Failure to Thrive (FTT)

Last updated 18.03.13

 

Index

 

Description

-  Poor weight gain in children <5yrs defined as either

-  Weight <3rd centile x2 occassions

-  OR Weight crossing down >2 centiles lines over time

 

Features

-  5% normal healthy children fulfill criteria for FTT

-  Must correct weight & growth for prematurity until 24months old

-  Note: centile charts cross sectional (not longitudinal) & on Caucasion population

-  Pattern poor growth assist in finding cause

-  Weight loss > Height or HC: inadequate intake or increased utilization

-  Weight & Height loss > HC: structural, endocrine, genetic short stature

-  Weight, Height & HC all low: intrauterine insult, genetic

 

Causes

-  Inadequate Intake

-  Insufficient energy supply

-  Poor breast feeding technique

-  Structural cause of poor feeding

-  Persistant vomiting: GOR/GORD

-  Anorexia of chorinc disease

-  Inadequate Absorption

-  Coleiac disease

-  Chronic liver disease

-  Pancreatic insufficiency (CF..)

-  Chronic diarrhoea: IBD

-  Excessive Utilisation

-  UTI

-  Chronic resp disease (CF..)

-  Congenital heart disease

-  DM Type 1

-  Hyperthyroidism

-  Other Medical Causes

-  Genetic syndromes

-  Inborn errors of metabolism

-  Psychosocial

-  Parental depression

-  Coercise feeding

-  Poverty

-  Behavioural disorders

-  Neglect

-  Distractions at meals

-  Poor social supports

 

DDx

-  Severe nerological problems: global developmental delay

 

Assessment

-  Mother – Child dyad

-  Plot measurements on growth charts (Blue book)

-  Current pattern + over time

-  Weight

-  Head circumference

-  Length

-  Feeding Hx

-  Poor feeding

-  Introducton of solids

-  Food refusal

-  Assessment feeding technique & attachment

-  Concurrent illness: UTI, gastro..

-  Midparental height & childhood weight gain patterns

-  Cachexia, irritable, lethargic

-  Jaundice, goiter

-  Cardio, Resp exam

-  Neurodevelopmental Hx

 

Ix

-  Weights not more than

-  >1/week if <3 months

-  >1/fortnight if older

-  +/- Paeditrician R/V

-  If otherwise healthy & normal child: reassure & monitor

-  Ix as per indicated cause

-  If cause uncertain screen

-  FBE, CRP: inflammation

-  U&E, LFT, Ferretin: metabolic screen

-  Urine MCS

-  +/- Coeliac screen

-  +/- stool fat globles & fatty acid crystals

-  Bone age (wrist X-ray)

 

Mx

-  As per identified cause

 

 

 

References

 

RCH – CPG: Failure to Thrive