Psychosocial causes of faltering gorwth and/or poor weight gain Flashcards

1
Q

What if altering growth defined as by NICE

A

> 1 centile spaces if birthweigth < 9th centile
2 centile spaces if birthweight 9-91st centile
3 sentile spaces if birthweight >91st centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a centile space

A

Distance between two centile lines on growth chart
eg between 50th and 75th centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Categories of causes of FTT

A
  • Inadequate nutritional intake
  • Difficulty feeding
  • Malabsorption
  • Increased energy requirements
  • Inability to process nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of inadequate nutritional intake

A

Maternal malabsorption if breastfeeding
Iron deficiency anaemia
Neglect
Family or parental problems
Availability of food - poverty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of difficulty feeding

A

Poor suck eg CP
Cleft lip or palate
Genetic conditions with abnoraml facial structure
Pyloric stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of malabsorption

A

CF
Coeliac disease
Cows milk intolerance
Chronic diarrhoea
IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of increased energy requirements

A

Hyperthyroidism
Chronic disease eg congenital heart disease + cystic fibrosis
Malignancy
Chronic infections eg HIV or immunodeficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Inability to process nutrients properly

A

Inborn errors of metabolism
T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Assessment of FTT

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a feeding history?

A

Breast or bottle
Feeding times
Volume and frequency
Any difficulties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Eating history in children

A

Ask to keep a food diary
Food choices
aversions
Meaktime routines
Appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is mid parental height

A

Mean average height of both parents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When do assessment outcomes for FTT suggest inadequate nutrtionor a growth disorder?

A

Height >2 centile spaces befrore mid-parental heigth centile
BMI below 2nd centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Investigations for faltering grwith

A

Urine dipstick for UTI
Coeliac screen - anti-TTG or anti-EMA antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Support for breast feeing difficulty

A

Midwives
Health visitiors
Peers grouos
Lactaction consultants
Supplementing formula milk helps growth
Express when not breast feeding - encourdage lactation to continue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inadequate nutrition management

A
  • Encouraging regular structured mealtimes and snacks
  • Reduce milk consumption to improve appetite for other foods
  • Review by a dietician
  • Additional energy dense foods to boost calories
  • Nutritional supplements drinks
    Enteral tube feeding
17
Q

Non organic/functional causes of faltering growth

A
  • Feeding difficulties.
  • Lack of preparation for parenting.
  • Family dysfunction (eg, divorce, spouse abuse, chaotic family style).
  • A difficult child.
  • Child neglect (there may be puerperal depression).
  • Emotional deprivation syndrome.
  • The mother may have an eating disorder but more often they tend to over-feed the rest of the family.
  • Fabricated or induced illness by carers (FII) - formerly known as Münchhausen’s syndrome by proxy.