Failure to Thrive (FTT) Overview
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Questions and Answers

Which anthropometric criterion is NOT commonly used to define failure to thrive (FTT)?

  • Weight below the 3rd percentile for age
  • Weight less than 80% of the median weight for the height of the child
  • Weight less than 90% of the median weight for the child's height (correct)
  • Weight decreasing, crossing two major percentile lines

What does a z-score of -2 typically indicate in the context of undernutrition?

  • The measure is two standard deviations above the population median.
  • The measure is two standard deviations below the population median. (correct)
  • The measure is borderline for overnutrition.
  • The measure is within the average range for the population.

Why is the traditional classification of FTT into 'organic' and 'nonorganic' etiologies considered problematic?

  • Because most cases are solely due to psychological factors.
  • Because it relies too heavily on anthropometric measurements.
  • Because it is overly simplistic and often involves multifactorial causes. (correct)
  • Because it inaccurately excludes cases caused by nutritional deficits.

What is a normal occurrence in the first few years of a child's life regarding their growth chart position?

<p>Fluctuations in percentile position (B)</p> Signup and view all the answers

Which factor is LEAST likely to be a direct cause of FTT?

<p>Constitutional delay of growth (A)</p> Signup and view all the answers

How do z-scores provide more detailed information than percentiles when tracking growth over time?

<p>Z-scores indicate the number of standard deviations from the median. (C)</p> Signup and view all the answers

According to the standards, what fraction of the population naturally falls below the 3rd percentile on growth charts?

<p>3% (C)</p> Signup and view all the answers

What is 'catch-down growth', as it relates to FTT?

<p>A growth pattern where a child born large experiences a significant drop in their growth percentile. (B)</p> Signup and view all the answers

Which of the following is NOT a typical component of a multidisciplinary treatment team for a child with Failure to Thrive (FTT)?

<p>Physical Therapist (A)</p> Signup and view all the answers

What is the primary nutritional strategy for formula-fed infants with FTT needing increased caloric intake?

<p>Adjusting the formula concentration by mixing with less water (A)</p> Signup and view all the answers

What is a key consideration when initiating nutritional treatment for a child who has experienced starvation?

<p>Slowly increasing nutrition while closely monitoring electrolytes. (D)</p> Signup and view all the answers

What is the rationale for using specific carbohydrate, fat, or protein additives in the treatment of FTT?

<p>To increase calories without increasing volume requirements. (C)</p> Signup and view all the answers

Why might nasogastric tube feedings be implemented in children with FTT?

<p>When children cannot safely take adequate calories by mouth. (D)</p> Signup and view all the answers

In addition to nutritional management, what else should treatment plans address for families of children with FTT?

<p>The psychosocial needs of the family. (D)</p> Signup and view all the answers

What is a re-feeding syndrome?

<p>A set of electrolyte imbalances that occurs following rapid reinstitution of feeding after starvation. (C)</p> Signup and view all the answers

What is a characteristic of psychosocial short stature?

<p>Polyphagia, polydipsia, and hoarding of food often concurrent with other notable behaviors. (C)</p> Signup and view all the answers

What is the prognosis for a child diagnosed with psychosocial short stature?

<p>Early removal from adverse environments often leads to rapid improvement in endocrine function and subsequent growth. (A)</p> Signup and view all the answers

What is the recommended approach to dietary changes for children with FTT?

<p>Focusing on the simplest and least costly dietary changes first. (B)</p> Signup and view all the answers

What percentage of children hospitalized for Failure to Thrive (FTT) have known complex chronic conditions?

<p>Approximately 50% (D)</p> Signup and view all the answers

Which of the following is NOT typically associated with inadequate intake as a cause of Failure to Thrive?

<p>Biliary atresia (B)</p> Signup and view all the answers

Which of the following is NOT considered a cause of increased metabolic demand leading to Failure to Thrive?

<p>Cystic fibrosis (B)</p> Signup and view all the answers

Which of the following historical details is LEAST relevant when evaluating a child for Failure to Thrive?

<p>Child's favorite color (A)</p> Signup and view all the answers

Which factor is MOST important when evaluating dietary history of a child with suspected Failure to Thrive?

<p>Lactation problems in breastfed infants and improper formula preparation (C)</p> Signup and view all the answers

Which of the following is NOT a typical finding on physical examination associated with Failure to Thrive?

<p>Increased subcutaneous fat (C)</p> Signup and view all the answers

Which of these is NOT an accurate statement relating to growth charts?

<p>There are no specific growth charts for Down syndrome and Turner syndrome. (A)</p> Signup and view all the answers

Which of the following BEST describes the initial effect of malnutrition on growth in children with Failure to Thrive?

