Failure to thrive Flashcards
What does failure to thrive refer to?
poor physical growth and development in a child
What is faltering growth?
a fall in weight across one or more centile spaces if birthweight was below 9%
a fall in weight across two or more centile spaces if birth weight was between 9% - 91%
a fall in weight across three or more centile spaces if birthweight was above 91%
What are centile spaces?
distance between two lines on graph
e.g. 75th and 50th is one centile space
What can lead to failure to thrive?
anything that leads to inadequate nutrition and energy
How can causes of failure to thrive be categorized?
inadequate nutritional intake
difficulty feeding
malabsorption
increased energy requirements
inability to process nutrition
What are causes of inadequate nutritional intake?
maternal malabsorption if breastfeeding
iron deficiency anaemia
family or parental problems
neglect
availability of food (poverty)
What are causes of difficulty feeding?
poor suck, CP
cleft palate or lip
pyloric stenosis
genetic abnormality with facial structure compromised
What are causes of malabsorption?
cystic fibrosis
celiac disease
cow’s milk intolerance
chronic diarrhea
IBD
What are causes of increased energy requirements?
hyperthyroidism
chronic disease, congenital heart disease and cystic fibrosis
malignancy
chronic infections, HIV or immunodeficiency
What are causes of inability to process nutrients properly?
inborn errors of metabolism
type 1 diabetes
BMI is used for what age?
greater than 2 years
What should be done to establish cause of failure to thrive?
full history and exam:
pregnancy, birth, developmental and social history
feeding or eating history
observe feeding
physical and mental health of mother
parent-child interactions
height, weight and BMI
mid-parental height
What is the mid parental height?
(height of mom + dad)/2
Inadequate growth and nutrition is assessed when?
height more than 2 centile spaces below mid parental height
BMI below 2nd centile
If a child has faltering growth, what tests are recommended?
urine dipstick for UTI
Celiac screen (anti-TTG, and anti-EMA)
All children with faltering growth should have?
regular reviews to monitor weight
If a mother is having difficulty breastfeeding what should be done?
midwives, health visitors, peer groups, and lactation consultants, supplementing with formula milk
Feeding with formula is likely to do what?
improve growth, however, results in breastfeeding stopping, mother should be encouraged to breastfeed prior to top up feeds, and express when not breastfeeding
If inadequate nutrition is the cause, what can be done?
encouraging regular structured mealtimes and snacks
reduce milk consumption to improve appetite for other foods
review by a dietician
additional energy dense foods to boost calories
nutritional supplement drinks
enteral feeding if other methods fail
