Failure to Thrive Flashcards
Failure to thrive is NOT only for infants
Be aware that it occurs across the lifespan
Why do we need to talk about this?
Parental concerns
Cognitive development
Why should we be concerned as PTs
We get more constant time with the patient and see them more ongoing than a PA for example
Failure to thrive - dx
It describes a problem and is not a diagnosis
A descriptive term, not a specific dx
Failure to thrive - is the result of what
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
FTT is AKA
Weight faltering
FTT refers to
failure to gain weight appropriately; in more severe cases, linear growth and head circumference also may be affected
The underlying cause of FT is always
Insufficient usable nutrition although a wide variety of medical and psychological stressors can contribute
Thriving - what it should be - what are we looking for in healthy babies
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
Underlying cause
Insufficient usable nutrition
Inadequate dietary energy intake
Inadequate nutrient absorption
Increased energy requirements
FTT affects growing children - severe malnutrition can cause
Persistent short stature
Secondary immune deficiency
Permanent damage to various parts of the brain and CNS
FTT - early identification and tx
may help to prevent long term developmental deficits
Up to 3 months, a baby should be gaining
an ounce (30 g) a day
Measurement of growth
Accurate measurement of the child’s weight, length, and head circumference is essential
Standard growth charts
One for M and F
Based on Caucasians
Different one’s for certain syndromes and premie
Also a different one for age 2-20
Standard growth charts - reading it
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
Diagnosis of FTT
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
What do you map
Height
Weight
Head circumference
AT EVERY WELL CHILD VISIT
Patterns of growth - over time you see changes in
Growth
Weight
Length
Head circumference may provide variable clues to the etiology of diminished weight
Growth trajectory - assessed how
by plotting the child’s growth parameters at various ages
Growth charts are standardized for
sex
age
medical condition
Growth trajectory - should be plotted from
birth
Growth trajectory - special attention should be paid to
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?
Pathophysiology
Inadequate intake or absorption
Excess metabolic demand
Defective utilization
ASSESS all children for
medical reasons as to why
Nutritional (is nutrition not available)
Developmental/bx
Social
Epidemiology - FTT affects
5-10% of young children
3-5% admitted to teaching hospitals
Epidemiology - FTT - most common causes
Under feeding is the single most common cause that results from parental poverty and/or ignorance
Epidemiology - FTT - what percent had inadequate food offered or taken
95% have inadequate food offered or taken
What are causes of FTT - Organic FTT
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
What are causes of FTT - nonorganic
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
Non-organic (Psychosocial) FTT
It is due to poverty, psychosocial problems in the family, maternal deprivation, lack of knowledge and skill in infant nutrition among caregivers
Non-organic (psychosocial) FTT - Other risk factos include
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
Organic FTT - examples
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
Other clues for FTT - If w, h, head are all less than what is expected for age, might suggest
An insult during intrauterine life or genetic/chromosomal factors
Other clues for FTT - If weight and height are delayed with a normal head circumference
Endocrinopathies or constitutional growth retardation should be suspected
Other clues for FTT - if only weight gain is delayed
usually reflects recent energy deprivation
Further evaluation
Use of appropriate growth charts
Developmental assessment
Parent-child interaction
Observation of feeding
Eval of a child with FTT - Prenatal
General OB hx
Recurrent miscarriages
Use of meds, drugs, or cigarettes
Eval of child with FTT - Labor, delivery, and neonatal events
Neonatal asphyxia Prematurity Birth weight Congenital malformations or infections Maternal bonding at birth Breastfeeding Feeding difficulties
Eval of child with FTT - Medical hx of child
Regular physician Immunizations Development Med or Surgical illnesses Frequent infections
Eval of child with FTT - social history
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
Eval of child with FTT - nutritional history
Details of breast feeding
Vitamin and mineral supplements
Solid foods
Food likes and dislikes, allergies, or idiosyncracies
Eval of child with FTT - Review of systems/clues to organic disease
Anorexia Change in mental status Dysphagia Stooling pattern Vomiting or reflux Recurrent fever Dysuria, urinary freq Activity level, ability to keep up with peers!
Eval of child with FTT - Psychosocial history
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
Eval of child with FTT - what are predominant cause of insufficient nutrient intake in children of all ages
Psychosocial stressors!!!
What can be helpful in psychosocial regard
A social worker
Eval of child with FTT - psychosocial history - assessment of the true caretakers and family composition
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
Management of the child with FTT
Diet and eating pattern Developmental stimulation Improvement in care giver skills Presence of any underlying disease Regular and effective follow up
Eval of child with FTT - Psychosocial hx - attempt should be made to determine what
If adequate food is available in the home
Development and Bx - with nutrition
Developmental and bx problems may contribute to undernutrition and vice versa
The goals of the physical exam of a child with FTT Include
Identification of signs of genetic disorders
Medical diseases contributing to undernutrition or malnutrition
Child abuse or neglect
Laboratory and diagnostic imaging evaluation
Simple routine blood testing, including CBC, urinalysis, blood urea nitrogen, electrolytes, lead testing are appropriate
The underlying cause of FTT is
Insufficient usable nutrition: Inadaquate dietary energy intake, inadequate nutrient absorption, or increased energy requirements
What might be related to irreversible developmental deficits and behavior problems
Nutritonal deprivation in infancy may be related
