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)

Failure to thrive (FTT), also known as faltering growth, can result from a single issue or a combination of multiple factors, including social, medical, and feeding issues. It is essential to support parents and thoroughly investigate all possible causes.

Introduction

• Failure to thrive (FTT) is defined as insufficient weight gain or inappropriate weight loss in pediatric patients, often during infancy and early childhood.
• A centile space refers to the space between adjacent centile lines on the UK WHO growth charts.
• FTT is typically applied to infants and children under two years of age who fail to gain or maintain weight according to expected growth patterns.

Failure to Thrive Defined As

• A fall across one or more weight centile spaces if the birth weight was below the 9th percentile.
• A fall across two or more weight centile spaces if the birth weight was between the 9th and 91st percentiles.
• A fall across three or more weight centile spaces if the birth weight was above the 91st percentile.
• When the current weight falls below the 2nd percentile for age, regardless of birth weight.

Background

• It is common for infants to lose some weight in the early days after birth, but most infants should return to their birth weight by 3 weeks of age.
• A weight loss greater than 10% is often indicative of dehydration, and it's important to assess hydration status and check for underlying illnesses or disorders.
• If infants lose more than 10% of their birth weight or fail to regain it by 3 weeks, consider referring to pediatric services, especially if there is marked weight loss or no response to feeding support.

Main Points

• FTT refers to slow physical development, and it may result from insufficient nutrition, a condition that can cause problems such as short stature, behavioral issues, and developmental delays.
• FTT can have many causes, including inadequate nutrition, issues with food absorption, or chronic health conditions requiring more nutrients than normal.
• In severe cases, neglect or abuse may be a contributing factor, with food being intentionally withheld from the child.
• Early intervention is crucial to prevent long-term nutritional deficiencies and developmental problems.

General Causes

General Assessments

• Take a full history and perform a comprehensive examination.
• Plot the child's growth on a growth chart.
• Plot midparental height for comparison.
• Observe feeding behavior, including volume and frequency.
• Maintain a food diary for further assessment of dietary intake.

Clinical Signs

• Failure to gain weight according to age expectations.
• Low height for age.
• Irritability, tiredness, excessive sleepiness.
• Lack of age-appropriate social responses, such as smiling.
• Delayed motor development.
• Learning and behavioral problems in older children.

Investigations

• Full blood count (FBC), urea & electrolytes (U&E), urine dipstick for urinary infection.
• Anti-TTG for celiac disease screening.
• Specific tests based on clinical suspicion (e.g., plasma lead levels in cases of suspected poisoning).

Management

• Support breastfeeding, and supplement with formula milk if necessary.
• Referral to a dietitian for review and nutritional supplements.
• Interdisciplinary collaboration is essential for evaluation and treatment.
• Hospitalization is reserved for severe or recalcitrant cases.
• In severe cases, nasogastric (NG) feeding may be required.

References

• NICE guidance on faltering growth