What is failure to thrive?
Poor physical growth + development in a child
What is the NICE guidelines definition of failure to thrive? (3 things)
Fall in weight across:
- 1+ centile spaces if birthweight was below 9th centile
- 2+ centile spaces if birthweight was between 9th and 91st centile
- 3+ centile spaces if birthweight was above 91st centile
What are the main causes of failure to thrive? (5 things)
- Increased energy req
- Inadequate nutritional intake
- Difficulty feeding
- Malabs
- Inability to process nutrition
What are the causes of Inadequate nutritional intake? (4 things)
- Maternal malabs (if breastfeeding)
- Iron deficiency anaemia
- Family / paternal problems (Neglect)
- Poverty (no food)
What are the causes of Difficulty feeding? (4 things)
- Poor suck (e.g in cerebral palsy)
- Cleft lip / palate
- Genetic conditions (–> abn facial structure)
- Pyloric stenosis
What are the causes of Malabs? (5 things)
- Cystic fibrosis
- Coeliac disease
- Milk intolerance
- Chronic diarrhoea
- IBS
What are the causes of Increased energy req? (4 things)
- Hyperthyroidism
- Chronic disease (e.g Congenital heart disease / Cystic fibrosis)
- Malignancy
- Chronic infections (e.g HIV / immunodeficiency)
What are the causes of inability to process nutrients properly? (2 things)
- Inborn errors of metabolism
- T1DM
What are the key areas of assessment of failure to thrive? (6 things)
- Pregnancy / Birth / Dev Hx
- Height, weight, BMI (plot on growth chart)
- Feeding / Eating Hx (food diary)
- SHx
- Mums health (physical + mental)
- Calculate mid-parental height centile
How do you calculate the mid parental height?
(Mum height + Dad height) / 2
What assessment outcomes would suggest inadeq nutrition / growth disorder? (2 things)
- Height: 2+ centile spaces below mid parental height centile
- BMI below 2nd centile
What are the initial investigations for faltering growth recommended by NICE? (2 things)
- Urine dip (check for UTI)
- Anti-TTG / Anti-EMA (check for Coeliac disease)
When should you do further focussed investigations for faltering growth?
When you sus other conditions from signs / symptoms (e.g cystic fibrosis / pyloric stenosis)
If the cause of faltering growth is Difficulty breastfeeding, what are the Mx options? (2 things)
- Support mother (midwives / health visitors / peer groups / lactation consultants)
- Supplement w formula milk
What is the disadvantage of supplementing breastfeeding w formula milk?
Often results in breastfeeding stopping
If the cause of faltering growth is Inadeq nutrition, what are the Mx options? (5 things)
- Regular structured mealtimes / snacks
- Reduce milk consumption –> improve appetite for food
- Dietician review
- Additional energy dense food
- Nutritional supplement drinks
If Mx options for faltering growth fail, what should you consider?
Enteral tube feeding
