Failure to thrive-O'Connor Flashcards
What is marasmus?
wasting of subcutaneous tissue over thorax w/ prominent ribs
How common is failure to thrive?
5-10% of kids seen in primary care
Which communities/pop is FTT more common in?
poor & rural communities
children w/ special health care needs
What are the nutritional causes of FTT?
Inadequate calorie and nutrient intake
Inadequate nutrient uptake or absorption
Increased metabolic demand/increased calorie requirements
What are some common causes of inadequate energy intake?
Breastfeeding problem
Improper formula preparation
GERD
Discoordination of suck/swallow/ breathe
Cleft lip or palate Mood disorder Eating disorder Constipation Irritable bowel syndrome Dental Caries
What are some psychosocial causes of inadequate energy intake?
poverty
parental depression, learning disability, neglect, drug abuse, eating disorder
sensory disorder, food phobia
What are some malabsorption problems for FTT?
Malabsorption
GI malformation
Inborn error of metabolism
Food intolerance or allergy
Celiac disease
Diabetes
Renal Disease
What are some things that can cause high metabolic needs & FTT?
Prematurity
Chronic infection or immunodeficiency disease
Pulmonary disease
Congenital heart disease or heart failure
Seizure disorder Thyroid disease Chronic pulmonary disease; asthma Heart disease or failure Malignancy
What are some red flags for a medical cause of FTT?
Cardiac findings suggesting congenital heart disease of heart failure
Developmental delay
Dysmorphic features
Recurrent or severe infections
Recurrent vomiting, diarrhea, or dehydration
What are some signs on PE of inadequate nutrition?
Hair: easily pluckable, changes in pigmentation
Skin: dry, scaly
Behavior: irritable, apathetic, socially unresponsive
Bloated abdomen
What is the clinical workup for FTT?
**if appropriate--test for HIV or TB swallowing studies genetic testing cardiac fcn pulmonary fcn CBC CMP Stool ph & culture fecal fat
What is a good latch for breastfeeding?
latching onto the areola, not just the nipple (hard on the mom & can’t squeeze the glands)
What’s best for newborns feeding?
exclusively breast for first 6 months
up to 12 mo +
What are the health benefits of breastfeeding?
Composition uniquely tailored to changing needs of growing infant
Fewer allergies, intestinal upsets, ear infections in infancy
Lower rates of diabetes and asthma in later life
Association between breastfeeding and improved school performance
Helps uterus regain pre-pregnancy size more rapidly
Women who breastfeed have lower rates of breast and ovarian cancer and fewer hip fractures in later life
What are good feeding practices during early infancy?
feed on demand, every 2-3 hrs
Signs of hunger: opening the mouth, suckling sounds, waving hands, hand-to-mouth, rooting, pre-cry fussing, crying
May need to wake baby to feed if longer than 4 hours
Burp midway through and after feeding
Breast: 20-45 minutes per feeding
Bottle: 2+ ounces per feeding
First foods should be offered at 4-6 months. Wht are some signs that you are approaching this time?
Offer at 4-6 months: digestive system has matured some tongue protrusion reflex is disappearing head and neck control are improving can sit with little or no assistance
What are good first foods?
rice cereal + iron made thin
When can kids eat mashed foods? Whole foods? Food hazards?
7-10 mo finely chopped foods
can’t chew until age 4
danger foods:
can feed themselves at 8-9 mo, master at 14-18 mo
Avoid uncut foods like hot dogs, grapes, cherry tomatoes, large chunks of meat , hard candy, popcorn, nuts, etc.
When should you take measurements of your baby?
0-9 months: every 4-6 weeks
10-24 months: every 3-4 months
2-5 years: every 6 months
When there is a fall in measurements, which go first?
Weight goes down first
then length
head circumference is last.
What is considered underweight?
<5th %ile weight/length or BMI
What is considered growth faltering?
Child’s rate of weight gain has slowed or stopped after it has previously been established
What are some ways to increase energy density for a child?
Change formula to 24 or 27 kcal/oz
Concentrate standard 20 kcal formula with different proportions powder to water
Foods: add fat/oil, avocado, Polycose, Moducal
—
Use whole milk
Add cream, powdered milk, instant breakfast powder
Add peanut butter, avocado, sour cream, yogurt, butter, cream cheese, ranch dressing
Avoid low energy dense foods (jello, juice, popsickles, candy)