<p>Wasting (A)</p> Signup and view all the answers

What might a symmetric pattern of FTT (proportional weight, height/length, and head circumference deficiencies) suggest?

<p>Long-standing malnutrition, chromosomal abnormalities or congenital infection (C)</p> Signup and view all the answers

Which of the following is LEAST likely to be part of the initial laboratory evaluation for FTT?

<p>Stool sample for culture and ova and parasites (C)</p> Signup and view all the answers

Besides growth parameters, which of the following assessments is MOST important in evaluating FTT?

<p>A complete psychosocial assessment (C)</p> Signup and view all the answers

What is the significance of observing a child during feeding in a FTT assessment?

<p>It is of great diagnostic value in assessing feeding problems, food preferences, mealtime distractions and parent-child interactions (C)</p> Signup and view all the answers

Which of the following is NOT a common risk factor associated with FTT?

<p>High socioeconomic status (B)</p> Signup and view all the answers

When does stunting typically occur in children with FTT?

<p>Generally after months of malnutrition (D)</p> Signup and view all the answers

What might short stature with preserved weight suggest in a child with suspected FTT?

<p>An endocrine etiology (C)</p> Signup and view all the answers

Flashcards

Failure to Thrive (FTT)

A condition where a child's growth is significantly slower than expected for their age, based on standard growth charts.

Anthropometric Measures

Body measurements used to assess a child's growth, such as weight, height, and head circumference.

Subjective Global Nutritional Assessment (SGNA)

A tool used to assess a child's overall nutritional status, considering factors like weight, height, and clinical observations.

Semi-Objective Failure to Thrive (SOFTT)

Another assessment tool for FTT, evaluating physical and behavioral factors, including growth, feeding, and interaction with caregivers.

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Etiology of FTT

The causes of FTT, which can include nutritional deficiencies, malabsorption, and increased metabolic demands.

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Malabsorption

A condition where the body struggles to absorb nutrients from food.

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Increased Metabolic Demands

The body's need for energy exceeds the amount it receives from food and drink.

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Organic vs. Nonorganic FTT

A classification that suggests the cause of FTT is either medical (organic) or psychological (nonorganic). This system is now considered outdated.

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Metabolic Adjustments in Starvation

A condition where a child's body uses its stores of glycogen, fat, and protein to maintain normal metabolic requirements during starvation.

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Re-feeding Syndrome

A potentially life-threatening complication that can occur when nutrition is rapidly restored after a period of starvation, causing electrolyte imbalances.

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Preventing Re-feeding Syndrome

The introduction of nutrition slowly and monitoring serum electrolytes closely during the early stages of feeding to prevent re-feeding syndrome.

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Psychosocial Short Stature

A syndrome characterized by short stature and delayed puberty in children living in psychologically deprived environments.

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Treatment for Psychosocial Short Stature

The removal of a child from a psychologically deprived environment, which often leads to improved endocrine function, rapid growth, and pubertal development.

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Malnutrition-Infection Cycle

A cycle where recurrent infections exacerbate malnutrition in children with FTT, leading to greater vulnerability to infections.

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Nutritional Management

The cornerstone of treatment for FTT that involves ensuring adequate calorie and nutrient intake.

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Calorie-Dense Feeding Strategies

Providing calorie-dense foods and adjusting formula concentrations for formula-fed infants to meet their nutritional needs.

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Nasogastric Tube Feedings

The use of nasogastric tubes to deliver nutrition when children cannot safely consume adequate calories orally.

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Psychosocial Support

Treatment for FTT that addresses the psychosocial needs of the family, providing resources and support for parents.

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TORCH infections

A group of infections that can be passed from mother to baby during pregnancy or childbirth.

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Inadequate Intake as a Cause of FTT

Inadequate intake of nutrients, often due to factors like improper feeding techniques, neglect, or food insecurity.

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Malabsorption/Increased Nutrient Losses as a Cause of FTT

The body's inability to absorb nutrients properly, leading to malnutrition. Examples include celiac disease and cystic fibrosis.

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Increased Metabolic Demand as a Cause of FTT

Conditions that increase the body's need for energy, leading to FTT if not met. Examples include heart disease and infections.

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Physical Examination in FTT Diagnosis

A physical examination to assess a child's overall health, evaluate their growth, and identify any potential signs of FTT.

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Medical History in FTT Diagnosis

A detailed account of the child's health history, including pregnancy, birth details, and family history.

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Dietary History in FTT Diagnosis

Gathering information on a child's dietary habits, including feeding techniques, food preferences, and mealtime routines.

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Psychosocial Assessment in FTT Diagnosis

Assessing the child's emotional and social well-being, including their temperament, home environment, and family dynamics.

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Wasting in FTT

The gradual decrease in weight relative to height, a common early sign of FTT.

