Failure to Thrive
Failure to Thrive: Excerpt from In A Page: Pediatric Signs and Symptoms
Failure to thrive (FTT) is a common problem accounting for 1–5% of referrals to pediatric centers. Although no consensus exists, FTT applies to children under 2 years of age whose weight is less than 5% on two occasions or crosses two major growth percentiles. It is more common among children in poverty. The causes can be broken down into three categories: decreased caloric intake, decreased caloric absorption, and increased caloric needs.
Differential Diagnosis
-
Psychosocial (non-organic)
–Insufficient caloric intake
–Most common etiology
–Cause accounts for 1/3–1/2 of cases investigated in tertiary settings
-
Gastrointestinal disorders
–Gastroesophageal reflux
–Celiac disease
–Milk protein allergy
–Pancreatic insufficiency
–Inflammatory bowel disease
-
Endocrine disorders
–Hypothyroidism
–Hyperthyroidism
–Diabetes mellitus
–Diabetes insipidus
–Growth hormone deficiency
-
Cardiac disorders
–Congestive heart failure
–Congenital anomalies
-
Pulmonary disorders
–Brochopulmonary dysplasia
–Asthma
–Cystic fibrosis
-
Infectious
–HIV
–Parasites
–Tuberculosis
-
Neurologic
–Hypotonia
–Cerebral hemorrhage
–Diencephalic syndrome
-
Metabolic
–Galactosemia
–Methylmalonic acidemia
–Tyrosinemia
-
Renal
–Renal tubular acidosis
–Chronic urinary tract infections
–Chronic renal insufficiency
-
Syndromes
–Down syndrome
–Turner syndrome
–Russell-Silver dwarfism
–Fetal alcohol syndrome
-
Anatomic
–Cleft lip/palate
–Malrotation
–Pyloric stenosis
-
Lead poisoning
Workup and Diagnosis
- History
–Emesis, number and quality of stools, excessive energy, diaphoresis, breathing difficulties, urinary frequency
–Diet history: Duration and quantity of feeding, food preferences, juice intake, food allergies
–Medical history: Chronic medical problems, surgeries
–Observation: Eye contact, absence of smile, lack of interest in environment, parental interaction
–Psychosocial history: Caretakers, financial status, employment, family stress, poverty indicators, support systems, parental age, substance abuse - Birth history
–Growth retardation, low birth weight, intrauterine stress, prematurity, parental substance abuse
- Physical exam
–Accurate height, weight, and head circumference, multiple points on growth curve
–Neuro/developmental age (milestones)
–Murmurs, wheezes/crackles, abdominal masses
–Exam of hard/soft palate, dysmorphic features
–Signs of neglect/abuse including poor hygiene
persistent diaper rash, bruising, unexplained scars
-
Initial lab screen to include CBC, electrolytes, urinalysis
–Consider thyroid function tests, HIV testing, TB skin testing, celiac testing (anti-tissue transglutaminase)
-
Radiographs/imaging only if history dictates
-
Diet journal, 3-day calorie counts
Treatment
-
Hospitalization unnecessary unless severe malnutrition or abuse
-
Psychosocial causes require team approach with physician, family, social worker, dieticians
-
Goal of refeeding to allow for catch-up growth at 1.25–1.5 times normal caloric intake for age
–Monitor for refeeding syndrome with electrolyte imbalances (e.g., phosphorus, potassium, glucose)
-
Structured and scheduled feeding crucial in appropriate feeding atmosphere
-
Consider nasogastric feedings if weight gain by other methods is insufficient within 4–6 weeks
-
Treat organic causes
–Diet restriction for food allergy, metabolic disease
–Correct electrolyte disturbances
–Treat endocrine disease
–Remove environmental exposures
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Thoracic outlet syndrome
More Medical Textbooks Online about Thoracic outlet syndrome
Review other book chapters online related to Thoracic outlet syndrome:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
|
|
» Next page: FAILURE TO THRIVE (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
