4.2 Failure To Thrive Flashcards
(28 cards)
Failure to thrive general definition
Kids less than 5, poor weight gain
Take home messages:
- Manage only what you measure
- energy in/out/utilisation
- Hx and Exam
- look at other family members
- non-organic/organic causes
- consult
What do you measure?
Weight
Length: Height if >2yrs
-plot on centile chart
-include previous measurements
What is normal weight gain in 0-3 month baby?
150-180g/week:
-double the weight in first 3/12
What is normal weight gain in 3-6 month baby?
120g/week
What is normal weight gain in 6-9 month baby?
80g/week
What is normal weight gain in 9-12 month baby?
70g/week
What is catch up growth?
Babies with IUGR or small for gestation age
Catch up from <3percentile to p50 at 12m
What is catch down growth?
Large babies of diabetic mothers
>p97 at birth, on p50 at 12m
Definition of failure to thrive?
- Weight below p3 or p5 on two measurements
- downward crossing of>2 percentiles on a chart
- BMI less than p5 for age
- weight <75% of median weight for length
- weight velocity <5 for age
Risk factors for FFT?
- Poverty/socioeconomic
- poor parental knowledge
- parental mental health
- young mother
- child abuse
Most FFT are organic of non-organic?
Non-organic
Initial approach to FFTY non-organic causes?
Energy in: foods?
Energy out:stool/vomit
Increased utilization: ?disease
Types of FFT-insufficient caloric intake?
-not enough Milk, breast milk, formula -poor feeding: cleft palate -lack of parental knowledge -parental mental health -parental non-orthodox beliefs -poverty/socioeconomic
FTT excessive loss of calories examples?
- Excessive vomiting
- Reflux, pyloric stenosis
- non GIT - CNS/metabolic - Malabsorption/excessive stool
- coaeliac disease
- CF
- Chronic liver disease
- Giardiasis
Examples of FTT excessive caloric utiliztation
Congenital heart disease UTIs Thyroid: hyper Chronic lung Immunodeficiency Recurrent infections Metabolic disorders
Non-FTT, other factors?
- parents reports no eating but normal growth
- Too much and only milk
- meal times battle ground
- Stats: 3% of normal children are
FFT history includes?
Caloric intake -specific and detailed facts -babies need 150ml/kg day milk -parental knowledge/recall of diet Observe mother-child interaction
Other FFT history (2)
- Child’s Medical Hx - other doctors and tests
- Preg and perinatal Hx
- developmental Hx
- family Hx
- parents and sibling heights and weights
- social Hx
FFT examination?
- Well/not well
- Dysmorphic
- Centiles
- Muscle bulk: thighs, buttocks
- Malabsorption/nutrient deficiency
In FFT what is impacted the earliest and most?
Weight
InFFT what is spared?
Head growth
What gets affected after weight in FFT?
Linear growth/height
Bloods for FFT?
UECs, LFTs, BGLs, CMP
FBE, Iron studies, B12, Folate, Coags
TTG Antibodies, Total IgA
Thyroid
