Failure to thrive and malnutrition Flashcards
What is failure to thrive?
Descriptive term that refers to less than expected growth over time for the first 3 years of life when tracked on appropriate growth charts for children of the same age and sex. It is a description not a diagnosis. This is demonstrated when a centile chart shows inadequate weight gain.
Mid failure - falls across 2 centile lines
Severe failure - falls across 3 centile lines
Epidemiology of failure to thrive?
- Most children with failure to thrive have a weight below the 2nd centile.
- A single observation of weight is difficult to interpret (unsure if going up or down) unless there is marked discrepancy in head circumference and length.
- Further below the 2nd centile - more likely child is failing to thrive.
- Children failing to thrive usually maintain height, but this may be compromised eventually due to prolonged inadequate weight gain (adversely affecting child’s development progress)
Differentiating between an infant failing to thrive and a small/thin baby?
- Difficult to do.
- Normal but short infants have no symptoms, are alert, responsive, happy and have satisfactory development
- Parents ay be short (low mid-parental height) or infant may be pre-term or growth restricted at birth.
Aetiology of failure to thrive?
FOUR KEY FACTORS!!!
1) Inadequate intake
2) Inadequate retention
3) Malabsorption
4) Increased requirements
Reasons for inadequate intake in failure to thrive?
1) Non-organic/environmental:
Inadequate availability of food - feeding problems (poor technique, insufficient breast milk), low socio-economic status, irregular feeding times, infant difficult to feed.
2) Psychosocial deprivation: Child abuse/neglect, poor maternal/infant interaction, poor maternal education, maternal depression
Reasons for inadequate retention in failure to thrive?
1) Vomiting
2) Severe GORD
Reasons for malabsorption in failure to thrive?
1) Coeliac
2) CMPA
3) Cholestatic liver disease
4) CF
Reasons for increased requirements in failure to thrive?
1) Thyrotoxicosis
2) CF
3) Malignancy
4) Congenital heart disease
5) Failure to utilise nutrients (Down’s syndrome, extreme prematurity, storage disorders)
Clinical presentation of failure to thrive?
1) Malabsorption - distention of abdomen, thin buttocks, misery
2) Dysmorphic features- systemic disorder such a Downs
3) Signs of chronic respiratory distress - chest deformity, clubbing
4) Signs of heart failure - sacral and ankle oedema
Diagnosis of failure to thrive?
1) FBC, WBC, immunoglobulins (immune deficiency)
2) LFT’s - liver disease or malabsorption
3) TFT’s - hypothyroidism or hyperthyroidism
4) IgA tTG - Coeliac disease
5) CXR/sweat test for CF
6) Karyotype in girls - Turners syndrome
Treatment of failure to thrive?
1) Treat cause
2) Paediatric dietician - quantity and food composition assessment to increase intake
3) Hospital admission if child under 6 months with severe failure to thrive - for active refeeding
Malnutrition RF? PPx?
Chronic illness:
1) Preterm babies
2) Congenital heart disease
3) Malignant disease
4) Cerebral palsy
5) Chronic renal failure
PPx: Combination of anorexia, malabsorption and increased energy requirements because of infection or inflammation.
Assessment of nutritional status?
1) Dietary assessment - parents record food intake of child
2) Anthropometry:
- Height and weight
- Measure skin-fold thickness of triceps (reflection of subcutaneous fat stores)
- Mid-upper arm circumference - gives indicator of skeletal muscle mass (6m-6yr, easy and repeatable)
3) Lab investigations:
- Not as valuable as history and examination.
- Low plasma albumin, glucose
- Low concentrations of specific minerals and vitamins e.g. potassium, magnesium
Presentation of malnutrition?
1) Multi-system disorder
2) Severe - impaired immunity, delayed wound healing, operative morbidity and mortality increased
3) Worsens outcome of illness e.g. respiratory dysfunction (child delayed in being weaned from ventilation)
4) Malnourished children are less active, less exploratory, more apathetic
5) Permanent delay in intellectual development if malnutrition is prolonged.
How does Marasmus occur and present?
- Due to a severe lack of calories
- Associated with severe wasting
- Discrepancy between weight and height (weight for height more than 3 standard deviations below median, <70% weight for height)
- Distended abdomen, wasted and wizened.
- Skin-fold thickness and mid-upper arm circumference markedly reduced.
- Withdrawn and apathetic.