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Stunting in FTT

A decrease in height relative to age, indicating prolonged malnutrition that affects linear growth.

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Feeding Observation in FTT Diagnosis

Observing a child's feeding patterns, interactions with caregivers, and home environment to gain insights into potential FTT causes.

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Complete Blood Count (CBC) in FTT Diagnosis

A blood test that provides essential information about a child's overall health, including red blood cell count, white blood cell count, and platelets.

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Screening Tests in FTT Diagnosis

Testing for common deficiencies and toxicities that can contribute to FTT, such as iron deficiency anemia and lead poisoning.

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Stool Examination in FTT Diagnosis

Examining a stool sample to identify potential causes of FTT such as infections or parasitic infestations.

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Study Notes

Failure to Thrive (FTT)

  • FTT is a clinical term describing inadequate growth compared to expected standards.
  • No universally accepted definition exists, with different anthropometric criteria used (e.g., weight below 3rd/5th percentile, weight loss crossing percentile lines, weight <80% of median for height).
  • Caveats include 3% naturally below 3rd percentile, constitutional delay of growth affects proportion, and fluctuations in early life in normal children.
  • z-scores, reflecting deviations from the population median, are also used (a z-score below -2 is commonly associated with undernutrition).
  • Clinical tools like SGNA and SOFTT help diagnose FTT when anthropometry alone is insufficient.

Etiology of FTT

  • Multiple causes exist, often multifactorial (interacting biologic and psychosocial factors).
  • Traditional categorization as organic (medical cause) and non-organic (no medical cause) is simplifying.
  • Potential causes include inadequate intake, malabsorption, and/or increased metabolic demands (TORCH infections, improper formula, neglect, food insecurity, allergies, chronic disease).
  • A significant proportion of hospitalized FTT children have complex underlying conditions.

Diagnosis and Clinical Manifestations of FTT

  • History (prenatal, perinatal, birth size, family, medical indicators) and physical exam are crucial.
  • Detailed dietary history is essential (breastfeeding problems, formula prep, solid food intake, parental beliefs, etc.).
  • Complete psychosocial assessment of child and family (child temperament, parental depression/violence, environmental factors) is necessary.
  • Growth parameters (weight, height/length, head circumference) are assessed, considering prematurity corrections.
  • Specific growth charts for genetic conditions (e.g., Down syndrome, Turner syndrome) should be used.
  • Clinical manifestations include malnutrition indicators (wasting, stunting, symmetric/asymmetric FTT patterns).
  • Assessment for physical indicators (injuries, oral/dental problems, infections, dysmorphic features, and neurologic status).
  • Home observation can offer valuable insights into feeding patterns, parent-child interactions, and home environment.

Laboratory Evaluation for FTT

  • Detailed clinical evaluation guides lab tests, avoiding extensive routine tests.
  • Screening tests for common illnesses (blood counts, anemia, lead toxicity, urinalysis, electrolytes) are initially recommended.
  • Additional tests performed based on clinical findings (stool cultures, newborn screening review).

Treatment of FTT

  • Outpatient treatment is common, but hospitalization may be necessary for severe malnutrition, underlying diagnoses, or safety concerns.

  • Nutritional management is key, adjusting formula or increasing caloric density of foods.

  • Dietary recommendations vary according to age and circumstances (e.g. calorie dense foods, formula concentration adjustments, high-calorie supplements).

  • Nasogastric tube feedings are utilized when oral intake is inadequate or unsafe.

  • Vitamin/mineral supplementation could be required. Important to prioritize the simplest, least costly dietary changes first.

  • Psychosocial needs of the family need to be addressed to foster success in treatment. Parents may feel overwhelmed or have personal struggles, affecting their ability to focus on their child.

Complications of FTT

  • Malnutrition compromises the immune system, leading to a malnutrition-infection cycle.
  • Re-feeding syndrome can occur after periods of starvation with rapid reintroduction of feeding, needing careful monitoring for electrolyte imbalances (P,K,Ca, Mg) and potentially life-threatening complications.
  • Possible negative impacts on metabolism and neurodevelopment.

Psychosocial Short Stature

  • This condition involves short stature due to psychological stress or deprivation; signs may include altered eating behaviors and emotional responses.
  • Endocrine dysfunction is common.
  • Improvement follows removal from adverse environment, typically resulting in rapid growth restoration.
  • Prognosis depends on age at diagnosis and trauma level, with early interventions leading to better outcomes.

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Description

This quiz explores the concept of Failure to Thrive (FTT), including its clinical definition, anthropometric criteria, and various causes. Understand the complexities of diagnosing FTT and the distinction between organic and non-organic factors. Prepare to delve into the multifactorial nature of this condition.

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