork should be kept pretty general and limited
- CBC, creatinine and BUN, electrolytes, urinalysis and culture, and stool analysis (if GI symptoms)
bone age scan - xray
targeted ix may include:
- CF ➔ sweat cloride
- celiac ➔ anti-tTG and EMA
- hypothyroidism ➔ TSH
- chromosomal abnormalities ➔ karyotype
- allergy testing
- growth hormone deficiency testing
