Failure to Thrive Flashcards
what is the current clinical concept of FTT?
it’s multifactorial
what % of children in primary care have FTT?
5-10%
at what age does FTT mostly present?
before 18 mo
what socioeconomic class is disproportionately affected w/ FTT?
poorer rural & urban communities
do children w/ special healthcare needs have higher or lower rates of FTT?
higher
How does severe, prolonged malnutrition in resource-poor countries affect a child’s growth & cognitive development?
negatively & permanently
what happens w/ babies w/ LBW who develop FTT?
long-term developmental effects > smaller, lower cognitive scores, poorer overall academic performance
T/F: serious nutrition deficiencies are rare in the US
true
what happens w/ babies w/ normal birth weight who develop FTT?
no correlation btwn long term health probs or lower cognitive development
what are the 3 main causes of FTT?
- inadequate intake
- inadequate uptake/absorption
- inc metabolic demand/inc calorie requirements
what period of your life has the most rapid growth?
infancy
what are the calorie needs of an infant?
3-4x adult
~100-110/kg
health & appropriate development are primarily dependent on WHAT?
adequate nutrition
what are examples of inadequate energy intake seen in primary care?
- breastfeeding prob
- improper formula prep
- GERD
- discoordination of suck/swallow/breathe
- cleft lip/palate
- mood disorder
- eating disorder
- constipation
- IBS
- dental caries
what are some examples of psychosocial causes of inadequate energy intake?
- poverty/financial stress (low food avail)
- parent (depression, eating disorder, low fxning, neglect, drugs)
- sensory disorder, food phobia, oral aversion
what are some examples of causes of inadequate energy UPtake?
- malabsorption
- GI malformation
- inborn error of metabolism
- food intolerance or allergy
- celiac
- diabetes
- renal dz
what are some examples of causes of high metabolic needs?
- prematurity
- chronic infxn or immunodeficiency
- pulm dz
- congenital heart dz or heart failure
- seizure disorder
- thyroid dz
- chronic pulmonary dz/asthma
- heart dz or failure
- malignancy
what things should you ask about in the workup of a FTT infant?
- pre/postnatal hx
- existing health probs (infxn, resp sx, vomiting, diarrhea, constipation, allergies)
- caregiver status
what are the 5 RED FLAG signs & sx suggesting a medical cause of FTT?
- cardiac findings that suggest congenital heart dz or heart failure
- developmental delay
- dysmorphic features
- recurrent/severe infxn
- recurrent vomiting, diarrhea, or dehydration
what should you do in the physical exam if you’re working up FTT? (4 main things)
- review growth chart
- note general appearance
- look for signs of injury/abuse
- look for signs of malnutrition
what are the signs of malnutrition?
hair > easily pluckable, changes in color
skin > dry & scaly
behavior > irritable, apathetic, socially unresponsive
bloated abd
how often does routine lab testing identify a cause for FTT?
only <1%
what tests can you do to evaluate a cause for FTT?
swallow studies
genetic tests
cardiac fxn
pulm fxn
what should you do for a medical workup of FTT?
- CBC
- CMP
- stool pH
- fecal fat
- stool o&p, culture
what are you looking for when you do a CBC in a FTT infant?
anemia or lymphopenia
what are you looking for when you do a CMP in an infant w/ FTT?
renal dz
electrolyte disorder
protein malabsorption
what should you be observing at the clinical visit when you are evaluating FTT?
- parent child interactions & bonding
- parent demeanor
- literacy level or intellectual ability
what part of the breast should an infant latch onto to breastfeed?
the ENTIRE areola & nipple
if a baby has an open mouth, is it likely that he wants to eat?
YUP
what is the best way to get back to pre-pregnancy weight for the mom?
breastfeed!
what are the health effects for women who breastfeed?
lower rates of breast & ovarian cancer
fewer hip fx
what are the 3 forms of formula you can buy?
