Failure To Thrive Flashcards
1
Q
Definition of FTT
A
- BMI < 3rdcentile on 2 or more separate occasions
- OR dropping two or more percentile tracks
2
Q
Which growth parameter is affected in FTT
A
- Implies failure to gain weight, with height and head circumference being initially well preserved
3
Q
Compare FTT vs short stature
A
- Failure to thrive:- generally indicative of underlying nutritional deficiency or chronic disease
- height centile exceeds that of weight = thin = lower BMI % (sds)
- Short stature:- generally indicative of endocrine disorders or skeletal abnormalities
- weight centile exceeds that of height = “chubby” = higher BMI % (sds)
4
Q
Give some examples of causative factors of FTT, dividing them into major categories
A
Prenatal • Prematurity with complications • Maternal malnutrition • Toxin exposure in utero • Alcohol, smoking, medications, infections during pregnancy • IUGR • Chromosomal abnormalities
Postnatal/organic • Poor intake • Inability to suck/swallow • Lack of appetite/chronic illness • Vomiting • GI pain or dysmotility
Poor absorption • Coeliac disease • Pancreatic/cholestatic condition • Intolerances of food products • CF • Crohn's disease • Anatomical GI abnormality
Excess utilisation i.e. inc metabolic demand • Cardiopulmonary disease • Inflammatory disease • Thyroid disease • Chronic infection • Renal failure • Malignancy
Psychosocial factors • Child neglect/abuse • Lack of parental support/prearation • Poverty • Dysfunctional family • Poor feeding • Mental health/behavioural disorders
5
Q
Outline a targeted Hx for FTT.
A
Intake • What is consumed? • How is it made up? • When were solids added? • Feeding difficulties
Output • Amount and colour of vomit • Stool frequency and consistency • Number of wet nappies • Post-tussive • Neurological? Strong gag?
Birth Hx • Gestation • Complications PHx • Chronic illness • Recurrent infections Fhx • Presence of maternal depression • Growth pattern of other family members • Illnesses • Consanguinity Developmental Hx • Especially looking for developmental regression
6
Q
What might you consider when ordering Ix for FTT?
A
- FBE and film - look for hypochromic microcytic anaemia of iron deficiency
- Urinalysis, urine culture
- Creatinine
- UEC, CMP, glucose
- LFTs, including protein and albumin
- ESR (raised in IBD)
- Stool MCS and OCP
- Coeliac screen
- Iron studies
- Fat soluble vitamins (ADEK)
- B12, folate
- Zinc, selenium
- Sweat chloride (for CF)
- Vitamin D (for rickets)
- TFTs
- HIV antibodies
7
Q
What is important in the Mx of FTT?
A
• Assessment on admission ○ Feeding technique ○ Parent-child interaction • Occasional NG feeding in short term • Regular growth measurements
