Failure to Thrive
last authored: Oct 2009, David LaPierre
last reviewed:
Introduction
Failure to Thrive (FTT) is defined by a weight <3rd percentile, ie falls across two major percentile curves.
The Case of...
Differential Diagnosis
Inadequate caloric intake is the most common factor.
Inability to feed
- insufficient breasfeeding
- poor retention: GERD, vomiting
- neuromuscular or mechanical difficulties
- chronic disease and anorexia
Inadequate absorption
- celiac disease
- cystic fibrosis
- pancreatic insufficiency
- chronic diarrhea or vomiting
- renal loss
Metabolic
- inborn errors of metabolism
- type I diabetes
- diabetes insipidus
- hypopituitarism
- congenital hypothyroidism
- hyperthyroidism
Increased demand
- pulmonary or cardiac disease
- malignancy
- chronic infection
- SLE
Decreased growth capacity
- chromosomal abnormality
- GH deficiency
- FAS
- TORCH infections
psychosocial
- inadequate nutrients
- poor feeding technique
- errors in formula reconstitution
These children often are thought of as picky eaters, with a difficult emotional situation at home
History and Physical Exam
- history
- physical exam
History
Duration of problem
Detailed dietary and feeding history, appetite
Behaviour before and after meals
Bowel and bladder function
Pregnancy, birth, postpartum history
Developemental milestones
Medical history
Family History
- parental height, weight, and growth
Social history
- temperament
- child-parent interactions
- feeding behaviour
- psychosocial stressors
Physical Exam
height, weight, head circumference
assessment of nutritional status
Tanner stage
observation of a feeding session and parent-child interaction
evidence of abuse or neglect
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
CBC, smear
lytes
BUN
TSH
urinalysis
ferritin
sweat chloride
fecal fat
karyotype in all short girls and in short boys as appropriate
Diagnostic Imaging
bone age X-ray
Management
Pathophysiology
Resources and References
Topic Development
created: DLP, Aug 09
authors: DLP, Aug 09
editors:
reviewers:
 |