Failure to thrive-O'Connor

Question 1

What is marasmus?

Answer 1

wasting of subcutaneous tissue over thorax w/ prominent ribs

Question 2

How common is failure to thrive?

Answer 2

5-10% of kids seen in primary care

Question 3

Which communities/pop is FTT more common in?

Answer 3

poor & rural communities

children w/ special health care needs

Question 4

What are the nutritional causes of FTT?

Answer 4

Inadequate calorie and nutrient intake
Inadequate nutrient uptake or absorption
Increased metabolic demand/increased calorie requirements

Question 5

What are some common causes of inadequate energy intake?

Answer 5

Breastfeeding problem
Improper formula preparation
GERD
Discoordination of suck/swallow/ breathe

Cleft lip or palate
Mood disorder
Eating disorder
Constipation
Irritable bowel syndrome
Dental Caries

Question 6

What are some psychosocial causes of inadequate energy intake?

Answer 6

poverty
parental depression, learning disability, neglect, drug abuse, eating disorder
sensory disorder, food phobia

Question 7

What are some malabsorption problems for FTT?

Answer 7

Malabsorption
GI malformation
Inborn error of metabolism
Food intolerance or allergy

Celiac disease
Diabetes
Renal Disease

Question 8

What are some things that can cause high metabolic needs & FTT?

Answer 8

Prematurity
Chronic infection or immunodeficiency disease
Pulmonary disease
Congenital heart disease or heart failure

Seizure disorder
Thyroid disease
Chronic pulmonary disease; asthma
Heart disease or failure
Malignancy

Question 9

What are some red flags for a medical cause of FTT?

Answer 9

Cardiac findings suggesting congenital heart disease of heart failure
Developmental delay
Dysmorphic features
Recurrent or severe infections
Recurrent vomiting, diarrhea, or dehydration

Question 10

What are some signs on PE of inadequate nutrition?

Answer 10

Hair: easily pluckable, changes in pigmentation
Skin: dry, scaly
Behavior: irritable, apathetic, socially unresponsive
Bloated abdomen

Question 11

What is the clinical workup for FTT?

Answer 11

**if appropriate--test for HIV or TB
swallowing studies
genetic testing
cardiac fcn
pulmonary fcn
CBC
CMP
Stool ph & culture
fecal fat

Question 12

What is a good latch for breastfeeding?

Answer 12

latching onto the areola, not just the nipple (hard on the mom & can’t squeeze the glands)

Question 13

What’s best for newborns feeding?

Answer 13

exclusively breast for first 6 months

up to 12 mo +

Question 14

What are the health benefits of breastfeeding?

Answer 14

Composition uniquely tailored to changing needs of growing infant
Fewer allergies, intestinal upsets, ear infections in infancy
Lower rates of diabetes and asthma in later life
Association between breastfeeding and improved school performance
Helps uterus regain pre-pregnancy size more rapidly
Women who breastfeed have lower rates of breast and ovarian cancer and fewer hip fractures in later life

Question 15

What are good feeding practices during early infancy?

Answer 15

feed on demand, every 2-3 hrs

Signs of hunger: opening the mouth, suckling sounds, waving hands, hand-to-mouth, rooting, pre-cry fussing, crying
May need to wake baby to feed if longer than 4 hours
Burp midway through and after feeding
Breast: 20-45 minutes per feeding
Bottle: 2+ ounces per feeding

Question 16

First foods should be offered at 4-6 months. Wht are some signs that you are approaching this time?

Answer 16

Offer at 4-6 months:
digestive system has matured some
tongue protrusion reflex is disappearing
head and neck control are improving
can sit with little or no assistance

Question 17

What are good first foods?

Answer 17

rice cereal + iron made thin

Question 18

When can kids eat mashed foods? Whole foods? Food hazards?

Answer 18

7-10 mo finely chopped foods
can’t chew until age 4
danger foods:
can feed themselves at 8-9 mo, master at 14-18 mo
Avoid uncut foods like hot dogs, grapes, cherry tomatoes, large chunks of meat , hard candy, popcorn, nuts, etc.

Question 19

When should you take measurements of your baby?

Answer 19

0-9 months: every 4-6 weeks
10-24 months: every 3-4 months
2-5 years: every 6 months

Question 20

When there is a fall in measurements, which go first?

Answer 20

Weight goes down first
then length
head circumference is last.

Question 21

What is considered underweight?

Answer 21

<5th %ile weight/length or BMI

Question 22

What is considered growth faltering?

Answer 22

Child’s rate of weight gain has slowed or stopped after it has previously been established

Question 23

What are some ways to increase energy density for a child?

Answer 23

Change formula to 24 or 27 kcal/oz
Concentrate standard 20 kcal formula with different proportions powder to water
Foods: add fat/oil, avocado, Polycose, Moducal
—

Use whole milk
Add cream, powdered milk, instant breakfast powder
Add peanut butter, avocado, sour cream, yogurt, butter, cream cheese, ranch dressing
Avoid low energy dense foods (jello, juice, popsickles, candy)