Growth Faltering

Question 1

What is this describing?
The falling of weight measurements across two or more centile lines on a growth chart which warrants further investigation.

Answer 1

Growth faltering

Question 2

What are the causes of growth faltering due to insufficient intake?

Answer 2

1. Difficulties with breast or bottle feeding
2. Neglect
3. Poor suck or swallow
4. GORD
5. Mechanical problems (cleft palate)

Question 3

What are the causes of growth faltering due to inadequate absorption?

Answer 3

1. Cow’s milk protein intolerance
2. Cystic fibrosis
3. Coeliac disease

Question 4

What are the causes of growth faltering due to increased loss?

Answer 4

1. Malabsorption
2. Diarrhoea
3. Vomiting

Question 5

What are the causes of growth faltering due to increased metabolic demands?

Answer 5

1. Congenital heart defect
2. Hyperthyroidism
3. Chronic or recurrent infection

Question 6

What does a normal growth until weaning imply?

Answer 6

Coeliac disease

Question 7

What should you ask about milk and stores in a history of growth faltering?

Answer 7

1. Milk - volume, type, frequency, top-ups?

2. Stools - green (inadequate milk intake), pale (obstructive jaundice), frequent (cow’s milk protein intolerance)

Question 8

How is growth faltering investigated?

Answer 8

1. Check feeding technique
2. Coeliac serology, U&Es, glucose, FBC, LFTs, TSH, sweat test.
3. ECG/echo
4. Skeletal survey if suspecting abuse