Poor growth Flashcards
Define failure to thrive
Wt below 2rd %tile for sex and gestation corrected on appropriate growth chart. 2% tile or wt less then 10% of Ht.
RCH children under 3 yr who’s wt crosses two or more percentiles
Most common causes of small child
Familial small size
Constitutional delay
Less common
Inadequate caloric intake usually secondary to abnormal feeding behaviour and less commonly due to neglect
Serious disease that can present as isolated poor growth
Coeliac and chronic renal failure
Most present with other signs
Poor growth due to poor social circumstances
Signs of neglect
Signs and symptoms of motion all and developmental delay
Poor growth due familial short statue
Hx and examination is normal
Calculate predicted adult Ht parents are short
Bone age is appropriate for chronological age
Constitutional delay in growth
Hx and examination are normal
FmHx of delayed puberty and menarche
Bone age is less than chronological age.
Hx child presenting poor growth
Hx consider pattern of growth Feeding and eating behaviour - details of breastfeeding, formula and solids. Meal time battle, coercive feeding. Parents attitudes Caloric intake Consider psychosocial deprivation Parent child interaction Check birth weight Look for signs and symptoms of underlying organic disease- malabsorption,chronic illness involving underlying organ or genetic disease. Antenatal cx and maternal health Vomiting or diarrhoea Development delay Calculate mid parental Ht Lack of financial resources, housing or support
First line Ix for a children with poor growth/FTT with no specific pointers to a medical cause
FBC ESR, CRP Urea, creatinine, LFTs Iron status Calcium, phosphate Thyroid function Blood glucose Coeliac serology if on solid foods containing gluten Urine for microscopy and culture Stool for microscopy and culture Stool for fat globules and fatty acid crystals Other investigations depending on findings in the Hx and Examintion If girl do Karyotype for turner's.
How to work out if a child Ht is normal
Boys in paternal Ht in cm plus maternal Ht in cm plus 13 then divide it by 2. This given adult Ht plus or minus 8
Girls is maternal Ht in cm plus paternal Ht in cm minus 13. Then divide by 2 to get adult Ht.
Causes of failure to thrive
Environmental and psychosocial - non organic Inadequate caloric intake/retention - Inadequate nutrition - Breast feeding difficulties - Restricted diet eg low fat or vegan - structural causes eg cleft palate - Persistent vomiting - anorexia of chronic disease - error in infant formula dilution - early or delayed introduction of solids Inadequate absorption - Coeliac - Chronic liver disease - Pancreatic insufficiency - Chronic diarrhoea - Cow milk protein intolerance Excessive caloric utilisation - Chornic illness - UTI - Chronic respiratory disease eg cystic fibrosis - Congenital heart disease - Diabetes mellitus - Hyperthyroidism Other - genetic syndromes and inborn errors of metabolism Cystic fibrosis IUGR Immunodeficiency Genetic syndromes Chronic illness Gastro-oesophageal reflux Coeliac disease Endocrine dysfunction eg hypothyroidism,
Environmental or psychosocial non organic causes of poor growth
Most common cause of weight faltering
Wt is usually affected first, then height and head growth
Eating difficulties are common
Neglect may be a factor.
Types of cause
- Eating difficulties - anxious and concerned parents
- difficulties in the home
- limitations in the parents
- disturbed attachment between mother and child
- Maternal depression or psychiatric disorder
- Neglect - also shows signs of physical signs poor care and emotion attachment. Often denied and compliance with poor intervention.
Mx -
- Tx underlying cause
- exclude organic causes
- family health visitor - nutritional support and eating problems
-Child support services
- case management
Examination of child with poor growth
G appearance of sick, scrawny, irritable or lethargic
Evidence of loss of muscle bulk and subcutaneous fat stores, especially upper arm, buttocks and thighs
Look for underlying diagnosis
Signs of child abuse, and neglect
In younger infant observe a feed.
Expected wt gain in infants
0 to 3 months 150-200g/week
3 to 6 months 100-150g/week
6 to 12 months 70-90g/week
Malabsorption
Diarrhoea and colic
Commonest cause are coeliac and cystic fibrosis
Coeliac gave classic fall off growth chart when started on solids
Causes of short stature
Steady growth below centiles - Familial short statue - Constitutional delay in growth - Turner's syndrome - IUGR - Skeletal dysphasia Fall-off in growth across centiles - Chronic illness - Acquired Hypothroidism - Cushing's disease - rare - Growth hormone deficiency - rare - psychosocial
