Failure to Thrive

A failure of expected growth and wellbeing – a shift in percentiles

Approach: Input vs Output

Input

  • Nutrition
    • Babies need 100 – 120 kCal/kg/day
    • Weight gain should be ~1oz/day except Sundays
    • Birth weight should be regained by 7-10 days
    • Birth weight should double by 5 months, triple by 1 year and quadruple by 2 years
    • Breast milk = formula = cow’s milk = 67 kCal/100cc or 20kCal/oz
  • Problems
    • Feeding
    • Swallowing dysfunction, aspiration
    • Formula mixed incorrectly

Output

  • Too much out
    • Reflux is normal, but babies may increase too much or be vomiting
    • Diarrhea
    • Insensible losses
  • Increased metabolic demands
    • Congenital
    • Malignancy
    • Recurrent infection
    • Hyperthyroidism

History

  • Birth history
  • Feeding/Nutrition
  • Stooling and voiding
  • Growth pattern
  • Recurrent Infections
  • Hospitalizations
  • HIV risk factors
  • Developmental history
  • Social and family history
  • Review of systems

Physical exam

  • Weight, height, head circumference
  • Fat stores (buttocks, thighs, neck)
  • Dysmorphic features
  • Neurologic signs (tone)
  • Developmental
  • CVS/Resp/Abdo
  • Signs of neglect (flat head, poor hygiene, bruises/abrasions)

Investigations

  • CBCD (anemia)
  • U/A (RTA)
  • Lytes, urea, Cr, albumin (renal), prealbumin (assess protein stores)
  • HIV, TB – if indicated
  • Swallowing study (can do at bedside first to assess clinically)
  • Sweat chloride (Cystic Fibrosis)
  • CXR (pulmonary)
  • Echo (cardiac)

* Note: wheeze and FTT think chronic lung disease (asthma, CF), if amenorrhea and weight loss think anorexia (malabsorb by drinking vinegar; hypokalemia)

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