GI - Failure To Thrive Flashcards
Definition
The poor physical growth and development in a child.
Faltering growth defintion (NICE 2017)
Fall in weight across:
- One or more centile spaces in their birthweight was below the 9th centile
- Two or more centile spaces if their birthweight was between the 9th and 91st centile
- Three or more centile spaces if their birthweight was above the 91st centile
Causes of failure to thrive
Anything that leads to inadequate energy and nutrition can lead to failure to thrive. The causes can be categorised as:
- Inadequate nutritional intake
- Difficulty feeding
- Malabsorption
- Increased energy requirements
- Inability to process nutrition
Causes of inadequate nutritional intake
- Maternal malabsorption if breastfeeding
- Iron deficiency anaemia
- Family or parental problems
- Neglect
- Availability of food (i.e. poverty)
Causes of difficulty feeding
Poor suck e.g due to cerebral palsy
Cleft lip or palate
Genetic conditions with an abnormal facial structure
Pyloric stenosis
Causes of malabsorption
- Cystic fibrosis
- Coeliacs disease
- Cow milk intolerance
- Chronic diarrhoea
- Inflammatory bowel disease
Causes of increased energy requirements
Hyperthyroidism
Chronic disease, for example congenital heart disease and cystic fibrosis
Malignancy
Chronic infections e.g. HIV or immunodeficiency
Inability to process nutrients properly
Inborn errors of metabolism
Type 1 diabetes
Assessment
Full history, examination and relevant investigations
- Pregnancy, birth, developmental and social history
- Feeding or eating history
- Observe feeding
- Mums physical and mental health
- Parent-child interactions
- Height, weight and BMI (if older than 2 years) and plotting these on a growth chart
- Calculate the mid-parental height centile
Feeding history
Milk
- breast or bottle
- feeding times
- volume and frequency
- any difficulties with feeding
Food
- food choices
- food aversion
- meal time routines
- appetite in children
* Asking the parent to keep food diary *
Mid parental height calculation
Height of mum + height of dad / 2
- Outcomes from the assessment that would suggest inadequate nutrition or a growth disorder are:
= Height more than 2 centile spaces below the mid-parental height centile
= BMI below the 2nd centile
Investigations
FIRST LINE =
- Urine dipstick for UTI
- Coeliac screen (anti-TTG and anti-EMA antibodies)
Further investigations are usually not necessary where no other clinical concerns.
Focused investigations should be considered where additional signs or symptoms suggest an underlying diagnosis, such as cystic fibrosis or pyloric stenosis.
Management
Management depends on the cause and may involve input from the multidisciplinary team. All children with faltering growth should have regular reviews to monitor weight gain. Reviews that are too frequent can increase parental anxiety.
Breastfeeding management
- Support from midwifes, health visitors, peer groups and ‘lactation consultants’
- Supplementing with formula milk = improve growth however can lead to stopping breastfeeding
- Encourage mum to breastfeed and top with with formula + express when not breastfeeding to encourage lactation to continue
Inadequate nutrition management
- Encouraging regular structured mealtimes and snacks
- Reduce milk consumption to improve appetite for other foods
- Review by a dietician
- Additional energy dense foods to boost calories
- Nutritional supplements drinks
SEVERE = Enteral tube feeding
- This needs to have clear goals and defined end point
