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Semester 5 PMNM Exam 9 > Failure to Thrive > Flashcards

Failure to Thrive Flashcards

1
Q

Failure to thrive is NOT only for infants

A

Be aware that it occurs across the lifespan

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2
Q

Why do we need to talk about this?

A

Parental concerns

Cognitive development

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3
Q

Why should we be concerned as PTs

A

We get more constant time with the patient and see them more ongoing than a PA for example

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4
Q

Failure to thrive - dx

A

It describes a problem and is not a diagnosis

A descriptive term, not a specific dx

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5
Q

Failure to thrive - is the result of what

A

Inadequate usable calories necessary for a child’s metabolic growth demands, and it manifests as physical growth that is significantly less than that of peers

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6
Q

FTT is AKA

A

Weight faltering

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7
Q

FTT refers to

A

failure to gain weight appropriately; in more severe cases, linear growth and head circumference also may be affected

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8
Q

The underlying cause of FT is always

A

Insufficient usable nutrition although a wide variety of medical and psychological stressors can contribute

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9
Q

Thriving - what it should be - what are we looking for in healthy babies

A

Double their birth weight by 4/5 months
Triple their weight by 1st yr
Height reaches 2x birth length by 3 or 4yrs
Children whose weight gain is similar to that of other children of similar age and sex

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10
Q

Underlying cause

A

Insufficient usable nutrition
Inadequate dietary energy intake
Inadequate nutrient absorption
Increased energy requirements

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11
Q

FTT affects growing children - severe malnutrition can cause

A

Persistent short stature
Secondary immune deficiency
Permanent damage to various parts of the brain and CNS

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12
Q

FTT - early identification and tx

A

may help to prevent long term developmental deficits

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13
Q

Up to 3 months, a baby should be gaining

A

an ounce (30 g) a day

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14
Q

Measurement of growth

A

Accurate measurement of the child’s weight, length, and head circumference is essential

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15
Q

Standard growth charts

A

One for M and F
Based on Caucasians
Different one’s for certain syndromes and premie
Also a different one for age 2-20

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16
Q

Standard growth charts - reading it

A

Can be very subtle
One point tells you nothing - has to be sequential view
Things that fall below 2nd or 3rd percentile is a red flag or also if they go over two thresholds of normal

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17
Q

Diagnosis of FTT

A

Child whose weight is less than 2nd or 3rd percentile for gestational corrected age and sex
Who have decreased velocity of weight gain that is disproportionate to growth in length

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18
Q

What do you map

A

Height
Weight
Head circumference
AT EVERY WELL CHILD VISIT

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19
Q

Patterns of growth - over time you see changes in

A

Growth
Weight
Length
Head circumference may provide variable clues to the etiology of diminished weight

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20
Q

Growth trajectory - assessed how

A

by plotting the child’s growth parameters at various ages

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21
Q

Growth charts are standardized for

A

sex
age
medical condition

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22
Q

Growth trajectory - should be plotted from

A

birth

23
Q

Growth trajectory - special attention should be paid to

A

timing of changes in the slopes of the weight, length, or head circumference
- What happened at that point in child’s life?
Initiation of food?
Parental stressors?

24
Q

Pathophysiology

A

Inadequate intake or absorption
Excess metabolic demand
Defective utilization

25
Q

ASSESS all children for

A

medical reasons as to why
Nutritional (is nutrition not available)
Developmental/bx
Social

26
Q

Epidemiology - FTT affects

A

5-10% of young children

3-5% admitted to teaching hospitals

27
Q

Epidemiology - FTT - most common causes

A

Under feeding is the single most common cause that results from parental poverty and/or ignorance

28
Q

Epidemiology - FTT - what percent had inadequate food offered or taken

A

95% have inadequate food offered or taken

29
Q

What are causes of FTT - Organic FTT

A

Growth failure is due to an acute or chronic disorder that interferes with nutrient intake, absorption, metabolism, or excretion or that increases energy requirements
Celiac disease, CF, neuro pathology

30
Q

What are causes of FTT - nonorganic

A

Up to 80% of children with growth failure do not have an apparent organic disorder - growth failure occurs because of environmental neglect (lack of food), stimulus deprivation, or both

