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Block 11 Week 1 > Failure to Thrive > Flashcards

Failure to Thrive Flashcards

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1
Q

what is the current clinical concept of FTT?

A

it’s multifactorial

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2
Q

what % of children in primary care have FTT?

A

5-10%

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3
Q

at what age does FTT mostly present?

A

before 18 mo

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4
Q

what socioeconomic class is disproportionately affected w/ FTT?

A

poorer rural & urban communities

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5
Q

do children w/ special healthcare needs have higher or lower rates of FTT?

A

higher

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6
Q

How does severe, prolonged malnutrition in resource-poor countries affect a child’s growth & cognitive development?

A

negatively & permanently

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7
Q

what happens w/ babies w/ LBW who develop FTT?

A

long-term developmental effects > smaller, lower cognitive scores, poorer overall academic performance

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8
Q

T/F: serious nutrition deficiencies are rare in the US

A

true

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9
Q

what happens w/ babies w/ normal birth weight who develop FTT?

A

no correlation btwn long term health probs or lower cognitive development

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10
Q

what are the 3 main causes of FTT?

A
  1. inadequate intake
  2. inadequate uptake/absorption
  3. inc metabolic demand/inc calorie requirements
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11
Q

what period of your life has the most rapid growth?

A

infancy

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12
Q

what are the calorie needs of an infant?

A

3-4x adult

~100-110/kg

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13
Q

health & appropriate development are primarily dependent on WHAT?

A

adequate nutrition

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14
Q

what are examples of inadequate energy intake seen in primary care?

A
  1. breastfeeding prob
  2. improper formula prep
  3. GERD
  4. discoordination of suck/swallow/breathe
  5. cleft lip/palate
  6. mood disorder
  7. eating disorder
  8. constipation
  9. IBS
  10. dental caries
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15
Q

what are some examples of psychosocial causes of inadequate energy intake?

A
  1. poverty/financial stress (low food avail)
  2. parent (depression, eating disorder, low fxning, neglect, drugs)
  3. sensory disorder, food phobia, oral aversion
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16
Q

what are some examples of causes of inadequate energy UPtake?

A
  1. malabsorption
  2. GI malformation
  3. inborn error of metabolism
  4. food intolerance or allergy
  5. celiac
  6. diabetes
  7. renal dz
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17
Q

what are some examples of causes of high metabolic needs?

A
  1. prematurity
  2. chronic infxn or immunodeficiency
  3. pulm dz
  4. congenital heart dz or heart failure
  5. seizure disorder
  6. thyroid dz
  7. chronic pulmonary dz/asthma
  8. heart dz or failure
  9. malignancy
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18
Q

what things should you ask about in the workup of a FTT infant?

A
  1. pre/postnatal hx
  2. existing health probs (infxn, resp sx, vomiting, diarrhea, constipation, allergies)
  3. caregiver status
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19
Q

what are the 5 RED FLAG signs & sx suggesting a medical cause of FTT?

A
  1. cardiac findings that suggest congenital heart dz or heart failure
  2. developmental delay
  3. dysmorphic features
  4. recurrent/severe infxn
  5. recurrent vomiting, diarrhea, or dehydration
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20
Q

what should you do in the physical exam if you’re working up FTT? (4 main things)

A
  1. review growth chart
  2. note general appearance
  3. look for signs of injury/abuse
  4. look for signs of malnutrition
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21
Q

what are the signs of malnutrition?

A

hair > easily pluckable, changes in color
skin > dry & scaly
behavior > irritable, apathetic, socially unresponsive
bloated abd

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22
Q

how often does routine lab testing identify a cause for FTT?

A

only <1%

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23
Q

what tests can you do to evaluate a cause for FTT?

A

swallow studies
genetic tests
cardiac fxn
pulm fxn

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24
Q

what should you do for a medical workup of FTT?

