Growth Faltering (Failure to Thrive)

Question 1

Nice definitions of growth faltering

Answer 1

A fall in weight across:

One or morecentile spacesif their birthweight was below the 9th centile

Two or morecentile spacesif their birthweight was between the 9th and 91st centile

Three or morecentile spacesif their birthweight was above the 91st centile

Question 2

Aetiologies of growth faltering

Answer 2

Inadequate nutritional intake

Difficulty feeding

Malabsorption
Increased energy requirements

Inability to process nutrition

Question 3

Assessment of growth faltering

Answer 3

Aim to establish cause

Full history & exam

Pregnancy, birth, developmental, social history

Feeding history

Eating history

Observe feeding

Mum’s physical & mental health

Parent-child interactions

Height, weight and BMI

Question 4

Investigations in growth faltering

Answer 4

Urine dipstick, for UTI

Coeliac screen (anti-TTG or anti-EMA antibodies)

Further investigations are usually not necessary where there are no other clinical concerns

Question 5

Management of inadequate nutrition

Answer 5

Encouraging regular structured mealtimes and snacks

Reduce milk consumption to improve appetite for other foods

Review by adietician

Additionalenergy dense foodsto boost calories

Nutritional supplements drinks

Question 6

Last resort management of growth faltering

Answer 6

Enteral tube feeding

Needs to have clear goals and a defined end point