Failure To Thrive With Notes
- 1. Failure to Thrive Shannon Pittman, M.D. University of Mississippi Jackson, MS
- 8. Objectives To define failure to thrive (FTT) To identify major classification of FTT To discuss diagnostic workup of FTT To discuss treatment of FTT
- 9. Things We Will Not Cover Geriatric FTT Am Fam Physician. 2004 Jul 15;70(2):248, 257. Rehabil Nurs. 2005 Jul-Aug;30(4):152-9 Adolescent FTT
- 10. Things We Will Not Cover Other specific causes (e.g.) Congenital defects Celiac disease HIV/AIDS Metabolic disorders CHF (reference for Jenny) Prog Pediatr Cardiol. 2000 Sep 1;11(3):195-202.
- 11. Why Do We Have to Talk About it at All? Personal Depending on current status in app. 9, 21, or 32 months you will sit for the ABFP (13%-pediatrics) ACGME competencies / AAFP core recommendations Patients Parental concerns Doc, is my baby growing right? Cognitive development Arch Dis Child. 2005 Sep;90(9):925-31. Epub 2005 May 12. J Child Psychol Psychiatry. 2004 Mar;45(3):641-54.
- 12. Clinical Vignette 15 month old admitted with lethargy from dermatology office Prior to admit, several days of decreased activity Med hx remarkable for eczema, treated with topical steroids
- 13. Clinical Vignette Wgt and ht both below 5 th percentile, but had grown along the 25 th percentile until age 4mo Extensive erythematous plaques on her back, diaper region, thighs, and polpliteal fossa bilaterally
- 14. Clinical Vignette What concerns you about this child What history questions should you ask What labs would you order How would you manage pt’s care
- 15. Okay, Tell Me What Happens Next - Afternoon clinic 10 Patients scheduled Everyone of them showed up Your 5 th pt is new & has a typed list It’s 4:00 and you are on pt 6 who happens to be a 9 mo well child
- 17. We’re not alone In England, 54% of GP failed to diagnosis FTT Residency clinic, 41% with delayed dx Residency clinic, 29 dx, 100% dx incorrectly
- 18. FTT – Definition “Inadequate physical growth diagnosed by observation of growth over time using a standard growth chart”
- 19. Normal Growth Average wgt 7 lbs (3kg) Double by 4 months, triple by 12 Grow 25 cm in length during 1 st year Make sure you have the right chart Premature Breastfeeding www.cdc.gov/growthcharts
- 20. FTT Criteria Ht/Wgt less than 3 rd to 5 th percentile for age on >1 occasion Ht or Wgt falling 2 major percentiles Below 10 th percentile for ht/wgt < 80% of ideal body wgt for age Head circumference important, but not part of FTT entity
- 21. FTT HISTORY ! HISTORY! HISTORY! Prenatal Feeding # oz needed in 24 hours Wgt (kgs) x 5 (need 100 kcal/kg/day) How formula prepared Good diet history (3 day journal) Bowel habits
- 22. FTT Physical Gomez Criteria <60 = severe; 61-75 = mod; 76-90 = mild Kwashiorkor – protein malnourishment Marasmus – caloric deficiency Short Stature Syndrome Constitutional Delay
- 23. FTT - Classification Organic FTT Pre/postnatal Nonorganic FTT (NOFT) Pre/postnatal Mixed (25%)
- 24. FTT - Classification Organic FTT Prenatal Causes Prematurity w/complications Toxic exposure Postnatal Inadequate intake Lack of appetite Inability to suck/swallow
- 25. FTT - Classification Organic, postnatal cont. Poor absorption and/or use of nutrients GI disorder (celiac, CF) Inborn errors of metabolism Increased metabolic demand Hyperthyroidism Chronic Disease
- 26. FTT - Classification Nonorganic Prenatal Malnourished mother ? Lack of prenatal bonding Postnatal Poor feeding skills/disorder Dysfunctional family Difficult parent-child interactions Difficult Child Abuse/Neglect
- 28. Recap - Classification Failure to Thrive Organic Nonorganic Prenatal Postnatal Toxic Exposure Inborn errors Prenatal Postnatal Malnourished mother Abuse/Neglect
- 29. FTT - Workup +/- Basic screening labs CBC, Chemistry, & UA Specific test directed by history HIV, ESR, TSH, Sweat chloride test, serum IGF-I, serum IgA/IgG antigliadin antibiodies X-rays for bone age
- 30. FTT – Treatment High calorie diet for catch up growth 150% of recommended daily caloric intake based on expected wgt +/- Feeding behavior modification Psychosocial involvement/ intervention Close follow up Physical and cognitive delays Hospitalization when necessary
- 31. Clinical Vignette 15 month old admitted with lethargy from dermatology office Prior to admit, several days of decreased activity Med hx remarkable for eczema, treated with topical steroids
- 32. Clinical Vignette Wgt and ht both below 5 th percentile, but had grown along the 25 th percentile until age 4mo Extensive erythematous plaques on her back, diaper region, thighs, and polpliteal fossa bilaterally
- 33. Clinical Vignette What concerns you about this child What history questions should you ask What labs would you order How would you manage pt’s care
- 34. Summary: G.R.O.W.T.H. G ather history and extensive physical R emember genetic contribution O nly order basic labs in initial eval W onder about zebras T rack growth trends H ospitalize or hormonally treat
- 35. Take Home The keys to diagnosing FTT is finding the time to accurately measure and plot wgt/ht and then access the trend
- 36. http://www.cha.state.md.us/edcp/html/immpg.html Afternoon clinic 10 Patients scheduled Everyone of them showed up Your 5th pt is new & has a typed list It’s 4:00 and you are on pt 6 who happens to be a 9 mo well child
- 37. Any Questions? www.child.com/.../ baby_babble.jsp
- 38. References Listernick, R. (2004). Accurate feeding history key to failure to thrive. Pediatr Ann , 33:3, 161-9. Burgos, R., Jutte, D. (2000). Resident’s column: “doctor, is my child growing ok?”. Pediatr Ann , 29:9, 585-7. Krugman, S., Dubowitz,H. (2003). Failure to thrive. American Fam Phy, 68:5, 879-84. Schwartz, R., Abegglen, J. (1996). Failure to thrive: an ambulatory approach. Nurse Pract, 21:5, 19-31. Careaga, M., Kernder, J. (200). A gastroenterologist’s approach to failure to thrive. Pediatr Ann . 29:9, 558-67. Bassali, R., Benjamin, J. (2004, August 11). Failure to Thrive. eMedicine. Retrieved September 17, 2005, from http:///www.emedicine.com/ped/topic738.htm.
- 39. Thanks for Your Attention! www.jade-designs.org/ tubetotin/jababybottom.gif