Failure to thrive

Question 1

Definition of FTT

Answer 1

Growth parameters persistently

Question 2

Ddx of FTT

Answer 2

1. Underfeeding
2. Emotional deprivation
3. Chronic infection; esp UTI
4. Malabsorption syndrome - Coeliac,CF, cow’s milk, protein allergy, lactase deficiency 2nd to severe gastroenteritis
5. Major systemic disease affecting the heart, lung and kidney
6. Decreased growth potential - Chromosomal disorder; Congenital infection; Drug; Irradiation; Perinatal brain damage
7. Inborn error of metabolism
8. Diencephalic Syndromes

Question 3

Steps to clinical examination for FTT

Answer 3

1. Impression of growth retardation - confirm with growth parameters measurements
2. Note the general activities of child and hygiene
   3.Note any dysmorphism
3. Look for effect of chronic illness/ malnutrition e.g. Pallor, Stomatitis, Bruises, Rickets, Excoriated buttocks, clubbing, loss of subcutaneous fat and dehydration
4. Systemic exam
   Chest - deformity and crepitations
   Heart - feature of HF and murmurs
   Abdo - scar, colostomy/ ileostomy, distention, organomegaly, ascites and gaseous bowel
   Retarted development
5. Pay attention to mother and child relationship

N.B.
If all parameters small - Drug, diseases, chromosomal and IUGR
If normal parameters but emaciated - assess for systemic disease, environment and bonding
If normal head size but decreased wt and ht- constitutionally small

Question 4

Ix for FFT

Answer 4

1. Rule out infection- stool urine MC/S, CBC, LRFTs, CA, PO4, Astrup,MT5
   Stool for reducing substances
   Bone age/ X-ray for Ricketic change
2. Trial of feeding