A
  1. CBC
  2. CMP
  3. stool pH
  4. fecal fat
  5. stool o&p, culture
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25
what are you looking for when you do a CBC in a FTT infant?
anemia or lymphopenia
26
what are you looking for when you do a CMP in an infant w/ FTT?
renal dz electrolyte disorder protein malabsorption
27
what should you be observing at the clinical visit when you are evaluating FTT?
1. parent child interactions & bonding 2. parent demeanor 3. literacy level or intellectual ability
28
what part of the breast should an infant latch onto to breastfeed?
the ENTIRE areola & nipple
29
if a baby has an open mouth, is it likely that he wants to eat?
YUP
30
what is the best way to get back to pre-pregnancy weight for the mom?
breastfeed!
31
what are the health effects for women who breastfeed?
lower rates of breast & ovarian cancer | fewer hip fx
32
what are the 3 forms of formula you can buy?
1. powdered 2. concentrated liquid 3. ready-to-feed
33
what do "enhanced" formulas possibly contain?
probiotics DHA fiber
34
how often should you feed a newborn?
on demand! | every 2-3 hours (8-12 feedings per 24 hours)
35
what are signs of hunger that an infant might display?
``` opening the mouth suckling sounds waving hands hand-to-mouth rooting pre-cry fussing crying ```
36
should you wake a baby up to feed it?
if it's jaundiced, YES | if it has already skipped one meal, YES
37
when should you burp a baby?
midway thru or after feeding
38
how long should you breastfeed at a time?
20-45 min per feeding
39
how many ounces should you give a baby per feeding?
2+ oz per feeding (from a bottle)
40
what are 3 common problems a/w food intake?
spitting up gas constipation
41
T/F: healthy infants need lots of water
FALSE | they don't need any extra! they get enough in breastmilk/formula
42
how many wet diapers should a baby have per day?
6-8/day cloth | 5-6/day disposable
43
what should you use as an indicator of hydration of an infant?
of wet diapers per day
44
when should you offer a baby their first foods?
4-6 mo | bc the digestive system has matured a little
45
what things indicate that a baby is ready for their first foods?
1. tongue protrusion reflex is disappearing 2. head & neck control improve 3. sitting w/ little or no assistance
46
what is a good idea to offer as a first food for a baby?
rice cereal + iron, thinned out w/ breastmilk or formula (thicken it as they get better)
47
what utensil should you use to feed a baby first?
a SPOON
48
at what age is a baby ready for finely chopped table foods?
7-10 mos
49
at what age do kiddos get good at chewing?
not until age 4!
50
how big should you chop food for babies?
1/4 inch pieces
51
at what age is a baby first ready to try feeding themselves?
~7-9 mos (bc pincer grasp is developing)
52
what types of foods should you offer a baby that is ready to start feeding itself?
foods that dissolve easily like baby crackers, bread pieces, sliced cheese, dry cereals
53
when can many babies master feeding themselves?
14-18 mos
54
at what age should you offer a cup to a baby?
``` 6 mos (cut down on bottles around 9-10 mos) ```
55
what type of cups are best for babies learning to drink for themselves?
``` open cups (supervised) use sippy cups w/ lids only when necessary ```
56
what is the best seating for a toddler?
must have foot and hand support must be seated must be secure & unable to get out must have a stable base
57
what is the appropriate interval for measuring a baby from 0-9 mos?
every 4-6 weeks
58
what is the appropriate interval for measuring a baby from 10-24 months?
every 3-4 months
59
what is the appropriate interval for measuring a baby from 2-5 yo?
every 6 months
60
what growth parameter is usu the first to respond to under-nutrition?
WEIGHT | length & head circumference are usu spared
61
what growth parameters change if a pt has a chronic medical condition?
a symmetric fall in BOTH weight & length
62
T/F: you really only need to pay attn to one growth parameter when evaluating FTT
FALSE | best to use a combo of measures
63
what is "underweight"?
weight is significantly lower than other children: | <5th %ile weight/length or BMI
64
what is growth faltering?
child's rate of weight gain slows or stops after it has previously been established
65
what 6 team members should be present to treat FTT?
1. medical 2. nutrition 3. development 4. occupational or speech/language 5. social work 6. mental health
66
how can you provide parent support to a parent w/ an infant w/ FTT?
1. treatment or counseling for identified conditions 2. parenting classes if low fxn 3. stress mgmt 4. "checking in"
67
what are the 4 criteria for treatment success of FTT infants?
1. optimal growth 2. developmentally appropriate feeding & eating skills 3. healthy eating habits firmly entrenched 4. healthy eating relationships firmly entrenched
68
look at slide 60 cause i don't wanna make cards for that
okay
69
how can you increase energy density for an INFANT?
change formula to 24 or 27 kcal/oz conc std 20 kcal formula w/ diff proportions powder to water add fat/oil, avo, polycose, moducal
70
what foods should you AVOID if you're trying to increase energy density?
jello juice popsicles candy
71
what foods can you use to increase energy density for a CHILD?
cream, powdered milk, instant breakfast powder, avocado, PB, sour cream, yogurt, butter, cream cheese, ranch

Block 11 Week 1 (2 decks)

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