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Flashcards in Poor growth Deck (22):
1

Define failure to thrive

Wt below 2rd %tile for sex and gestation corrected on appropriate growth chart. 2% tile or wt less then 10% of Ht.

RCH children under 3 yr who's wt crosses two or more percentiles

2

Most common causes of small child

Familial small size
Constitutional delay

Less common
Inadequate caloric intake usually secondary to abnormal feeding behaviour and less commonly due to neglect

3

Serious disease that can present as isolated poor growth

Coeliac and chronic renal failure
Most present with other signs

4

Poor growth due to poor social circumstances

Signs of neglect
Signs and symptoms of motion all and developmental delay

5

Poor growth due familial short statue

Hx and examination is normal
Calculate predicted adult Ht parents are short
Bone age is appropriate for chronological age

6

Constitutional delay in growth

Hx and examination are normal
FmHx of delayed puberty and menarche
Bone age is less than chronological age.

7

Hx child presenting poor growth

Hx consider pattern of growth
Feeding and eating behaviour - details of breastfeeding, formula and solids. Meal time battle, coercive feeding. Parents attitudes
Caloric intake
Consider psychosocial deprivation
Parent child interaction
Check birth weight
Look for signs and symptoms of underlying organic disease- malabsorption,chronic illness involving underlying organ or genetic disease.
Antenatal cx and maternal health
Vomiting or diarrhoea
Development delay
Calculate mid parental Ht
Lack of financial resources, housing or support

8

First line Ix for a children with poor growth/FTT with no specific pointers to a medical cause

FBC
ESR, CRP
Urea, creatinine, LFTs
Iron status
Calcium, phosphate
Thyroid function
Blood glucose
Coeliac serology if on solid foods containing gluten
Urine for microscopy and culture
Stool for microscopy and culture
Stool for fat globules and fatty acid crystals
Other investigations depending on findings in the Hx and Examintion
If girl do Karyotype for turner's.

9

How to work out if a child Ht is normal

Boys in paternal Ht in cm plus maternal Ht in cm plus 13 then divide it by 2. This given adult Ht plus or minus 8
Girls is maternal Ht in cm plus paternal Ht in cm minus 13. Then divide by 2 to get adult Ht.

10

Causes of failure to thrive

Environmental and psychosocial - non organic
Inadequate caloric intake/retention
- Inadequate nutrition
- Breast feeding difficulties
- Restricted diet eg low fat or vegan
- structural causes eg cleft palate
- Persistent vomiting
- anorexia of chronic disease
- error in infant formula dilution
- early or delayed introduction of solids
Inadequate absorption
- Coeliac
- Chronic liver disease
- Pancreatic insufficiency
- Chronic diarrhoea
- Cow milk protein intolerance
Excessive caloric utilisation
- Chornic illness
- UTI
- Chronic respiratory disease eg cystic fibrosis
- Congenital heart disease
- Diabetes mellitus
- Hyperthyroidism
Other - genetic syndromes and inborn errors of metabolism
Cystic fibrosis
IUGR
Immunodeficiency
Genetic syndromes
Chronic illness
Gastro-oesophageal reflux
Coeliac disease
Endocrine dysfunction eg hypothyroidism,

11

Environmental or psychosocial non organic causes of poor growth

Most common cause of weight faltering
Wt is usually affected first, then height and head growth
Eating difficulties are common
Neglect may be a factor.
Types of cause
- Eating difficulties - anxious and concerned parents
- difficulties in the home
- limitations in the parents
- disturbed attachment between mother and child
- Maternal depression or psychiatric disorder
- Neglect - also shows signs of physical signs poor care and emotion attachment. Often denied and compliance with poor intervention.
Mx -
- Tx underlying cause
- exclude organic causes
- family health visitor - nutritional support and eating problems
-Child support services
- case management

12

Examination of child with poor growth

G appearance of sick, scrawny, irritable or lethargic
Evidence of loss of muscle bulk and subcutaneous fat stores, especially upper arm, buttocks and thighs
Look for underlying diagnosis
Signs of child abuse, and neglect
In younger infant observe a feed.

13

Expected wt gain in infants

0 to 3 months 150-200g/week
3 to 6 months 100-150g/week
6 to 12 months 70-90g/week

14

Malabsorption

Diarrhoea and colic
Commonest cause are coeliac and cystic fibrosis
Coeliac gave classic fall off growth chart when started on solids

15

Causes of short stature

Steady growth below centiles
- Familial short statue
- Constitutional delay in growth
- Turner's syndrome
- IUGR
- Skeletal dysphasia
Fall-off in growth across centiles
- Chronic illness
- Acquired Hypothroidism
- Cushing's disease - rare
- Growth hormone deficiency - rare
- psychosocial

16

Turner's syndrome

Features of turners
- web neck
- Side chest plate and nipples
- wide carry angle
- Short
- lymph oedematous hands and feet
XO Karyotype
No pubertal signs
No delay in the bone age
Tx with
Oestrogens to start puberty
GH to prevent short statue

17

IUGR

Low birth weight
Underlying reason for IUGR may be evident
Short

18

Skeletal dysphasia

Short
Body disproportion with shortened limbs
Achondroplasia is the most common form

19

Chronic diseases that cause short stature and poor growth

Usually identificable on Hx and physical examination
Crohn's disease and chronic renal failure may be occult
Some delay in bone age occurs

20

Acquired Hypothroidism

Clinical features of Hypothroidism
Goitre may be present
Fall off in school performance, constipation, dry skin and delayed puberty
Low T4, high TSH and thyroid antibodies
Delayed bone age
Tx with thyroxine

21

Cushing disease

Usually iatrogenic due to prescribed steroid
Cushingoid features
Delayed bone age

22

Growth hormones deficiency

Rare
Congenital or acquired
Delayed bone age