Failure to thrive

Question 1

Definition

Answer 1

Significant interruption in the expected rate of growth compared with other children of a similar age and sex
Mild/moderate: crossing 2 spaces
Severe: crossing 3

Question 2

Causes

Answer 2

Most often due to undernutrition for child’s specific energy output - problems with diet or feeding patterns
Neglect
Maternal mental health problems or addiction
Organic causes

Question 3

Organic causes

Answer 3

Inadequate food intake:
Breast feeding - inadequate supply, poor technique
Formula feeding - milk too dilute
Anorexia - due to chronic illness
Unable to feed - cleft palate, cerebral palsy
Vomiting - reflux
Malabsorption:
Coeiac disease
CF
Short gut - postoperative
Cow's milk protein allergy
Increased energy requirements:
Chronic illness - CF, congenital heart disease, chronic renal failure

Question 4

Presents

Answer 4

Routine heights and weights
Parents concerned
Charts!

Question 5

Management

Answer 5

Advice, education, health visitor/dietician input
Dietary: Extra snacks/meals; limit fluid intake; increase energy density of food
Behavioural: Meals at regular times with other family members, including parents; praise when food is eaten, ignore if it is not; limit meal time to 30 mins; avoid mealtime conflict; do not force feed
Treat underlying social, maternal or organic cause