Psychosocial causes of faltering gorwth and/or poor weight gain Flashcards
What if altering growth defined as by NICE
> 1 centile spaces if birthweigth < 9th centile
2 centile spaces if birthweight 9-91st centile
3 sentile spaces if birthweight >91st centile
What is a centile space
Distance between two centile lines on growth chart
eg between 50th and 75th centile
Categories of causes of FTT
- Inadequate nutritional intake
- Difficulty feeding
- Malabsorption
- Increased energy requirements
- Inability to process nutrition
Causes of inadequate nutritional intake
Maternal malabsorption if breastfeeding
Iron deficiency anaemia
Neglect
Family or parental problems
Availability of food - poverty
Causes of difficulty feeding
Poor suck eg CP
Cleft lip or palate
Genetic conditions with abnoraml facial structure
Pyloric stenosis
Causes of malabsorption
CF
Coeliac disease
Cows milk intolerance
Chronic diarrhoea
IBD
Causes of increased energy requirements
Hyperthyroidism
Chronic disease eg congenital heart disease + cystic fibrosis
Malignancy
Chronic infections eg HIV or immunodeficiency
Inability to process nutrients properly
Inborn errors of metabolism
T1DM
Assessment of FTT
- Pregnancy, birth, developmental and social history
- Feeding or eating history
- Observe feeding
- Mums physical and mental health
- Parent-child interactions
- Height, weight and BMI (if older than 2 years) and plotting these on a growth chart
- Calculate the mid-parental height centile
What is a feeding history?
Breast or bottle
Feeding times
Volume and frequency
Any difficulties
Eating history in children
Ask to keep a food diary
Food choices
aversions
Meaktime routines
Appetite
What is mid parental height
Mean average height of both parents
When do assessment outcomes for FTT suggest inadequate nutrtionor a growth disorder?
Height >2 centile spaces befrore mid-parental heigth centile
BMI below 2nd centile
Investigations for faltering grwith
Urine dipstick for UTI
Coeliac screen - anti-TTG or anti-EMA antibodies
Support for breast feeing difficulty
Midwives
Health visitiors
Peers grouos
Lactaction consultants
Supplementing formula milk helps growth
Express when not breast feeding - encourdage lactation to continue