Failure to thrive Flashcards
describe patterns of height growth over newborn to adolescent period
gradual decline in height velocity after the age of 2 until 12 years for girls and 15 for boys when height increases rapidly again briefly and then slows to stop
why do girls stop growing sooner
oestrogen closes epiphysis
describe patterns of weight gain over newborn to adolescent period
rate of weight gain declines until age 6 then velocity increases. Peaks at 13y for girls and 15 for boys then decreases to a stop at 16 for girls and 18 for boys
what is the peak age for lymphoid tissue development?
12y
describe what is required for growth
adequate hormones
neural mechanisms
positive energy balance
hormones involved in growth
insulin
thyroid
GH
sex steroids
what things increase HGH release
peptide hormones hypoglycaemia sex steroids sleep fasting exercise
what things decrease HGH
IGF1
sleep deprivation
hyperglycaemia
glucocorticoids
effects of HGH
acts on chondrocytes to promote division
acts on hepatocytes to release IGF1 which acts on muscle growth, osteoblasts and chondrocytes
causes lipolysis, gluconeogenesis and protein synthesis
effect of thyroxine (6)
Increases metabolism
Promotes division, development and maturation of chondrocytes
Promotes secretion of extracellular proteins in cartilage
Synergistic with IGF and HGH
Increases HGH and GHRH secretion
Bone maturation
how do we measure bone age?
look at wrist- ossicles in wrist develop in a predictable way at ages
affect of poor nutrition on growth
Poor nutrition at first delays growth
Later causes permanent reduction in height
what is failure to thrive?
A description, not a diagnosis
Height or weight below 3th percentile
Low weight-for-height
Crossing 2 major percentiles in 6 months
frequency of failure to thrive?
5-10% in community
features of failure to thrive
Of underlying disease Pallor, listless Reduced fat and muscle Buttock and thigh wasting cheeks preserved ascites PICA (eating random things), other deficiencies Sparse or thin hair. No features
features of organic cause of failure to thrive
asymmetric growth weight loss
crossing ‘centiles
out of parents ranges
corrects with management
does GH deficiency affect length or weight more?
length
does inadequate calorie intake affect height or weight more?
weight
features of constitutional failure to thrive on growth charts
not crossing centiles
symmetrical
no other features
appropriate for parents
features of hormonal FTT on growth charts
crossing centiles
symmetric or short n fat
growth>other features
not like parents
features of diet or disease FTT on growth charts
cross centiles
asymmetric
other features>growth
not like parents
what do we use to assess whether a baby is growing in proportion to what is expected from parental height
mid-parental height:
Girls: MPH – 7cm +/- 10 cm
Boys: MPH + 7cm +/- 10 cm
causes of non-organic FTT
Insufficient food Improper presentation No consistency of nutrition Emotional neglect Lack of nurturing
causes of organic FTT
Inadequate intake: Swallowing problems Pain on eating Gastro-oesophageal reflux Lactation failure Milk made up wrong Dietary fads The milk drinker Psychological problems
Poor utilisation- gut Malabsorption: -Bile absent -Pancreatic deficiency -Intestinal wall enzyme lack -Short gut -Intestinal inflammation
Poor utilisation- body Metabolic disorders: * Renal tubular acidosis; * Hypercalcaemia; * Disorders of Amino-Acid metabolism; * Glycogen storage disorders; * Mucopolysaccharidoses.
Excessive energy use: Recurrent infections: Chest, GI, renal Lung disease Heart failure Neurological problems
Investigations
Any needed? Relate to history. Sweat test. Stool fat. Immunoglobulins and subsets FBC Thyroid function tests ?stimulation test for GH Urine for protein Remeasure later
other professionals related to FTT
Speech and language therapy
Social worker
Child psychologist
Health visitor
top 10 reasons for FTT
metabolic immunodeficiency HIV Genetic e.g. Down's acyanotic heart disease coeliac disease CF non-organic dietary and feeding constitutional- just a small person
2 diseases that are common in Downs that may cause FTT
coeliac
hypothyroidism
