failure to thrive Flashcards
what is FTT?
poor physical growth and development within a child
Faltering growth – fall in weight:
how would FTT present on growth charts?
Faltering growth – fall in weight:
- One or more centile spaces if birth weight is below 9th centile
- Two or more centile if birth weight between 9th and 91st
- Three or more centiles if birthweight was >91st
what is measured within growth charts?
head circumference
weight
height - length
what is most common place on growth charts?
50th centile
why is there a gap between 0-2weeks on growth charts?
- Gap between 0-2 weeks: baby especially if BF may take time to adjust and loose weight
is it worrying if baby moves one centile once?
- Not strange is baby changed one centile once growth spurt, infections
how should head circumference by in relation to weight on charts?
- Should be same centile for head circumference, height (length) and weight
- Do this until 2yrs
how does a preemie work on growth chart and how long for?
plot it and move it back by how many weeks early
until 2yrs
what is premature delivery?
<37weeks
how common are organic causes of FTT?
in 5% of cases
what categories cause organic FTT?
poor absorption
increased metabolism
difficulty in feeding
abnormalities in anatomy
what can cause poor absorption leading to FTT?
Poor absorption – coeliac, CF, cows milk intolerance, chronic diarrhoea, inflame bowel disease
what can cause increased metabolism leading to FTT?
Increased metabolism hyperthyroidism, chronic disease, malignancy, chronic infections
Increased energy requirements
Increased excretion
what can cause difficulty feeding leading to FTT?
Difficulty feeding: poor suck (cerebral palsy), cleft lip/ palate, genetic conditions causing abnormal facial structure, GORD, pyloric stenosis
what can cause non-organic causes of FTT?
Poverty/ food insufficiency
Errors in food prep
Child/ parent interaction problems
Poor parenting skill – lack of knowledge of diet required/ feeding techniques
Issues with BF – not latching
Environmental neglect/ deprivation/ abuse
how often should a newborn baby be eating?
every 2hrs
how long should BF be for each sitting?
20 mins
what assessment is needed for ?FFT?
want to establish cause
- Full Hx pregnancy, birth, developmental, social, feeding/ eating history
- Examining child
- Observe eating
- Mums physical health and MH
- Parent-child interactions
- Find mid-parental height centile constitutionally small? (height of mum + height of dad)/ 2
what is included within feeding history?
- BF/ formula
- Amount: time on boob, volume
- Freq: feeding times
- Feeding routine who feeds, when, what to do after?
- How is baby after feed – sick, irritable, asleep?
- Food diary
what investigations are required within FTT post Hx/ exam?
- Urine dip – UTI
- Coeliac screen – anti-TTG/ anti-EMA antibodies
- CF/ pyloric stenosis if symptoms continue and worsen
how would BF help be given?
BF help: midwives, health visitors, peer groups, ‘lactation consultants’
- Supplementing with formula can often help can lead to BF stopping
- Mothers should be encouraged to feed with BF prior to top up feeds
- May need thickeners/ PPI in formula if struggle with GORD
how would you promote inadequate nutrition?
- Encouraging regular and structured meal times and snacks should make toddler sit for 30mins at dinner table for 3meals a day and two snacks
- Reduce milk consumption/ juice in order to not fill up on that
- Review by dietician
- Additional energy dense foods – milk, cream, cheese
- Nutritional supplements drinks
what age does a baby start to wean?
6mths
what age should a baby start having cows milk?
1yr
at what point would an NG tube be considered?
life threatening
with clear goals + clear end point
