growth monitoring

Question 1

what are the 3 key parameters we monitor

Answer 1

weight (g/kg)

length (cm) or height (if >2y)

head circumference (up till 2y, OFC, cm)

Question 2

other measurements that aren’t routine but may be done

Answer 2

weight for age 
length/height for age 
BMI
weight for length 
rate of weight gain (infants only)

Question 3

how are growth charts developed

Answer 3

population derived references

followed children through early years in different countries to see differences in growth and normal range

Question 4

weight, length and OFC at birth

Answer 4

3.3kg

50cm

35cm

Question 5

weight and length at 4mths

Answer 5

6.6kg

60cm

Question 6

weight, length and OFC at 12 mths

Answer 6

10kg

75cm

35cm

Question 7

weight and length at 3y

Answer 7

15kg

95cm

Question 8

centiles and normal development

Answer 8

no single measurement is abnormal

pattern, progress and hx are crucial

Question 9

what is failure to thrive

Answer 9

child growing too slowly in form and usually in function at the expected rate for their age

significantly low rate of weight gain - crossing centile spaces

not a diagnosis but a description of a pattern

supply of energy/nutrients < demand

Question 10

maternal causes of failure to thrive in early life - deficient intake

Answer 10

poor lactation
incorrectly prepared feeds
unusual milk/other feeds
inadequate care

Question 11

infant causes of FTT in early life - deficient intake

Answer 11

prematurity
small for dates
oro palatal abnormalities (e.g. cleft palate)
neuromuscular disease (e.g. cerebral palsy)
genetic disorders

Question 12

causes of FTT in early life - increased metabolic demands

Answer 12

congenital lung disease
heart/liver/renal disease
infection 
anaemia 
inborn errors of metabolism 
CF
thyroid disease
crohn's/IBD
malignancy

Question 13

causes of FTT in early life - XS nutrient loss

Answer 13

gastro-oesophageal reflux
pyloric stenosis
gastroenteritis - post infectious phase
malabsorption - food allergy, persistent diarrhoea, coeliac, pancreatic insufficiency, short bowel syndrome

Question 14

causes of FTT in early life - non-medical causes

Answer 14

• poverty/socio-economic status
• dysfunctional family interactions - esp maternal depression/drug use
• difficult parent-child interactions
• lack of parental support - no friends/extended family
• lack of preparation for parenting/education
• child neglect
• emotional deprivation
• poor feeding/feeding skills disorder

Question 15

process for assessing FTT

Answer 15