Failure to thrive

Question 1

Definition of failure to thrive?

Answer 1

Failure to gain adequate height and weight gain at a normal rate for age

Question 2

What ‘values’ are considered failure to thrive?

Answer 2

Weight/Height below the 2nd centile
Weight/Height falls below 2 centile lines
Weight > 2 centile lines above the height

Question 3

What is the main driver of growth in infancy?

Answer 3

Nutrition!
Insulin
IGF
Thyroxine

Question 4

Causes of FTT

Answer 4

1) Inadequate calorie intake
Non-organic: neglect, social deprivation
Organic: cleft palate, neuromuscular disease, anorexia due to chronic illness
2) Malabsorption - Coeliac, Crohn’s disease, Cystic fibrosis, Cow’s milk protein allergy
3) Excessive losses - GORD, pyloric stenosis
4) Increased requirements - Chronic illness, malignancy
5) Failure to utilise nutrients - premature/IUGR, Chromosomal abnormalities, metabolic abnormalities i.e congenital hypothyroidism, metabolic storage disease

Question 5

Histories to ask?

Answer 5

Feeding history
Birth history
Obstetric history
Developmental history 
FHx, Psychosocial history

Question 6

Investigations?

Answer 6

FBC + Ferritin
Urinalysis, U + Es, Ca and PO4
LFTs
TFTs
Coeliac autoantibodies
Karyotyping
Stool MCS &Faecal elastase
Sweat test