Makindo Medical Notes

Related Subjects: |Causes of Short Stature in Children |Causes of Male Infertility |Causes of Tall Stature in Children |Marfan syndrome |Klinefelter Syndrome |Turner's syndrome (Children)

The causes may be a single issue or many and multifactorial - social, medical, feeding. Support parents. Look for any causes.

Introduction

• Insufficient weight gain or inappropriate weight loss in paediatric patients
• A centile space is the space between adjacent centile lines on the UK WHO growth charts)
• It is usually applied to infants and children up to two years of age who do not gain or maintain weight as they should.

Failure to thrive defined as

• A fall across 1 or more weight centile spaces, if birthweight was below the 9th centile
• A fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles
• A fall across 3 or more weight centile spaces, if birthweight was above the 91st centile
• When current weight is below the 2nd centile for age, whatever the birthweight.

Background

• It is common for infants to lose some weight during the early days of life but this usually stops after about 3 or 4 days of life and most infants have returned to their birth weight by 3 weeks of age.
• If there is a 10% loss the commonest reason is dehydration. Assess hydration, or of an illness or disorder that might account for the weight loss. Take a detailed history to assess feeding. Consider the direct observation of feeding. Ensure done by a person with appropriate training and expertise (for example, in relation to breastfeeding and bottle feeding) perform further investigations only if they are indicated based on the clinical assessment.
• If infants lose more than 10% of their birth weight in the early days of life, or they have not returned to their birth weight by 3 weeks of age, consider referral to paediatric services if there is evidence of illness, marked weight loss, or failure to respond to feeding support

Main Points

• Failure to thrive is slow physical development in a baby or child. It may be caused by a baby or child not having enough nutrition. Child is at risk for problems such as short height, behaviour problems, and developmental delays.
• FTT has many possible causes. A baby or child may not be getting enough nutrients and calories. Or a baby or child may take in enough food, but not be able to absorb enough nutrients and calories.
• A baby or child with an ongoing (chronic) health condition may also need more calories and nutrients than normal.
• In some cases, a family may not understand what a baby needs. In severe cases, neglect or abuse may lead to FTT if food is kept from a baby on purpose. FTT can be prevented by seeking early help with a child's nutritional needs

General Causes

General Assessments

• Full history and Full examination
• Plot growth chart
• Plot midparental height
• Observe feeding, volume, frequency
• Food diary

Clinical

• Not enough weight gain for age
• Low height (or length, if a baby) for age
• Irritability, Tiredness
• More sleepiness than normal
• Lack of age-appropriate social response, such as smiling
• No vocal sounds
• Delayed physical movement changes (motor development)
• Learning and behaviour problems in older children

Investigations

• FBC, U&E, Urine dipstick for urinary infection
• Anti TTG ? Coeliac
• Specific tests as indicated by assessment
• Plasma lead levels in specific cases

Management

• Breast feeding support +/- supplement with formula milk
• Dietician review with supplements
• Interdisciplinary collabouration is ideal in evaluation and treatment.
• Hospitalisation should be reserved for severe or recalcitrant cases.
• Severe cases may need NG feeding

References

• NICE guidance on faltering growth