Failure to thrive

Question 1

Sequence of events and symptom analysis

Answer 1

Open question
Clarify- height, weight or both
Timeline- when did you first notice it, how has it been since, have they always been small/thin, have they put any weight/height on, have they lost any weight

Question 2

Systems review

Answer 2

See paediatric history template

GIT- stools, diarrhoea, tummy ache, vomiting 
RS- cough, how long, bring anything up
Constitutional- FWARJNL
Traffic light system
Feeding history
Pregnancy and birth history
developmental history 
Immunisation history

Question 3

Patients perspective

Answer 3

Feeling and impact

ICE

Question 4

Background

Answer 4

PMH
DH (inc. allergies)
FH- any coeliac, CF, diabetes, how were you and your partner growing up ie. any problems
SH- how are siblings, how are they doing at school, do you have support at home

Question 5

Organic causes

Answer 5

Prenatal;
-prematurity, maternal malnutrition, congenital infections, IUGR, toxin exposure in utero eg. alcohol, cigarettes, recreational drugs

Intake issues;

• neuromuscular disorder eg. can’t suck/swallow properly
• cleft pallet, GORD

Malabsorption;

• diarrhoea
• CF
• coeliac disease
• IBD
• cows milk intolerance

Metabolic disorders;

• hypothyroidism and diabetes
• hyperthyroidism, heart and renal failure

Question 6

Non-organic causes

Answer 6

Constitutional delay

• genetic predisposition (short parents will have a short child)
• no other problems identified in history

Inadequate feeds;

• not being fed enough or often enough (neglect)
• distractions at meal time
• poor breastfeeding technique
• bottle feeds not made up properly
• could be due to lack of knowledge by parent/lack of supervision/child neglect
• lack of support and problems in home environment

Question 7

Investigations

Answer 7

Bedside- physical exam, growth and weight charts, observe child feeding (if obvious cause- no further tests needed), urinalysis and MC, stool culture OCP and fat (malabsorption)

Bloods- FBC UE LFT ESR TFT glucose coeliac antibodies

Specialist- sweat tests for CF

Question 8

Management

Answer 8

General- suitable feeding environment, parent education

MDT approach- health visitors, dieticians, paediatricians if organic cause, child neglect- social services