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Block 11 Week 1 > Failure to Thrive > Flashcards

Failure to Thrive Flashcards

1
Q

what is the current clinical concept of FTT?

A

it’s multifactorial

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2
Q

what % of children in primary care have FTT?

A

5-10%

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3
Q

at what age does FTT mostly present?

A

before 18 mo

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4
Q

what socioeconomic class is disproportionately affected w/ FTT?

A

poorer rural & urban communities

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5
Q

do children w/ special healthcare needs have higher or lower rates of FTT?

A

higher

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6
Q

How does severe, prolonged malnutrition in resource-poor countries affect a child’s growth & cognitive development?

A

negatively & permanently

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7
Q

what happens w/ babies w/ LBW who develop FTT?

A

long-term developmental effects > smaller, lower cognitive scores, poorer overall academic performance

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8
Q

T/F: serious nutrition deficiencies are rare in the US

A

true

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9
Q

what happens w/ babies w/ normal birth weight who develop FTT?

A

no correlation btwn long term health probs or lower cognitive development

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10
Q

what are the 3 main causes of FTT?

A
  1. inadequate intake
  2. inadequate uptake/absorption
  3. inc metabolic demand/inc calorie requirements
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11
Q

what period of your life has the most rapid growth?

A

infancy

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12
Q

what are the calorie needs of an infant?

A

3-4x adult

~100-110/kg

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13
Q

health & appropriate development are primarily dependent on WHAT?

A

adequate nutrition

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14
Q

what are examples of inadequate energy intake seen in primary care?

A
  1. breastfeeding prob
  2. improper formula prep
  3. GERD
  4. discoordination of suck/swallow/breathe
  5. cleft lip/palate
  6. mood disorder
  7. eating disorder
  8. constipation
  9. IBS
  10. dental caries
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15
Q

what are some examples of psychosocial causes of inadequate energy intake?

A
  1. poverty/financial stress (low food avail)
  2. parent (depression, eating disorder, low fxning, neglect, drugs)
  3. sensory disorder, food phobia, oral aversion
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16
Q

what are some examples of causes of inadequate energy UPtake?

A
  1. malabsorption
  2. GI malformation
  3. inborn error of metabolism
  4. food intolerance or allergy
  5. celiac
  6. diabetes
  7. renal dz
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17
Q

what are some examples of causes of high metabolic needs?

A
  1. prematurity
  2. chronic infxn or immunodeficiency
  3. pulm dz
  4. congenital heart dz or heart failure
  5. seizure disorder
  6. thyroid dz
  7. chronic pulmonary dz/asthma
  8. heart dz or failure
  9. malignancy
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18
Q

what things should you ask about in the workup of a FTT infant?

A
  1. pre/postnatal hx
  2. existing health probs (infxn, resp sx, vomiting, diarrhea, constipation, allergies)
  3. caregiver status
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19
Q

what are the 5 RED FLAG signs & sx suggesting a medical cause of FTT?

A
  1. cardiac findings that suggest congenital heart dz or heart failure
  2. developmental delay
  3. dysmorphic features
  4. recurrent/severe infxn
  5. recurrent vomiting, diarrhea, or dehydration
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20
Q

what should you do in the physical exam if you’re working up FTT? (4 main things)

A
  1. review growth chart
  2. note general appearance
  3. look for signs of injury/abuse
  4. look for signs of malnutrition
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21
Q

what are the signs of malnutrition?

A

hair > easily pluckable, changes in color
skin > dry & scaly
behavior > irritable, apathetic, socially unresponsive
bloated abd

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22
Q

how often does routine lab testing identify a cause for FTT?

A

only <1%

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23
Q

what tests can you do to evaluate a cause for FTT?

A

swallow studies
genetic tests
cardiac fxn
pulm fxn

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24
Q

what should you do for a medical workup of FTT?

A
  1. CBC
  2. CMP
  3. stool pH
  4. fecal fat
  5. stool o&p, culture
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25
Q

what are you looking for when you do a CBC in a FTT infant?

A

anemia or lymphopenia

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26
Q

what are you looking for when you do a CMP in an infant w/ FTT?

A

renal dz
electrolyte disorder
protein malabsorption

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27
Q

what should you be observing at the clinical visit when you are evaluating FTT?

A
  1. parent child interactions & bonding
  2. parent demeanor
  3. literacy level or intellectual ability
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28
Q

what part of the breast should an infant latch onto to breastfeed?

A

the ENTIRE areola & nipple

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29
Q

if a baby has an open mouth, is it likely that he wants to eat?

A

YUP

30
Q

what is the best way to get back to pre-pregnancy weight for the mom?

A

breastfeed!

31
Q

what are the health effects for women who breastfeed?

A

lower rates of breast & ovarian cancer

fewer hip fx

32
Q

what are the 3 forms of formula you can buy?

