failure to thrive

Question 1

what physiological causes are there for short stature? (2)

what endocrine causes may cause short stature? (3)

Answer 1

• constitutionally small
• maturational delay (often familial)
• hypothyroidism
• corticosteroid excess
• growth hormone deficiency

Question 2

chronic illnesses that may cause short stature? (3)

genetic causes? (2)

antenatal?

Answer 2

• chronic renal failure
• IBD
• coeliac disease
• Turners syndrome
• (other genetic syndrome)
• skeletal dysplasia
• IUGR

Question 3

What might make you worry about a childs growth? (4)

Answer 3

• crossing of centiles (two centile lines crossed)
• discrepancy between child height and weight
• discrepancy with parental heights
• parental or professional concern

Question 4

what sex should you consider Turners syndrome in?

Answer 4

• girls (X linked condition)

Question 5

what investigations might you do to investigate a child with short stature?

Answer 5

• karyotype
• Growth hormone tests
• TFT
• FBC/ ESR/ coeliac antibodies
• x-ray of wrist for bone age

Question 6

what can a delayed bone age suggest?

Answer 6

• maturational delay
• hypothyroidism
• growth hormone deficiency
• corticosteroid excess (Cushings)

Question 7

what can a plateau in growth suggest?

Answer 7

• chronic illness (coeliac, CF)

- endocrine causes (GHD, cushings, hypothyroid)

Question 8

apart from crossing two centiles for height or weight, what else should be used for clinical evaluation?

Answer 8

• weight below 2nd centile

- height below 2nd centile

Question 9

what may present with vomiting, irritability and occasionally apnoea that may cause failure to thrive in a child?

what might you elicit in a psychosocial cause of F to T?

Answer 9

• Gastro-oesophageal reflux
• eating difficulties common
• maternal depression
• poor maternal-infant attachment may be evident

Question 10

when does the posterior fontanelle close?

the anterior fontanelle?

Answer 10

• 8 weeks of age

- 12-18 months

Question 11

up to what age is it normal for head circumference to cross centiles?

what kind of symptoms might indicate raised ICP in a big headed baby? (4)

Answer 11

• up to a year old
• vomiting
• lethargy
• irritability
• poor appetite

Question 12

name 4 causes of a large head in a baby

Answer 12

• normal variation
• hydrocephalus
• subdural effusion or haematoma
• features of dysmorphic syndromes

Question 13

what groups of kids may have small head growth (microcephaly)?

Answer 13

• Downs syndrome
• hypoxic- ischaemic changes
• infection
• craniosynostosis

Question 14

what clinical features do you get in turners syndrome?

Answer 14

• webbed neck

- lymph oedematous hands and feet