Growth problems

Question 1

Define failure to thrive/faltering growth? - 2 - think about a chart used

What else may they also have?

Answer 1

Low growth in infancy
Falling across 2 gentile lines and manifest in poor weight gain

May also have proportionally small height and head circumference through some acute causes tend to affect weight only.
If height low as well, might just be a constitutionally small child so check height of parents.

Question 2

What is normal weight loss in the first 3-4 days of life?

Answer 2

10% likely due to fluid losses but this should be regained by 3 wks

Question 3

What should the average weekly gain for a newborn be?

Answer 3

150-200 grams in normal children

Weight should double by 4 months and tripling by 12 months

Question 4

What does faltering growth indicate and what can it cause?

Answer 4

Underlying disease

Long term problems such as low growth and IQ

Question 5

How are the causes split up?

Answer 5

Organic and Non-organic/environmental

Question 6

Organic causes:

Feeding problems (common) - list examples

Maternal problems - 2

Answer 6

unskilled feeding (breast/bottle)
Insufficient breast milk
Infant difficult to feed (low appetite, weak suck)

Neglect
Postnatal depression

Question 7

Non-organic causes:

GI - 4 
Swallowing problems -2 
Chronic disease - 3 
Multi-system -3 
One more

Answer 7

IBD
Coeliac disease
Cows milked protein allergy
GORD

Cleft palate
Cerebral palsy

Kidney
Liver
Heart failure

Down’s
CF
Hypothyroidism

Chronic infection

Question 8

S+S:

Non-organic
Organic

Answer 8

May be minimal if non-organic or maybe non-specific (.g. unhappy child)

Thin buttocks in coeliac, res problems in CF

Question 9

Constitutionally small babies:

What is a key thing that would differentiate them from children that are struggling to grow?

Answer 9

Small but otherwise normal - happy, alert and responsive

Usually won’t be crossing centile lines but always small;;.

Question 10

Investigations:

What measurements should be taken?

Answer 10

Height using correct device

Weight - remove shoes and nappies

Question 11

Investigations:

What’s can the doctor as in the history?

What about the health visitor?

Answer 11

Milk feeding
Weaning
Range of food
Mealtime routines

Have a family completes three-day diary

Question 12

Management:

Non-organic causes:

What should be told to parents?
Who provides this?
What if unsuccessful?
When should social services get involved?

Answer 12

Provide guidance and support on correct feeding
Health visitor
Dietician if unsuccessful

Other signs of neglect

Question 13

Management:

When should organic causes be investigated

Basic investigations:

Tests for anaemia/leukaemia
Test low iron
Test for kidney disease
Other basic tests for causes

Answer 13

If other symptoms indicated
Persistent faltering growth despite dietary interventions

FBC 
Ferritin 
U&E
TFT
MSU 
Coeliac bloods

Question 14

Management:

Further tests:

CF
Rickets
Cardiac anomalies/CF
Turner’s syndrome

What if all else fails?

Answer 14

Sweat test
Vitamin D
Chest x-ray
Chromosomal analysis in girls

Admitting for observation with correct feeding

Question 15

Define short stature?

Answer 15

Height <2nd centile

Question 16

Causes of short stature

Usual causes - 2

Others:

• In-utero
• Psychological
• Genetic
• GI
• Endocrine

Answer 16

Familial short stature
Constitutional delay and growth in puberty - bone age is matched with height age so no further investigation needed

IUGR 
Neglect and poverty
Downs, Turners, CF, dwarfism 
Coeliac, IBD
Steroid treatments, hypothyroidism, growth hormone deficiency