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Peds: Growth and Development > Failure to Thrive > Flashcards

Failure to Thrive Flashcards

1
Q

Define FTT

A
  1. A sign that describes a particular problem, rather than a diagnosis
    Failure to gain weight appropriately
  2. In more severe cases, HC and length may also be affected
  3. Wide variety of medical problems and psychosocial stressors can contribute to FTT, yet, the underlying cause is mostly “insufficient usable nutrition.”
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2
Q

What can FTT lead to?

A
  1. Important to recognize as malnutrition, as severe malnutrition can cause develop-mental delays:
    A. Permanent damage to CNS: Cognitive deficits
    B. Short stature
    C. Secondary immune deficiency
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3
Q

What are the categories of FTT?

A
  1. Inadequate nutrient intake: MC
  2. Inadequate appetite or inability to eat large amounts
  3. Inadequate nutrient absorption or increased losses
  4. Increased nutrient requirements or ineffective utilization
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4
Q

What growth measurements should be recorded on the growth curve?

A
  1. Wt, length (
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5
Q

How is growth assessed for a premature infant?

A
  1. For premature infants, correct growth curve parameters:

A. Subtract the number of weeks child was premature from the age at the time of evaluation through 24 months of age

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6
Q

What can indicate inadequate nutritional intake causing FTT?

A

Normal growth parameters at birth followed by deceleration in weight, then deceleration in stature (weeks to months later), then deceleration in HC

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7
Q

What can indicate genetic short stature?

A
  1. Can be confused with FTT
  2. Normal growth patterns at birth followed by deceleration in length and weight before age 2 yrs, with low-normal growth velocity after 2 years of age (throughout life)
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8
Q

What are the deviations from normal head growth?

A
  1. May be 1st sign of underlying congenital or genetic problem
  2. Deceleration of HC before deceleration in weight or length
  3. Macrocephaly (HC > 2 SD above the mean)
    A. Hydrocephalus
  4. Microcephaly (HC > 2 SD below the mean)
    A. Severe malnutrition, Down syndrome, fetal alcohol syndrome, congenital infections, PKU, maternal DM, in utero drug or toxin exposure, anoxia, perinatal insult (hypoglycemia, hypothyroidism), neural tube defect
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9
Q

What are the criteria for FTT?

A
  1. Weight 6 months old has not grown for 3 consecutive months
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10
Q

What is the epidemiology for FTT?

A
  1. Affects 8% of infants & children (Hay 2013)

2. 1% - 2% of referrals to children’s hospitals or tertiary care centers (UTD, n.d.)

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11
Q

How many grams/day should a baby gain from 0-3 months?

A

26-31

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12
Q

How many grams/day should a baby gain from 3-6 months?

A

17-18

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13
Q

How many grams/day should a baby gain from 6-9 months?

A

12-13

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14
Q

How many grams/day should a baby gain from 9-12 months?

A

9

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15
Q

How many grams/day should a baby gain from 1-3 yrs?

A

7to 9

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16
Q

What is FTT commonly asst w/?

A
  1. Environmental / behavioral factors
    A. low socioeconomic status, poor parenting skills
  2. Organic causes
    A. Reflux, renal tubular acidosis, infections, CF, etc.
17
Q

What are the medical risk factors for FTT?

A
  1. Prematurity
  2. Developmental delay
  3. Congenital anomalies
    A. Cleft lip &/or cleft palate
    4, Intrauterine exposures
    A. Alcohol, anticonvulsants, infection
  4. Lead poisoning
  5. Anemia
  6. Medical problems
    A. Malabsorption, maldigestion, hyperthyroidism, inadequate intake
18
Q

What are the psychosocial risk factors for FTT?

A
  1. Low socioeconomic status
  2. Social isolation
  3. Life stressors
  4. Poor parenting skills
  5. Substance abuse
  6. Violence
  7. Abuse/Neglect
19
Q

What is the goal of evaluating a child with FTT?

A
  1. Identify potential contributing factors and intervene
  2. Must obtain detailed hx, physical exam, and appropriate labs to rule in or rule out metabolic cause
  3. Interdisciplinary evaluation
    A. Dietician, OT / speech therapist, social worker, behavioral / developmental pediatrician
20
Q

What hx needs to be obtained for a child with FTT?

A 
1. Pre and perinatal hx
A. Low birth weight, intrauterine growth restriction, perinatal stress, prematurity, prenatal exposures
2. PMH
A. Celiac disease, CF, immunodeficiency
3. Fam Hx
A. Height & weight of parents and sibs, developmental delays
4. ROS
5. Nutritional intake & feeding
A. Duration of mealtimes
B. Type of food
C. Quantity of food
D. V/D
6. Psychosocial
A. Assessment of caregivers
B. Employment status
C. Financial status
D. Family stress
E. Formal behavior and developmental evaluation of child
21
Q

What components are needed in the pe for FTT?

A 
1. Observation
A. Observe relationship between child and caregiver
2. Complete physical exam
A. Looking for metabolic cause of undernutrition
-Genetic disorders
-Organic disease
-Vitamin deficiency
-Child abuse or neglect
22
Q

What dx studies are needed for FTT?

A 
1. Basic Labs
A. CBC
B. U/A
C. BUN/Cr
D. Electrolytes
E. Lead level
F. ESR
G. TSH, FT4
2. Additional Labs
A. Albumin
B. Alk Phos
C. Ca
D. Phosphorous
E. UGI with SBFT
F. Swallow study
G. Gastric emptying scan
H. Bone age determination* (skeletal age)
23
Q

How is FTT managed?

A
  1. # 1 Goal : Improve nutritional status for catch-up growth
  2. Individualized plan based on needs of child and family
  3. May require:
    A. Changes to diet, feeding schedule or feeding environment
    B. Addressing psychosocial stressors
    C. Enhancing nurturing ability of caregivers
24
Q

What are the components of a successful plan to address FTT?

A
  1. Medical problems
  2. Nutritional needs
  3. Developmental/behavioral factors
  4. Psychosocial factors
25
Q

What are the areas of intervention for FTT?

A
  1. Establish appropriate nutrient intake
  2. Improved parent-child interactions
  3. Emphasis on feeding practices
  4. Management of organic disease
  5. Special stimulation of infant in some cases
  6. Amelioration of social problems
  7. Mental health support for parents
26
Q

What are the indications for hospitalization for FTT?

A
  1. Severe malnutrition
  2. Significant dehydration
  3. Serious illness
  4. Psychosocial circumstances that place child at risk for harm
  5. Failure to respond to outpatient management after 2-3 months
  6. Precise documentation of energy intake
  7. Extreme parental impairment / anxiety

Peds: Growth and Development (13 decks)

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