Failure to Thrive Flashcards
What is failure to thrive?
Poor weight or height gain in infancy resulting in crossing of 2 or more centile lines on the growth charts. Head circumference preserved relative to height and height also preserved relative to weight
What are the risk factors for failure to thrive?
SGA Gastro problems such as reflux or coeliac Cerebral palsy Prematurity Poverty Autism Swallowing disorder Carer depression
What are the common causes of failure to thrive?
95% due to not enough food either being offered or taken
This can be as a result of: poverty, difficulty at home, neglect, unskilled feeding, not enough breast milk
Normal child of short stature e.g. low birth weight, short parents
What should you ask about in the history for a child with failure to thrive?
Abuse, feeding patterns, behaviour, activity levels, family finances, health and happiness, chart family height, parental illness and dysmorphic face
Assess breast feeding technique - latching and swallowing
Check bottle of bottle fed babies
Does weight gain return if child removed
Any safeguarding concerns?
What investigations should be considered in a child with failure to thrive?
FBC for anaemia Urinalysis for UTI Coeliac serology Sweat test Skeletal survey Glucose tests Thyroid function
What is short stature?
A height < 2nd centile
What causes a short stature?
Familial or prematurity Constitutional delay (bone age 1-2 years off) short stature accentuated by puberty delay Hypothyroidism or reduced GH Nutritional/chronic illness – coeliac, IBD, infection – falling off centiles, large bone delay Psychological neglect Poverty, physical abuse Turner’s or cystic fibrosis Cushing syndrome e.g. Steroids
What parameters should you take into consideration when investigating someone who has short stature and what investigations might you order?
Growth velocity – most sensitive indicator of growth failure, need 2 accurate measurements 6 months apart and value given in cm/yr.
Predicted parental height – Add parents height together, divide by 2 then add 7cm for boys and take away 7cm for girls. Range is +/-10cm.
Skeletal survey for bone age IGF1 and IGF binding protein 3 and GH stimulation test FBC, U&E, LFT, TFT Coeliac screen Karyotype to exclude Turner’s in girls
How often should children of different ages have their growth measured?
Infants aged 0-1 years should have at least 5 recordings of weight
Children aged 1-2 years should have at least 3 recordings of weight
Children older than 2 years should have annual recording of weight
Children below 2nd centile for height should be reviewed by their GP
Children below 0.4th centile for height should be reviewed by a paediatrician
