Development - Failure To Thrive

Question 1

What is failure to thrive?

Answer 1

Inadequate physical growth resulting from insufficient nutrition, medical, or psychosocial factors

Question 2

What is the difference between failure to thrive and faltering growth?

Answer 2

Faltering growth = growth pattern on charts
Failure to thrive = clinical syndrome with underlying causes

Question 3

What is faltering growth?

Answer 3

Fall in birth weight across:
- One or more centile spaces if they were below 9th
- Two or more centile spaces if between 9th and 91st
- Three or more centile spaces if above 91st centile

Question 4

Which growth parameter is affected first in undernutrition?

Answer 4

Weight
Then height
Then head circumference (late and concerning)

Question 5

What is a centile space?

Answer 5

Distance between two centile lines on a growth chart e.g. distance between 75th and 50th centile lines

Question 6

What are the general causes of failure to thrive?

Answer 6

Inadequate intake
Feeding difficulty
Malabsorption
Increased energy requirements
Ineffective utilisation of nutrients (e.g. diabetes mellitus)

Question 7

What are the causes of inadequate nutritional intake?

Answer 7

Low breast milk supply
Feeding technique issues
Iron deficiency anaemia
Parental or family factors
Neglect
Food insecurity (poverty)

Question 8

What are some causes of feeding difficulties?

Answer 8

Poor suck (e.g. cerebral palsy)
Cleft lip or palate
Oromotor dysfunction

Question 9

What are some causes of malabsorption?

Answer 9

Cystic fibrosis
Coeliac disease
Cow’s milk protein allergy
Chronic diarrhoea
IBD

Question 10

What can cause an increased energy requirement?

Answer 10

Chronic disease (e.g. congenital heart disease, cystic fibrosis)
Chronic infection
Malignancy

Question 11

When should neglect be considered in failure to thrive?

Answer 11

Poor growth despite adequate advice
Missed appointments
Concerning parent–child interaction

Question 12

What needs to be assessed in failure to thrive?

Answer 12

• Pregnancy, birth, developmental and social history
• Feeding or eating history
• Observe feeding
• Mum physical and mental health
• Parent child interactions
• Height, weight and head circumference (if <2 years)
  BMI (if >2 years)
• Calculate mid-parental height centile

Question 13

What does a feeding history involve?

Answer 13

Breast or bottle feeding
Feeding times
Volume and frequency
Difficulties feeding

Question 14

What does eating history involve?

Answer 14

Food choices
Food aversion
Meal time routines
Appetite in children

Question 15

What can be useful for parents to do after a feeding history?

Answer 15

Food diary

Question 16

What outcomes from assessment suggest inadequate nutrition or growth disorder?

Answer 16

Height >2 centile spaces below mid-parental height centile
BMI < 2nd centile

Question 17

What initial investigations should be done for faltering growth?

Answer 17

Urine dip (exclude UTI)
Coeliac screen (anti-TTG ± total IgA)

Other investigations considered when symptoms suggest underlying diagnosis e.g. CF or pyloric stenosis

Question 18

What happens if faltering growth reviews are too frequent?

Answer 18

Increases parental anxiety

Question 19

What can be done when there is difficulty with breastfeeding?

Answer 19

Midwife support
Health visitor support
Lactation consultants
Supplementing with formula milk

Question 20

What can supplementation with formula milk sometimes lead to?

Answer 20

Results in reduced or stopped breastfeeding

Question 21

Why should mothers be encouraged to express when not breastfeeding?

Answer 21

To encourage lactation to continue

Question 22

What can be done for inadequate nutrition?

Answer 22

Encouraging regular structured mealtimes and snacks
Limit excessive milk intake to improve appetite for solid foods
Review by a dietician
Energy dense foods
Nutritional supplement drinks

Question 23

What is a last-line measure for inadequate nutrition?

Answer 23

Enteral tube feeding