failure to thrive

Question 1

what is FTT?

Answer 1

poor physical growth and development within a child
Faltering growth – fall in weight:

Question 1

how would FTT present on growth charts?

Answer 1

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

Question 2

what is measured within growth charts?

Answer 2

head circumference
weight
height - length

Question 3

what is most common place on growth charts?

Answer 3

50th centile

Question 4

why is there a gap between 0-2weeks on growth charts?

Answer 4

• Gap between 0-2 weeks: baby especially if BF may take time to adjust and loose weight

Question 5

is it worrying if baby moves one centile once?

Answer 5

• Not strange is baby changed one centile once  growth spurt, infections

Question 6

how should head circumference by in relation to weight on charts?

Answer 6

• Should be same centile for head circumference, height (length) and weight
• Do this until 2yrs

Question 7

how does a preemie work on growth chart and how long for?

Answer 7

plot it and move it back by how many weeks early
until 2yrs

Question 8

what is premature delivery?

Answer 8

<37weeks

Question 9

how common are organic causes of FTT?

Answer 9

in 5% of cases

Question 10

what categories cause organic FTT?

Answer 10

poor absorption
increased metabolism
difficulty in feeding
abnormalities in anatomy

Question 11

what can cause poor absorption leading to FTT?

Answer 11

Poor absorption – coeliac, CF, cows milk intolerance, chronic diarrhoea, inflame bowel disease

Question 12

what can cause increased metabolism leading to FTT?

Answer 12

Increased metabolism  hyperthyroidism, chronic disease, malignancy, chronic infections
Increased energy requirements
Increased excretion

Question 13

what can cause difficulty feeding leading to FTT?

Answer 13

Difficulty feeding: poor suck (cerebral palsy), cleft lip/ palate, genetic conditions causing abnormal facial structure, GORD, pyloric stenosis

Question 14

what can cause non-organic causes of FTT?

Answer 14

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

Question 15

how often should a newborn baby be eating?

Answer 15

every 2hrs

Question 16

how long should BF be for each sitting?

Answer 16

20 mins

Question 17

what assessment is needed for ?FFT?

Answer 17

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

Question 18

what is included within feeding history?

Answer 18

• 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

Question 19

what investigations are required within FTT post Hx/ exam?

Answer 19

• Urine dip – UTI
• Coeliac screen – anti-TTG/ anti-EMA antibodies
• CF/ pyloric stenosis if symptoms continue and worsen

Question 20

how would BF help be given?

Answer 20

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

Question 21

how would you promote inadequate nutrition?

Answer 21

• 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

Question 22

what age does a baby start to wean?

Answer 22

6mths

Question 23

what age should a baby start having cows milk?

Answer 23

1yr

Question 24

at what point would an NG tube be considered?

Answer 24

life threatening
with clear goals + clear end point