Failure to Thrive for Investigators · 3/16/2018 · • Failure to thrive is a common problem....
Transcript of Failure to Thrive for Investigators · 3/16/2018 · • Failure to thrive is a common problem....
3/16/2018
WI CAN Educational SeriesHillary W. Petska, MD, MPH, FAAP
Child Advocacy and Protection Services
Children’s Hospital of Wisconsin
• Normal patterns ofgrowth
• Definition andcauses of FTT
• Medical evaluationand management
• Effects of FTT
• Early intervention
• Infants typically lose5-10% of birthweight, but regainby 10-14 days
• Double birth weightby 5-6 months
• Triple birth weightby 1 year
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• Infants should be breast or formula fed until 1 yo
• Breastfed babies should be given Vit D
• Solids can be started around 6 mos
• At 1 yo, transition to whole cow’s milk (max: 24 ounces), low fat milk at 2 yo
• For kids > 1 yo, limit juice to 4-6 oz/d
• Not all diets are created equal.
• Cow milk or low iron formula – iron deficiency
• Goat milk – folatedeficiency
• Raw milk – infection risk
• Almond milk – multiple deficiencies
• Fruit juice – kwashiorkor
• Mostly diagnosed inchildren < 2 yo
• Seen in 5-10% ofchildren in primary care settings
• Accounts for 1-5% ofall referrals to children’s hospitals
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• Prolonged cessationof appropriate weightgain compared toage/gender norms
• Weight < 3rd
percentile
• Decline of weightacross 2 majorpercentiles in 6months
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Actual weightIdeal body weight
x 100
% of Ideal Body Weight
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• Decreased weight inproportion to length= FTT
• Inadequatenutrition: weight,then height, thenhead circumferenceaffected
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• Decreased length inproportion to weight =endocrine abnormality
• Isolated cessation ofhead circumferencegrowth = neurologicdisorder
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• Proportionatedecrease in weight-for-length withnormal growthvelocity ≠ FTT
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• Intrauterine growth restriction,prematurity, genetic shortstature, constitutional growthdelay
• Conditional growth charts forchildren with altered growthpatterns:
• Trisomy 21 (Downsyndrome)
• Prader-Willi syndrome• Williams syndrome• Cornelia deLange syndrome• Turner syndrome• Rubinstein-Taybi syndrome• Marfan syndrome• Achondroplasia
• •
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FTT is a sign, not a diagnosis
• Inadequate energy intake
• Inadequate nutrientabsorption
• Increased energyrequirements
May be due to a medical condition, psychosocial reasons, or both
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• Prematurity
• Congenital anomalies
• Developmental delay
• Intrauterine exposures
• Lead poisoning
• Dietary beliefs/practices
• Any condition that results in inadequate intake, malabsorption, or increased metabolic rate
• Poverty
• Social isolation
• Domestic violence
• Substance abuse
• Mental health
• Knowledge deficits
• Stress
• Comprehensivehistory and exam cantypically r/o medicalcauses
• Observation/historyof feeding:• Preparation of formula
• Oral-motor dysfunction
• Feeding environment
• Parent-child interaction
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• Hospitalizationmay be required:• Diagnostic work-
up
• Severe malnutrition or dehydration
• Refeedingsyndrome
• Protection
• Multidisciplinaryteam
• Feedingrecommendations
• Nutrition education
• Referral for resources
• Close follow-up
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• Neglect• Physical
• Environmental• Supervisory
• Medical• Emotional• Educational
• Abuse• Physical• Sexual
• Poor linear growth
• Decreased brain growth
• Lower IQ
• Developmental delay
• Behavioral problems
• Increased risk ofinfection
• Poor wound healing
• Weak bones
• Death
• General appearance
• Behavior
• Stealing, hoardingfood
• Disclosures
• Reports missingmeals
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• Inadequateformula/food
• No clean dishes
• No electricity
• No runningwater
• Safety hazards
• Follow-up with PMD
• Medical recordsrequest
• WIC records
• Interview of childand/or siblings at aChild AdvocacyCenter
• Medical/investigator collaboration
• Failure to thrive is a common problem.
• Failure to thrive is due to inadequate nutrition,although the underlying cause is typically multifactorial.
• Failure to thrive has significant short- and long-term health consequences.
• Failure to thrive may be a sign of child neglect.
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• Jenny C (ed). Child Abuse and Neglect: Diagnosis, Treatment, and Evidence. Saunders: St. Louis; 2011.
• Kirkland RT, Motil KJ. Etiology and evaluation of failure to thrive (undernutrition) in children younger than2 years. UpToDate; 2013.
• The National Center on Addiction and Substance Abuse (CASA) at Columbia University. No safe haven: Children of substance-abusing parents. New York, NY: The National Center on Addiction and Substance Abuse (CASA) at Columbia University; 1999b.
• Osofsky JD. The impact of violence on children. Future Child. 9(3):33-49; 1999.
• Schwartz ID. Failure to thrive: an old nemesis in the new millennium. Pediatr Rev. 21(8):257-264; 2000.
• Tranchida, Vincent. The Pathology of Fatal Child Neglect. University of Wisconsin School of Medicine and Public Health. Monona Terrace Community and Convention Center, Madison, WI. 15 February 2013. Conference Presentation.
• I would also like to acknowledge Dr. Lynn K. Sheets and Dr. Angela L. Rabbitt who provided additional cases/slide content.