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Paeds: Gastro and Growth > Faltering growth > Flashcards

Faltering growth Flashcards

1
Q

What is meant by weigth faltering?

A

Suboptimal weight gain in infants or young children

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2
Q

What can weight faltering lead to, if prolonged and severe?

A

Reduction in height or length (stunting) and reduction in head growth, and may be associated with delayed development

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3
Q

How will a healthy child’s weight usually progress on a growth chart?

A

Usually progresses within one centil space (distance between two major centile lines on the growth chart)

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4
Q

What often happens to babies in the first few weeks after birth, depending on their birth weight?

A

Infants who are large at birth often cross down centiles (catch down growth) whereas small babies will move up centiles (catch up growth) to find genetic centile growth lines

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5
Q

What can often cause infants to lose weight acutely and what happens subsequently?

A

Acutely ill; will regain weight centile within 2-3 weeks

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6
Q

What is the meaning of weight faltering in terms of growth charts?

A

Sustained drop down two centile spaces

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7
Q

What proportion of children after the first 4 months will cross down two centile spaces?

A

Around 0.5% of children in UK

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8
Q

What is the only situations when a single weight measurement on its own tells us much about a baby’s growth?

A

If it is markedly different on growth chart from lengths or head circumference

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9
Q

What are 5 points at which all babies should be weighed? What else would prompt them to be weighed?

A
  1. Within first week
  2. 8 weeks
  3. 12 weeks
  4. 16 weeks
  5. 1 year

+ wherever concerns are raised

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10
Q

Why is it important to weigh the baby in the first week of life?

A

to assess feeding

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11
Q

What are 3 situations when you should evaluate a baby for weight faltering?

A
  1. Weight crosses two centile lines
  2. Weight below 0.4th centile
  3. BMI less than second centile
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12
Q

What do you need to differentiate an infant with growth faltering from?

A

Small but normal or thin baby

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13
Q

What should you remember with faltering growth and prematurity?

A

if born preterm, allow for this when plotting during first 1-2 years

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14
Q

What is usually the pattern seen after infants are born with severe intrauterine growth restriction?

A

some remain small, but most exhibit catch-up growth

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15
Q

What are 5 groups of causes of weight faltering?

A
  1. Inadequate intake
  2. Inadequate retention
  3. Malabsorption
  4. Failure to utilise nutrients
  5. Increased requirements
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16
Q

What are 5 groups of causes within the ‘inadequate intake’ group of causes of weight faltering?

A
  1. Inadequate availability of food
  2. Psychosocial deprivation
  3. Neglect or child abuse
  4. Impaired suck/swallow
  5. Chronic illness leading to anorexia
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17
Q

What are 7 causes of inadequate availability of food that could lead to inadequate intake causes of weight faltering?

A
  1. Feeding problems - insufficient breast milk or poor technique, incorrect preparation of formula
  2. Insufficient or unsuitable food offered
  3. Lack of regular feeding times
  4. Infant difficult to feed- resists or disinterested
  5. Conflict over feeding, intolerance of normal feeding behaviour e.g. messiness, throwing food round, leading to early cessation of meals
  6. Problems with budgeting, shopping, cooking food, famine
  7. Low socioeconomic status
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18
Q

What are 3 forms of psychosocial deprivatino that could contribute to inadequate intake as a cause of faltering weight?

A
  1. Poor maternal-infant interaction
  2. Maternal depression
  3. Poor maternal education
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19
Q

What could neglect or child abuse include that contributes to inadequate intake as a cause of weight faltering?

A

factitious illnes: deliberate underfeeding to generate weight faltering

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20
Q

What are 3 causes of impaired suck/swallow that can lead to inadequate intake and weight faltering?

A
  1. Oro-motor dysfunction
  2. Neurological disorder e.g. cerebral palsy
  3. Cleft palate
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21
Q

What are 4 examples of chronic illnesses that could lead to anorexia, and hence reduced intake and weight faltering?

A
  1. Crohn disease
  2. CKD
  3. Cystif fibrosis
  4. Liver disease
22
Q

What are 2 causes of inadequate retention leading to weight faltering?

A
  1. Vomiting
  2. Severe GORD
23
Q

What are 6 causes of malabsorption that can cause weight faltering?

A
  1. Coeliac disease
  2. Cystic fibrosis
  3. Cow’s milk protein allergy
  4. Cholestatic liver disease
  5. Short gut syndrome
  6. Post-necrotising enterocolitis (NEC)
24
Q

What are 7 causes of failure to utilise nutrients that can lead to weight faltering?

A
  1. Chromosomal disorders e.g. Down syndrome
  2. IUGR
  3. Extreme prematurity
  4. Congenital infection
  5. Metabolic disorders e.g. congenital hypothyroidism
  6. Storage disorders
  7. Amino and organic acid disorders
25
Q

What are 6 examples of diseases that have increased requirements so could lead to faltering weight?

A
  1. Thyrotoxicosis
  2. Cystic fibrosis
  3. Malignancy
  4. Chronic infection (HIV, immune deficiency)
  5. Congenital heart disease
  6. Chronic kidney disease
26
Q

What are 10 things to consider in the history/ examination of a child with weight faltering?

