Failure to thrive Flashcards
What is failure to thrive or “poor growth”?
a child whose current weight, or rate of weight gain, is significantly below that expected of similar children of the same age and sex
Red flags in FTT?
- Signs of abuse or neglect
- Poor carer understanding e.g. non-English speaking, intellectual disability
- Signs of family vulnerability e.g. drug and alcohol abuse, domestic violence, social isolation, no family support
- Signs of poor attachment
- Parental mental health issues
- Already/previously case managed by child protection services
- Did not attend or cancelled previous appointment/s
- Signs of dehydration
- Signs of malnutrition or significant illness
Differentials for Inadequate caloric intake/retention in FTT
Inadequate nutrition (breastmilk, formula and/or food)
Breast feeding difficulties
Restricted diet (e.g. low fat, vegan)
Structural causes of poor feeding eg. cleft palate
Persistent vomiting
Anorexia of chronic disease
Error in infant formula dilution
Early (before 4 months) or delayed introduction of solids
Differentials for psychosocial factors in FTT
Parental depression, anxiety or other mood disorders
Substance abuse of one or both parents
Attachment difficulties
Disability or chronic illness of one or both parents
Coercive feeding (including feeding child whilst asleep)
Difficulties at meal times
Poverty
Behavioural disorders
Poor social support
Poor carer understanding
Exposure to traumatic incident/family violence
Neglect of this infant or siblings
Current or past Child Protection involvement
Differentials for inadequate absorption in FTT
Coeliac disease Chronic liver disease Pancreatic insufficiency eg. Cystic fibrosis Chronic diarrhoea Cow milk protein intolerance
Differentials for excessive caloric intake in FTT
Chronic illness Urinary tract infection Chronic Respiratory disease eg. Cystic Fibrosis Congenital heart disease Diabetes Mellitus Hyperthyroidism
Other medical causes for FTT?
Genetic syndromes
Inborn Errors of Metabolism
What are the main groups of causes for FTT?
1) Inadequate caloric intake/retention
2) Psychosocial factors
3) Inadequate absorption
4) Excessive caloric utilization
5) Other Medical Causes
What members of a multidisciplinary team may be involved with a child with FTT?
maternal child health nurse (MCHN) general practitioner (GP) paediatrician dietitian lactation consultant speech pathologist OT psychologist social worker infant mental health clinician child protection worker
Which babies need specific/different growth charts?
Down syndrome, Turner syndrome and Williams syndrome
Investigations for FTT
FBE, ESR UEC, LFT Iron studies Calcium, phosphate Thyroid function Blood glucose Urine for microscopy and culture Coeliac screen if on solid feeds containing gluten Stool microscopy and culture Stool for fat globules and fatty acid crystals
When to admit for FTT?
- signs of significant illness or dehydration.
- signs of child abuse, neglect, poor parental understanding or psychosocial concerns (ie when parents have failed to follow advice or attend follow up appointments), discuss with a senior doctor and consider admission.
- Children who continue to have persistent poor growth despite adequate intervention.
Normal weight for a baby? (up to 12 mo)
0 to 3 months
150 -200g/week
3 to 6 months
100 - 150g/week
6 to 12 months
70-90g/week
Formula for predicting a child’s height?
Boys:
[Paternal height in cms + (maternal height in cms +13 cm)] divided by 2
= adult height in cms
Girls: [Maternal height in cms + (paternal height in cms - 13 cms)] divided by 2
= adult height in cms
Good first foods for baby?
infant cereals, pureed meat, poultry and fish (all sources of haem iron), or cooked tofu and legumes. Vegetables,
fruits, and dairy products such as full-fat yoghurt, cheese and custard can then be added.
• from 6 months of age, infants should be offered purees and then mashed foods, progressing to minced and
chopped foods
• by 8 months most infants can manage ‘finger foods’
• by 12 months, infants can have nutritious choices from the foods eaten by the rest of the family and should be
consuming a wide variety of foods.
Which foods should be avoided for baby?
-No child <15 months old should be offered foods such as popcorn, hard lollies, raw carrot or apples (or food of similar consistency). **CHOKING HAZARD
- Children <4 yo should not be offered peanuts.
- cow’s milk should not be given as a main drink to infants
under the age of 12 months (no goats milk either)
- avoid salty food (baby kidneys + fat kids)
- Honey can contain the spores of Clostridium botulinum, and should not be given to infants aged under 12 months.
- nut pastes and nut spreads can be offered to infants from around 6 months of age
- low fat milk (can drink at age 2)
- tea/coffee/sweetened drinks
Advice for mum feeding baby a vegan diet?
- Vegetarian diets do not provide sufficient iron for infants without the use of iron-fortified cereals, milks or other
foods. Vegan diets are also low in iron and in vitamin B12, which is only found in animal foods.
*Mothers who follow a vegan diet should breastfeed their infants for as long as possible( >2 yrs or more is desirable) For infants being fed a vegan diet who are not breastfed or are partially breastfed, a commercial soy-based infant formula during the first 2 years of life is recommended.
*Dietetic advice is recommended. - may require nutritional supplements, especially
iron and vitamin B12.
Investigations for coeliac disease
Determine if patient is eating gluten.
NO = gluten challenge
= 2 slices bread/day for 2–8 wks then coeliac
serology
YES = coeliac serology
- IgA-tTG (tissue transglutaminase)
+/– IgA-EMA (endomysial antibody)
+/– IgA-DGP; total IgA levels (deamidated gliadin peptide)
POSITIVE = refer for duodenal biopsy = diagnostic
