Flashcards in Failure to thrive-O'Connor Deck (23):
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?
Improper formula preparation
Discoordination of suck/swallow/ breathe
Cleft lip or palate
Irritable bowel syndrome
What are some psychosocial causes of inadequate energy intake?
parental depression, learning disability, neglect, drug abuse, eating disorder
sensory disorder, food phobia
What are some malabsorption problems for FTT?
Inborn error of metabolism
Food intolerance or allergy
What are some things that can cause high metabolic needs & FTT?
Chronic infection or immunodeficiency disease
Congenital heart disease or heart failure
Chronic pulmonary disease; asthma
Heart disease or failure
What are some red flags for a medical cause of FTT?
Cardiac findings suggesting congenital heart disease of heart failure
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
What is the clinical workup for FTT?
**if appropriate--test for HIV or TB
Stool ph & culture
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
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
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