- powdered
- concentrated liquid
- ready-to-feed
what do “enhanced” formulas possibly contain?
probiotics
DHA
fiber
how often should you feed a newborn?
on demand!
every 2-3 hours (8-12 feedings per 24 hours)
what are signs of hunger that an infant might display?
opening the mouth suckling sounds waving hands hand-to-mouth rooting pre-cry fussing crying
should you wake a baby up to feed it?
if it’s jaundiced, YES
if it has already skipped one meal, YES
when should you burp a baby?
midway thru or after feeding
how long should you breastfeed at a time?
20-45 min per feeding
how many ounces should you give a baby per feeding?
2+ oz per feeding (from a bottle)
what are 3 common problems a/w food intake?
spitting up
gas
constipation
T/F: healthy infants need lots of water
FALSE
they don’t need any extra! they get enough in breastmilk/formula
how many wet diapers should a baby have per day?
6-8/day cloth
5-6/day disposable
what should you use as an indicator of hydration of an infant?
of wet diapers per day
when should you offer a baby their first foods?
4-6 mo
bc the digestive system has matured a little
what things indicate that a baby is ready for their first foods?
- tongue protrusion reflex is disappearing
- head & neck control improve
- sitting w/ little or no assistance
what is a good idea to offer as a first food for a baby?
rice cereal + iron, thinned out w/ breastmilk or formula (thicken it as they get better)
what utensil should you use to feed a baby first?
a SPOON
at what age is a baby ready for finely chopped table foods?
7-10 mos
at what age do kiddos get good at chewing?
not until age 4!
how big should you chop food for babies?
1/4 inch pieces
at what age is a baby first ready to try feeding themselves?
~7-9 mos (bc pincer grasp is developing)
what types of foods should you offer a baby that is ready to start feeding itself?
foods that dissolve easily like baby crackers, bread pieces, sliced cheese, dry cereals
when can many babies master feeding themselves?
14-18 mos
at what age should you offer a cup to a baby?
6 mos (cut down on bottles around 9-10 mos)
what type of cups are best for babies learning to drink for themselves?
open cups (supervised) use sippy cups w/ lids only when necessary
what is the best seating for a toddler?
must have foot and hand support
must be seated
must be secure & unable to get out
must have a stable base
what is the appropriate interval for measuring a baby from 0-9 mos?
every 4-6 weeks
what is the appropriate interval for measuring a baby from 10-24 months?
every 3-4 months
what is the appropriate interval for measuring a baby from 2-5 yo?
every 6 months
what growth parameter is usu the first to respond to under-nutrition?
WEIGHT
length & head circumference are usu spared
what growth parameters change if a pt has a chronic medical condition?
a symmetric fall in BOTH weight & length
T/F: you really only need to pay attn to one growth parameter when evaluating FTT
FALSE
best to use a combo of measures
what is “underweight”?
weight is significantly lower than other children:
<5th %ile weight/length or BMI
what is growth faltering?
child’s rate of weight gain slows or stops after it has previously been established
what 6 team members should be present to treat FTT?
- medical
- nutrition
- development
- occupational or speech/language
- social work
- mental health
how can you provide parent support to a parent w/ an infant w/ FTT?
- treatment or counseling for identified conditions
- parenting classes if low fxn
- stress mgmt
- “checking in”
what are the 4 criteria for treatment success of FTT infants?
- optimal growth
- developmentally appropriate feeding & eating skills
- healthy eating habits firmly entrenched
- healthy eating relationships firmly entrenched
look at slide 60 cause i don’t wanna make cards for that
okay
how can you increase energy density for an INFANT?
change formula to 24 or 27 kcal/oz
conc std 20 kcal formula w/ diff proportions powder to water
add fat/oil, avo, polycose, moducal
what foods should you AVOID if you’re trying to increase energy density?
jello
juice
popsicles
candy
what foods can you use to increase energy density for a CHILD?
cream, powdered milk, instant breakfast powder, avocado, PB, sour cream, yogurt, butter, cream cheese, ranch
