Failure to thrive

Question 1

Definition of failure to thrive

Answer 1

• Suboptimal weight gain / faltering growth
• Weight <0.4th centile or crossing over 2 centiles

Question 2

Causes of failure to thrive

Answer 2

Non-organic

• Inadequate availability of food
• Neglect

Organic

• ↓ intake
  
  • Impaired suck/swallow
    
    • Oro-motor dysfunction, neurological disorder (e.g. Cerebral palsy)
    • Cleft palate
  • Chronic illness leading to anorexia
• Malabsorption
  
  • Coeliac
  • Cystic fibrosis
  • Lactose intolerance
• Inability to process nutrients
  
  • Hypothyroidism
  • Diabetes
  • GH deficiency
• ↑ metabolic demand
  
  • Thyrotoxicosis
  • Cystic fibrosis
  • Chronic infection
• ↑ excretion
  
  • Vomiting / severe reflux
  • Diarrhoea

Question 3

Failure to thrive history

Answer 3

• Detailed dietary history
  
  • Breakfast, lunch, dinner, in between
• Feeding
  
  • Regular meals
  • Details of exactly what happens at mealtimes
• Is the child well with lots of energy? Other symptoms?
  
  • Diarrhoea
  • Vomiting
  • Breathless
  • Lethargy
• Premature?
• IUGR?
• Significant medical problems?
• Is development normal?
• Are there psychosocial problems at home?