A
  1. powdered
  2. concentrated liquid
  3. ready-to-feed
33
Q

what do “enhanced” formulas possibly contain?

A

probiotics
DHA
fiber

34
Q

how often should you feed a newborn?

A

on demand!

every 2-3 hours (8-12 feedings per 24 hours)

35
Q

what are signs of hunger that an infant might display?

A 
opening the mouth
suckling sounds
waving hands
hand-to-mouth
rooting
pre-cry fussing
crying
36
Q

should you wake a baby up to feed it?

A

if it’s jaundiced, YES

if it has already skipped one meal, YES

37
Q

when should you burp a baby?

A

midway thru or after feeding

38
Q

how long should you breastfeed at a time?

A

20-45 min per feeding

39
Q

how many ounces should you give a baby per feeding?

A

2+ oz per feeding (from a bottle)

40
Q

what are 3 common problems a/w food intake?

A

spitting up
gas
constipation

41
Q

T/F: healthy infants need lots of water

A

FALSE

they don’t need any extra! they get enough in breastmilk/formula

42
Q

how many wet diapers should a baby have per day?

A

6-8/day cloth

5-6/day disposable

43
Q

what should you use as an indicator of hydration of an infant?

A

of wet diapers per day

44
Q

when should you offer a baby their first foods?

A

4-6 mo

bc the digestive system has matured a little

45
Q

what things indicate that a baby is ready for their first foods?

A
  1. tongue protrusion reflex is disappearing
  2. head & neck control improve
  3. sitting w/ little or no assistance
46
Q

what is a good idea to offer as a first food for a baby?

A

rice cereal + iron, thinned out w/ breastmilk or formula (thicken it as they get better)

47
Q

what utensil should you use to feed a baby first?

A

a SPOON

48
Q

at what age is a baby ready for finely chopped table foods?

A

7-10 mos

49
Q

at what age do kiddos get good at chewing?

A

not until age 4!

50
Q

how big should you chop food for babies?

A

1/4 inch pieces

51
Q

at what age is a baby first ready to try feeding themselves?

A

~7-9 mos (bc pincer grasp is developing)

52
Q

what types of foods should you offer a baby that is ready to start feeding itself?

A

foods that dissolve easily like baby crackers, bread pieces, sliced cheese, dry cereals

53
Q

when can many babies master feeding themselves?

A

14-18 mos

54
Q

at what age should you offer a cup to a baby?

A 
6 mos 
(cut down on bottles around 9-10 mos)
55
Q

what type of cups are best for babies learning to drink for themselves?

A 
open cups (supervised)
use sippy cups w/ lids only when necessary
56
Q

what is the best seating for a toddler?

A

must have foot and hand support
must be seated
must be secure & unable to get out
must have a stable base

57
Q

what is the appropriate interval for measuring a baby from 0-9 mos?

A

every 4-6 weeks

58
Q

what is the appropriate interval for measuring a baby from 10-24 months?

A

every 3-4 months

59
Q

what is the appropriate interval for measuring a baby from 2-5 yo?

A

every 6 months

60
Q

what growth parameter is usu the first to respond to under-nutrition?

A

WEIGHT

length & head circumference are usu spared

61
Q

what growth parameters change if a pt has a chronic medical condition?

A

a symmetric fall in BOTH weight & length

62
Q

T/F: you really only need to pay attn to one growth parameter when evaluating FTT

A

FALSE

best to use a combo of measures

63
Q

what is “underweight”?

A

weight is significantly lower than other children:

<5th %ile weight/length or BMI

64
Q

what is growth faltering?

A

child’s rate of weight gain slows or stops after it has previously been established

65
Q

what 6 team members should be present to treat FTT?

A
  1. medical
  2. nutrition
  3. development
  4. occupational or speech/language
  5. social work
  6. mental health
66
Q

how can you provide parent support to a parent w/ an infant w/ FTT?

A
  1. treatment or counseling for identified conditions
  2. parenting classes if low fxn
  3. stress mgmt
  4. “checking in”
67
Q

what are the 4 criteria for treatment success of FTT infants?

A
  1. optimal growth
  2. developmentally appropriate feeding & eating skills
  3. healthy eating habits firmly entrenched
  4. healthy eating relationships firmly entrenched
68
Q

look at slide 60 cause i don’t wanna make cards for that

A

okay

69
Q

how can you increase energy density for an INFANT?

A

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

70
Q

what foods should you AVOID if you’re trying to increase energy density?

A

jello
juice
popsicles
candy

71
Q

what foods can you use to increase energy density for a CHILD?

A

cream, powdered milk, instant breakfast powder, avocado, PB, sour cream, yogurt, butter, cream cheese, ranch

Block 11 Week 1 (2 decks)

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