Failure to Thrive

Question 1

Failure to Thrive

Definition

Answer 1

Failure to grow at the expected rate, given the child's age 
Height and weight looked at 
Height manifests later
Weight manifests early 
Monitored from birth to 36 mo.

Question 2

Failure to thrive

Misconceptions

Answer 2

It is due to neglect- it is more common in underdeveloped countries, illness, or difficulty feeding

It is diagnosed whenever a child crosses down 1 %- it isn’t a problem until the child crosses 2%

It necessitates admission- only in severe cases or neglect cases, not for mild cases where the cause has been identified

Question 3

Failure to Thrive

Causes

Answer 3

Inadequate caloric intake
Incorrect formula prep
Inadequate breast milk intake (latching problems or poor sucking, or congenital problems)
Poverty
Neglect
Fad Diets

Question 4

Failure to Thrive

Caused by Malabsorption

Answer 4

Celiac Disease
Cystic Fibrosis
Cow’s Milk Enteropathy (under 1 should not have cow milk)
Vitamin or Mineral Deficiency

Question 5

Failure to Thrive

Caused by Renal Insufficiency

Answer 5

Malignant Process

Hypoxemia

Question 6

Failure to Thrive

Management

Answer 6

Education
Require 150% of dietary needs until normal
Follow up with 1 week food diary
SHould gain 2oz per day
Dietician
If severe due to neglect- social services

Question 7

Failure to Thrive

History Taking

Answer 7

Feeding schedule
Social/economic conditions
Timing of milestones
OB history
Neonatal history
PMH of child
ROS

Question 8

Failure to Thrive

Physical Exam

Answer 8

Color of Skin (anemia?)
Skin and Hair
Poor Hygiene 
Swollen head (infection)
Conjunctiva (anemia)
Pupils (congenital infection)
Ears (congenital immunodeficiency)
Mouth (metabolic disorder)
Thyroid
Skeletal (edema)
Neuro 
Psych
Abuse

Question 9

Failure to Thrive

Non-Organic Causes

Answer 9

Over dilution of formula
Using condensed milk 
Preemie being measured on standard chart 
Worries food will run out 
No vitamin or mineral replacement 
Infrequent feeding