Failure to Thrive

Question 1

Failure to thrive is NOT only for infants

Answer 1

Be aware that it occurs across the lifespan

Question 2

Why do we need to talk about this?

Answer 2

Parental concerns

Cognitive development

Question 3

Why should we be concerned as PTs

Answer 3

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

Question 4

Failure to thrive - dx

Answer 4

It describes a problem and is not a diagnosis

A descriptive term, not a specific dx

Question 5

Failure to thrive - is the result of what

Answer 5

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

Question 6

FTT is AKA

Answer 6

Weight faltering

Question 7

FTT refers to

Answer 7

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

Question 8

The underlying cause of FT is always

Answer 8

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

Question 9

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

Answer 9

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

Question 10

Underlying cause

Answer 10

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

Question 11

FTT affects growing children - severe malnutrition can cause

Answer 11

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

Question 12

FTT - early identification and tx

Answer 12

may help to prevent long term developmental deficits

Question 13

Up to 3 months, a baby should be gaining

Answer 13

an ounce (30 g) a day

Question 14

Measurement of growth

Answer 14

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

Question 15

Standard growth charts

Answer 15

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

Question 16

Standard growth charts - reading it

Answer 16

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

Question 17

Diagnosis of FTT

Answer 17

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

Question 18

What do you map

Answer 18

Height
Weight
Head circumference
AT EVERY WELL CHILD VISIT

Question 19

Patterns of growth - over time you see changes in

Answer 19

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

Question 20

Growth trajectory - assessed how

Answer 20

by plotting the child’s growth parameters at various ages

Question 21

Growth charts are standardized for

Answer 21

sex
age
medical condition

Question 22

Growth trajectory - should be plotted from

Answer 22

birth

Question 23

Growth trajectory - special attention should be paid to

Answer 23

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?

Question 24

Pathophysiology

Answer 24

Inadequate intake or absorption
Excess metabolic demand
Defective utilization

Question 25

ASSESS all children for

Answer 25

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

Question 26

Epidemiology - FTT affects

Answer 26

5-10% of young children | 3-5% admitted to teaching hospitals

Question 27

Epidemiology - FTT - most common causes

Answer 27

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

Question 28

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

Answer 28

95% have inadequate food offered or taken

Question 29

What are causes of FTT - Organic FTT

Answer 29

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

Question 30

What are causes of FTT - nonorganic

Answer 30

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

Question 31

Non-organic (Psychosocial) FTT

Answer 31

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

Question 32

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

Answer 32

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

Question 33

Organic FTT - examples

Answer 33

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

Question 34

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

Answer 34

An insult during intrauterine life or genetic/chromosomal factors

Question 35

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

Answer 35

Endocrinopathies or constitutional growth retardation should be suspected

Question 36

Other clues for FTT - if only weight gain is delayed

Answer 36

usually reflects recent energy deprivation

Question 37

Further evaluation

Answer 37

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

Question 38

Eval of a child with FTT - Prenatal

Answer 38

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

Question 39

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

Answer 39

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

Question 40

Eval of child with FTT - Medical hx of child

Answer 40

``` Regular physician Immunizations Development Med or Surgical illnesses Frequent infections ```

Question 41

Eval of child with FTT - social history

Answer 41

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

Question 42

Eval of child with FTT - nutritional history

Answer 42

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

Question 43

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

Answer 43

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

Question 44

Eval of child with FTT - Psychosocial history

Answer 44

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

Question 45

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

Answer 45

Psychosocial stressors!!!

Question 46

What can be helpful in psychosocial regard

Answer 46

A social worker

Question 47

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

Answer 47

``` 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 ```

Question 48

Management of the child with FTT

Answer 48

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

Question 49

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

Answer 49

If adequate food is available in the home

Question 50

Development and Bx - with nutrition

Answer 50

Developmental and bx problems may contribute to undernutrition and vice versa

Question 51

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

Answer 51

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

Question 52

Laboratory and diagnostic imaging evaluation

Answer 52

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

Question 53

The underlying cause of FTT is

Answer 53

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

Question 54

What might be related to irreversible developmental deficits and behavior problems

Answer 54

Nutritonal deprivation in infancy may be related