A
  1. History of milk feeding
  2. Age at weaning
  3. Range and type of foods now taken
  4. Mealtime routine and eating and feeding behaviours
  5. 3-day food diary - can provide more detailed info
  6. Observe meal being eaten if possible
  7. Was child born pretern or had IUGR?
  8. Well with lots of energy or other symptoms e.g. diarrhoea, vomiting, cough, lethargy?
  9. Growth of other family members, illnesses in family
  10. Is chld’s development normal?
27
Q

What are 5 things to look for in the examination of a child with weight faltering?

A
  1. Signs of organic disease e.g. dysmorphic features
  2. Signs suggestive of malabsorption - distended abdomen, thin buttocks, misery
  3. Signs suggestive of chronic respiratory disease
  4. Signs of heart failure
  5. Evidence of nutritional deficiencies - koilonychia, angular stomatitis
28
Q

What are 2 key possible investigations that can be performed in weight faltering and why?

A
  1. Full blood count
  2. Serum ferritin

to identify iron deficiency anaemia

29
Q

Why can it be useful to investigate for iron deficiency anaemia in weight faltering?

A

usually secondary to inadequate iron intake; correcting it may improve appetite

30
Q

In total what are 12 investigations that can be performed in weight faltering?

A
  1. FBC
  2. U+Es, acid-base status, calcium, phosphate
  3. LFTs
  4. TFTs
  5. CRP
  6. Ferritin
  7. Immunoglobulins
  8. IgA tTG
  9. Urine dip
  10. Stool microscopy, culture, elastase
  11. Karyotype in girls
  12. Sweat test, CXR
31
Q

Why can it be helpful to perform FBC in weight faltering?

A

Anaemia, neutropenia, lymphopenia (immune deficiency)

32
Q

Why can it be helpful to perform U+Es, acid-base status, calcium and phosphate in weight faltering? 4 things

A

Renal failure, renal tubular acidosis, metabolic disorders, William syndrome

33
Q

What are 3 reasons to perform LFTs in weight faltering?

A
  1. Liver disease
  2. Malabsorption
  3. Metabolic disorders
34
Q

Why can it be helpful to perform TFTs in weight faltering?

A

hypo or hyperthyroidism

35
Q

Why can it be helpful to perform immunoglobulin blood levels in weight faltering?

A

immune deficiency

36
Q

Why can it be helpful to perform a urine dip in weight faltering? 2 reasons

A

UTI, renal disease

37
Q

What are 3 reasons to perform stool microscopy, culture and elastase in weight faltering?

A
  1. Intestinal infection
  2. Parasites
  3. Elastase decreased in pancreatic insufficiency
38
Q

Why can it be helpful to perform karyotyping in weight faltering in girls?

A

Turner syndrome

39
Q

Why can it be helpful to perform sweat test and CXR in weight faltering?

A

cystic fibrosis and other respiratory disorders

40
Q

Where is the management of most weight faltering carried out?

A

Primary care

41
Q

What are 6 people who can help to manage weight faltering?

A
  1. Health visiors
  2. Paediatric dietitian
  3. Speech and language therapist
  4. Clinical psychologist
  5. Social services
  6. Nursery placement
42
Q

How can a health visitor help to manage weight faltering?

A

Mealtime observations and food diaries, can assess and support families to improve feeding and increase calorie intake

43
Q

How can a paediatric dietitian be helpful to manage weight faltering?

A

Assessing quantity and composition of food intake, recommending strategies for increasing engergy intake

44
Q

How can nursery placement help with management of weight faltering?

A

Alleviating stress at home and assisting with feeding

45
Q

What is the key outcome measure in weight faltering?

A

rise up the weigth centiles

46
Q

When do you usually start to see a change following intervention for weight faltering?

A

4-8 weeks after intervention

47
Q

When might hospital admission be necessary for weight faltering and what can they offer?

A

Children under 6 months with severe weight faltering

Active refeeding and MDT involvemet

48
Q

What is the limitation of managing weight faltering with hospital admision?

A

while it may offer opportunity to observe and improve parent’s method and skill in feeding, it rarely transfers back to home

wards busy and focused on acute illness so admission unlikely to be helpful unless clear and agreed preadmission plan

49
Q

What is the benefit of hospital admission for weight faltering in extreme circumstances?

A

can be used to demonstrate child will gain weight when fed appropriately

50
Q

What is the likely long term effect of weight faltering? 3 things

A
  1. appears to have long term effect with children remaining on low centile; but at 4 years children who received intervention heavier and taller than untreated
  2. adverse effect on cognition
  3. some children continue to undereat
51
Q

What are 6 examples of good behavioural practice for mealtimes to improve a child’s eating?

A
  1. offer meals at regular times with other family members
  2. praise when food is eaten, ignore when not
  3. limit mealtime to 30 minutes
  4. eat at same time as child
  5. avoid mealtime conflict
  6. never force feed

Paeds: Gastro and Growth (14 decks)

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