Faltering Growth Flashcards
What is defined as faltering growth?
Sub-optimal weight gain with crossing of 2 centile lines.
Causes can be organic and non organic.
Which age range is most vulnerable to faltering growth and why?
Infants
- High energy requirements (3 x adult/kg)
- Rapid growth (2 x weight in 1st 4 months)
- Low density diet (milk)
- Higher morbidity
- Dependence on others for all food
How can you categorise causes of faltering growth?
Reduced Intake: neglect, vomiting, can’t feed (bronch)
Reduced absorption: coeliac, CF, diahorrea
Increased energy requirements: Illness (chronic kidney), heart failure, respiratory illness
Congenital
Hormonal: (hypothyroidism)
What is a sign of severe faltering growth?
Head circumference is usually spared in faltering growth.
Length is also usually spared.
If these begin to falter suggests severe faltering growth.
What is the likely diagnosis: 18/12 old girl with faltering growth, thriving until 6/12.
Became miserable and lethargic was beginning to stand now just sits on parents knee.
No vomiting but there is diahorrea. Poor appetite and a varied diet.
O/e: abdominal distension and buttock wasting.
Coeliac disease is most likely.
Started at 6 months aka weaning age.
Regression due to lack of energy.
Abdominal distension, diahorrea and wasting all suggestive.
What are the causes of malabsorption?
Coeliac is the most common.
- Enzyme deficiencies: Lactase deficiency
- Pancreatic insufficiency: CF
- Cholestatic liver disease or biliary atresia – bile salts no longer enter the duodenum in the bile.
- Loss of function of bowel: small bowel resection, Crohns affecting terminal ileum
How should suspected malabsorption be investigated?
Review by a dietician
Stool samples – check for pH (carbohydrate malabsorption), bile acids, large proteins, parasites and other infections
Urinalysis – the kidney shares many of the same transporters as the gut so may show high concentrations of certain substances here. There may also be evidence of infection
Bloods dependent on clinical impression and previous results.
If needed endoscopy and biopsy. (gold standard for IBD, coeliac)
What is coeliac disease?
Coeliac disease is an autoimmune disorder in which gluten provokes a damaging immunological response in the proximal small intestinal mucosa.
In coeliac disease the mucosa will become smooth and there will no longer be villi.
What are the classical signs and symptoms of coeliac disease?
Usually presents between 6 -24 months at the introduction of gluten, but can present later.
Presents with:
- Faltering growth
- Fatigue and irritability
- Diahorrea and vomiting
- Abdominal distension and pain
- Buttock wasting
What is the test which is used for coeliac disease who should receive it and how should they be counselled?
IgA tTG (transglutaminase antibodies)
Should be offered to those that are asymptomatic on a gluten free diet.
They should be advised to eat gluten for 6 weeks prior to testing or there may be a false -ve result.
Define malnutrition, how does it differ from faltering growth?
Child malnutrition may be defined as a pathological state resulting from inadequate nutrition, including inadequate intake of energy, protein and other nutrients. It also encompasses over nutrition and obesity.
I child can be undernourished from birth and therefore the weight will have never faltered. Faltering growth does not encompass over nutrition.
Which deficiencies remain relatively common in the UK?
Iron (Iron deficiency anaemia)
Vitamin D (Rickets)
Which children are at increased risk of undernutrition?
Those with chronic and absorption diseases: CF, CCD, chronic kidney disease, IBD, malignancy.
What is the MUST score?
The MUST score is a universal guide to assess malnutrition in adults:
- Step 1: Measure height and weight to get a BMI score
- Step 2: Note percentage unplanned weight loss and score
- Step 3: establish acute disease effect and score
- Step 4: add scores together to obtain an overall risk of malnutrition.
- Step 5: use management guidelines to develop a care plan
What is the paediatric equivalent to the must score called?
Paediatric Yorkhill Malnutrition Score
