Paeds: FG Flashcards
Potential causes of faltering growth in milk fed (NICE)
Potential causes of faltering growth in milk fed (NICE)
* breastfed infants: ineffective suckling
* ineffective bottle feeding
* feeding patterns or routines being used
* the feeding environment
* feeding aversion
* parent/carer–infant interactions
* how parents or carers respond to the infant’s feeding cues
* physical disorders that affect feeding.
Potential causes of faltering growth in non-milk fed children (NICE)
Potential causes of faltering growth in non-milk fed children (NICE)
* mealtime arrangements and practices
* types of foods offered
* food aversion and avoidance
* parent/carer–child interactions, for example responding to the child’s mealtime cues
* appetite, for example a lack of interest in eating
* physical disorders that affect feeding.
Factors contibuting to faltering weight (SHAW, 2020)
Factors contibuting to faltering weight (SHAW, 2020)
Inability to digest or absorb nutrients
* Coeliac disease
* Cystic fibrosis
Excessive loss of nutrients
* Diarrhoea
* Vomiting
* Protein losing enteropathy (blood proteins are lost via GI tract)
Increased requirements due to underlying disease
* Chronic cardiac/respiratory failure
* Chronic infection
Inability to fully utilise nutrients
* Metabolic disease
Reduced intake of nutrients
* Functional problems
* Suck-swallow incoordination
* Oral hypersensitivity
Factors contributing to inadequate intake (SHAW, 2020)
Factors contributing to inadequate intake (SHAW, 2020)
* Delayed/problematic progression to solids
* Early feeding difficulties: tube feeding, gastro-oesphageal reflux
* Poor appetite: dentition/following illness
* Parental attitudes to feeding: cultural/preferences/behaviour
* Coercive feeding
* Limited/rigid parenting skills
* Parental ill health: maternal depression
* Imbalance of foods offered e.g. too much fluid disrupts solids (own)
* Environment: chaotic eating environment, neglect, lack of routine, inadequate cooking facilities
Growth faltering leading to short in stature is ? detrimental than acute undernourishment.
Growth faltering leading to short in stature is more detrimental than acute undernourishment.
Why is short stature more detrimental than acute undernourishment?
Short stature is more detrimental than acute undernourishment because acute undernourishment has less of an effect on cognitive development.
When are children more at risk of growth faltering?
Children are more at risk of growth faltering if:
* They are poor
* Of ethnic minorities
* Have underlying medical conditions
* Are extreme fussy eaters
What can poor growth cause?
Poor growth can cause:
* Reduced school performance
* Reduced cognitive development
* Reduced educational performance in adulthood
* Reduced economic performance in adulthood
What is poor growth associated with?
Poor growth is associated with:
* Increased morbidity
* Increased mortality
* Increased hospital stay
What is the expected/normal amount of weight loss in the first few days of life?
Expected/normal amount of weight loss in 1st few days of life:
~10% (common in exclusively breastfed)
What should the overall goal be in faltering growth?
The overall goal of intervention in faltering growth should be: weight gain but this should be individualised.
Organic?
Organic=related to disease
Non-organic?
Non-organic= not related to disease
Physical assessment of faltering growth
Physical assessment of faltering growth
* muscle wasting? temporal/facial
* poor skinfold thickness?
* visible/prominent bones?
* pale complexion/pale palms? (indicative of IDA)
* poor sleep
* developmental delay (especially communication)
* emotional/behavioural issues
* fat around wrist?
* stomach distenstion?
Are most faltering growth cases due to organic or non-organic causes?
Most faltering growth cases are due to non-organic causes. Only 5% of causes are organic.
In non-organic faltering growth cases, what is usually the cause?
Inadequate intake is usually the cause of faltering growth in non-organic cases.
What can dependence on cow’s milk/fruit juice lead to in infants/children?
Overdependence on cow’s milk/fruit juice in infants/children can lead to restricted intake of solid foods and disrupt optimal growth.
Optimal percentage of protein for lean & fat mass improvement?
Optimal percentage of protein for lean & fat mass improvement:
8.9-11.5%
How long should mealtimes be?
Mealtimes should be 20-30minutes long
Energy requirements <3/12 months
Energy requirements <3/12 months
Normal: 100-115 kcal/kg/day
High: 130-150 kcal/kg/day
Very high: 150+ kcal/kg/day
Protein requirements <3/12 months
Protein requirements <3/12 months:
Normal: 2.1g/kg/day
High: 3.0-4.5 g/kg/day
Very high: 6.0g/kg/day
NICE recommendations for wt monitoring in FG
Weight monitoring of FG (NICE)
· daily if less than 1 month old
· weekly between 1–6 months old
· fortnIghtly between 6–12 months
· monthly from 1 year of age.
