FAILURE TO THRIVE - Common Patterns

1)      Normal Centile Shifting – growth of a baby and a child is highly variable, with 5% of children shifting up or down two inter centile spaces between 0-6 weeks, 5% shifting 2 inter centile spaces, and 1% 3 spaces between 6 weeks to 1 yr.  5% of children in the 98th centile (large babies) may shift down 2 centile spaces during regression to mean, and 1% of children in the 2nd centile (small babies) may cross 2 spaces during regression to mean.  Clinical evaluation of these children includes growth over time, development status, dietary status, and psychosocial factors to determine the overall severity of FT if present.

2)      Familial short stature – infant and parents small, growth runs parallel to and just below the normal curves,

3)      Constitutional Growth Delay – weight and height percentiles drop at the end of 1 yr, but run parallel to the normal curves in middle childhood, but then accelerate towards adolescence, adult size is normal or if at all taller than average, parents had similar growth patterns of childhood short stature, delayed puberty (delayed age of menarche of mother, age of first shaving of the father), eventual normal adult height,

4)      Kwashiorkor – in the 2nd yr of life, limb edema, skin lesions (typically hyperpigmentation, depigmentation, desquamation, ulceration, mucous membrane changes), brittle sparse hair, apathy, lethargy, anemia, hepatomegaly, hypoalbuminemia – Mx pediatric referral

5)      Marasmus – in the 1st yr of life, smaller and lighter than kwashiorkor babies of same age, markedly reduced subcutaneous fat and muscle mass, - Mx pediatric referral

6)      Underweight – as a mild malnutrition present with acute gastroenteritis, acute respiratory infections, pulmonary TB, apathy, debilitation, poor school performance, Mx – exclude underlying infections, treat anemia, worms, medical nutritional therapy, 15-20 ml/kg milk added to the child’s present diet, 

7)      Chronic Energy Deficiency – Poor weight gain due to dietary energy deficiency, the commonest cause of FT, may affect growth and cognitive development, treatment is by medical nutrition therapy to give the energy requirements

8)      Slow weight gain in the 6-12/12 age – maternal anxiety, a medical consultation, and forced feeding, more food refusal, more maternal anxiety

9)      Low weight but apparently well child – small parents, light for dates at birth, past chronic diseases now in remission like asthma, acute nephritis syndrome

10)  Underfeeding of babies – low milk intake, nipple retraction, sore nipples, preterm babies (full-term baby needs 150 ml milk/kg/day while a preterm requires 188 ml/kg/day), errors in the reconstitution of powdered  milk, parental food fads, despite mothers report baby is hungry – Tx – proper feeding according to schedules

11)  Emotional deprivation – frequently crying, loss of weight,

12)  Child abuse OR non-accidental injury – repeated injuries, constant crying, mother complaining about child’s bad behavior, delayed consultations, history incompatible with clinical syndromes, burns, poisoning, any fracture below 2 yrs old child,

13)  GERD

14)  Rumination syndrome

 

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