poor growth

Question 1

red flags on growth charts

Answer 1

Question 2

intake and output history

Answer 2

breast/bottle
number/volume of feeds per day
breast milk supply
formula preparation
solids: age commenced, composition, number and quantitiy of meals and snacks
milk intake per 24 hours period in toddlers
vomiting, stool, urine output, other losses eg. stoma
any identified triggers to increased output

Question 3

food behaviour and dietary practices

Answer 3

acceptance of food
meal time set up and duration
dietary restrictions
Hx of chronic or current illness
recurrent infections
pattern of weight gain and growth in other family members
mid parenntal height
family psychosocial andd vulnerability

Question 4

examination

Answer 4

hydration
growth charts
musle bulk and subcutaneous fat stores
skin, hhair, gums, eyes and nails
developmental level

Question 5

possible referrals may include

Answer 5

child health nurse or lactation consultant
GP or paediatrician
dietician, speech pathologist, multiddisciplinary feeding clinic
psychologist, infant mental health clinician
social worker or child protection services

Question 6

investigations to consider for all ages

Answer 6

urine: urinalysis, microscopy and culture (especially in infannts <12 months, as occult UTI can present with slow weight gain)
blood:
- FBC, ferritin, UECm TSH, glucose, LFT
- if on solids or feeds containing gluten - coeliac serology and tital IgA
- micronutrients: especially active B12 if suspicion of malabsorption or restricted dietary intake
stool:
- microscopy, fat globules, fatty acid crystals

Question 7

investigations to consider for kids older than 12 months

Answer 7

ESR, faecal calprotectin

Question 8

causes of slow weight gain relating to inadequate caloric intake/retention

Answer 8

Question 9

causes of slow weight gain relating to psychosocial factors

Answer 9

Question 10

causes of slow weight gain relating to inadequate absorption

Answer 10

Question 11

causes of slow weight gain relating to excessive caloric utilisation

Answer 11

Question 12

other medical causes of slow weight gain

Answer 12

Question 13

how much should baabies gain per week

Answer 13

Question 14

pattern of poor weight gain with coeliac disese

Answer 14

weigtht gain will fall off around 6 months due to the introduction of gluten into the diet

Question 15

how to measure height and weight in babies

Answer 15

weigh babies naked
up to the age of 24 months, use a measuring frame or mat, hold head firmly against the head board and ensure legs are straight
weigh older children in light clothing
enter height and weight on centile chrt using dots

Question 16

changes in centiles

Answer 16