31
Q

Non-organic (Psychosocial) FTT

A

It is due to poverty, psychosocial problems in the family, maternal deprivation, lack of knowledge and skill in infant nutrition among caregivers

32
Q

Non-organic (psychosocial) FTT - Other risk factos include

A

Substance abuse by parent, single parenthood, general immaturity of one or both parents, economic stress and strain, temporary stresses such as family tragedies or marital disharmony

33
Q

Organic FTT - examples

A

Infections (HIV, TB, Parasitosis)
GI (chronic diarrhea, GERD)
Neuro (CP, MR)
UTI is a major preventable and treatable cause of FTT and all pts presenting should be evaluated for UTI

34
Q

Other clues for FTT - If w, h, head are all less than what is expected for age, might suggest

A

An insult during intrauterine life or genetic/chromosomal factors

35
Q

Other clues for FTT - If weight and height are delayed with a normal head circumference

A

Endocrinopathies or constitutional growth retardation should be suspected

36
Q

Other clues for FTT - if only weight gain is delayed

A

usually reflects recent energy deprivation

37
Q

Further evaluation

A

Use of appropriate growth charts
Developmental assessment
Parent-child interaction
Observation of feeding

38
Q

Eval of a child with FTT - Prenatal

A

General OB hx
Recurrent miscarriages
Use of meds, drugs, or cigarettes

39
Q

Eval of child with FTT - Labor, delivery, and neonatal events

A 
Neonatal asphyxia
Prematurity
Birth weight
Congenital malformations or infections
Maternal bonding at birth
Breastfeeding 
Feeding difficulties
40
Q

Eval of child with FTT - Medical hx of child

A 
Regular physician
Immunizations
Development
Med or Surgical illnesses
Frequent infections
41
Q

Eval of child with FTT - social history

A

Age and occupation of parents
Who feeds child
Life stressors
Variability of social and economic support
Perception of growth failure as a problem
Hx of violence or abuse of care giver

42
Q

Eval of child with FTT - nutritional history

A

Details of breast feeding
Vitamin and mineral supplements
Solid foods
Food likes and dislikes, allergies, or idiosyncracies

43
Q

Eval of child with FTT - Review of systems/clues to organic disease

A 
Anorexia
Change in mental status
Dysphagia
Stooling pattern
Vomiting or reflux
Recurrent fever
Dysuria, urinary freq
Activity level, ability to keep up with peers!
44
Q

Eval of child with FTT - Psychosocial history

A

Critical!!
Can be indication for serious social or psychologic problems
Psychosocial stressors are the predominant cause of insufficient nutrient intake in children of all ages

45
Q

Eval of child with FTT - what are predominant cause of insufficient nutrient intake in children of all ages

A

Psychosocial stressors!!!

46
Q

What can be helpful in psychosocial regard

A

A social worker

47
Q

Eval of child with FTT - psychosocial history - assessment of the true caretakers and family composition

A 
Employment status
Financial state
Degree of social isolation
Family stress
If there are multiple caretakers it is important to figure out their views on eating problem
48
Q

Management of the child with FTT

A 
Diet and eating pattern
Developmental stimulation
Improvement in care giver skills
Presence of any underlying disease
Regular and effective follow up
49
Q

Eval of child with FTT - Psychosocial hx - attempt should be made to determine what

A

If adequate food is available in the home

50
Q

Development and Bx - with nutrition

A

Developmental and bx problems may contribute to undernutrition and vice versa

51
Q

The goals of the physical exam of a child with FTT Include

A

Identification of signs of genetic disorders
Medical diseases contributing to undernutrition or malnutrition
Child abuse or neglect

52
Q

Laboratory and diagnostic imaging evaluation

A

Simple routine blood testing, including CBC, urinalysis, blood urea nitrogen, electrolytes, lead testing are appropriate

53
Q

The underlying cause of FTT is

A

Insufficient usable nutrition: Inadaquate dietary energy intake, inadequate nutrient absorption, or increased energy requirements

54
Q

What might be related to irreversible developmental deficits and behavior problems

A

Nutritonal deprivation in infancy may be related

Semester 5 PMNM Exam 9 (6 decks)

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