FAILURE TO THRIVE
by Leslie Brown
1. -problem, not a diagnosis. Failure to gain weight properly, growth deficiency, underlying causes:
1.1. insufficient usable nutrition
1.2. inadequate dietary energy intake
1.3. inadequate nutrient absorption
1.4. increased energy requirements
2. weight < 3rd% for age & sex ON MORE THAN ONE OCCASION
3. weight depressed in proportion to height
4. weight trajectory that DROPS & CROSSES 2 OR > MAJOR PERCENTILE LINES OVER TIME
5. Dx:
5.1. child's weight < 2nd% for gestation-corrected for age&sex when plotted on appropriate growth chart
5.2. decreased velocity of weight gain / disproportionate to growth in length
5.2.1. take into account size @ birth
5.3. FTT not used to describe children growing along a curve w/ normal interval growth rate
5.3.1. even if weight is < 2nd %
6. determine FTT result from med. prob.(organic)/factors of environment(inorganic)=abuse/ neglect??
6.1. Most causes=non-organic or psychosocial in origin
7. PE:
7.1. Attn: genetic disorders
7.2. organic disease
7.3. malnutrition(vit. deficiencies)
7.4. child abuse/neglect
8. Lab/imaging
8.1. for organic disease should be guided by info from H&P exam
9. Review growth velocity-wt.
9.1. newborns:gain approx. 30g/day until 3 months
9.2. infants:gain approx. 20g/day between 3-6 months & approx 10g/day between 6-12months.
9.3. infants double birth weight by 4 months age & triple birth weight by 1 year old
9.4. Weight gain in kids 2 & > gain approx. 2kg/year (4.4lbs) between 2 & puberty
10. affects growing children
10.1. sever malnutrition can cause
10.1.1. persistent short stature
10.1.2. 2ndary immune deficiency
10.1.3. Perm. damage to various parts of brain&CNS
10.2. EARLY I.D. & TX OF FTT MAY HELP TO PREVENT LONG-TERM DEVELOPMENTAL DEFICITS
11. daily weight gain < expected for age(newborn)
12. MAP HEIGHT, WEIGHT, & HEAD CIRCUMFERENCE EVERY WELL CHILD VISIT!!
12.1. OVER TIME: CHANGES
12.1.1. in weight
12.1.2. length
12.1.3. head circumf.
12.1.4. May provide clues to etiology of diminished weight
13. NUTRITIONAL DEPRIVATION IS RELATED TO SEVERE IRREVERSIBLE DEVELOPMENTAL DEFICITS & BEHAVIOR PROBLEMS
14. Identify factors to be addressed
15. INVOLVE DIETITIAN, PT, OCC. OR SPEECH THERAPIST, SOCIAL WORKER, AND/OR DEVELOPMENTAL & BEHAVIORAL PEDIATRICIAN-CAN BE HELPFUL IN GATHERING THIS INFO. & FORMING A MANAGEMENT PLAN.
16. valuable info thru observation of child & parent/guardian particularly during feeding
17. Remember:
17.1. most healthy infants/children grown in a predictable fashion=typical progression of wt/length/head circumf.
17.2. normal human growth is pulsatile
17.2.1. periods of rapid growth (growth spurts) separated by times of no measurable growth
17.2.2. growth is seasonal, w/ growth velocities increased during spring&summer months