Podcast
Questions and Answers
Which anthropometric criterion is NOT commonly used to define failure to thrive (FTT)?
Which anthropometric criterion is NOT commonly used to define failure to thrive (FTT)?
What does a z-score of -2 typically indicate in the context of undernutrition?
What does a z-score of -2 typically indicate in the context of undernutrition?
Why is the traditional classification of FTT into 'organic' and 'nonorganic' etiologies considered problematic?
Why is the traditional classification of FTT into 'organic' and 'nonorganic' etiologies considered problematic?
What is a normal occurrence in the first few years of a child's life regarding their growth chart position?
What is a normal occurrence in the first few years of a child's life regarding their growth chart position?
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Which factor is LEAST likely to be a direct cause of FTT?
Which factor is LEAST likely to be a direct cause of FTT?
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How do z-scores provide more detailed information than percentiles when tracking growth over time?
How do z-scores provide more detailed information than percentiles when tracking growth over time?
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According to the standards, what fraction of the population naturally falls below the 3rd percentile on growth charts?
According to the standards, what fraction of the population naturally falls below the 3rd percentile on growth charts?
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What is 'catch-down growth', as it relates to FTT?
What is 'catch-down growth', as it relates to FTT?
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Which of the following is NOT a typical component of a multidisciplinary treatment team for a child with Failure to Thrive (FTT)?
Which of the following is NOT a typical component of a multidisciplinary treatment team for a child with Failure to Thrive (FTT)?
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What is the primary nutritional strategy for formula-fed infants with FTT needing increased caloric intake?
What is the primary nutritional strategy for formula-fed infants with FTT needing increased caloric intake?
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What is a key consideration when initiating nutritional treatment for a child who has experienced starvation?
What is a key consideration when initiating nutritional treatment for a child who has experienced starvation?
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What is the rationale for using specific carbohydrate, fat, or protein additives in the treatment of FTT?
What is the rationale for using specific carbohydrate, fat, or protein additives in the treatment of FTT?
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Why might nasogastric tube feedings be implemented in children with FTT?
Why might nasogastric tube feedings be implemented in children with FTT?
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In addition to nutritional management, what else should treatment plans address for families of children with FTT?
In addition to nutritional management, what else should treatment plans address for families of children with FTT?
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What is a re-feeding syndrome?
What is a re-feeding syndrome?
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What is a characteristic of psychosocial short stature?
What is a characteristic of psychosocial short stature?
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What is the prognosis for a child diagnosed with psychosocial short stature?
What is the prognosis for a child diagnosed with psychosocial short stature?
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What is the recommended approach to dietary changes for children with FTT?
What is the recommended approach to dietary changes for children with FTT?
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What percentage of children hospitalized for Failure to Thrive (FTT) have known complex chronic conditions?
What percentage of children hospitalized for Failure to Thrive (FTT) have known complex chronic conditions?
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Which of the following is NOT typically associated with inadequate intake as a cause of Failure to Thrive?
Which of the following is NOT typically associated with inadequate intake as a cause of Failure to Thrive?
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Which of the following is NOT considered a cause of increased metabolic demand leading to Failure to Thrive?
Which of the following is NOT considered a cause of increased metabolic demand leading to Failure to Thrive?
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Which of the following historical details is LEAST relevant when evaluating a child for Failure to Thrive?
Which of the following historical details is LEAST relevant when evaluating a child for Failure to Thrive?
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Which factor is MOST important when evaluating dietary history of a child with suspected Failure to Thrive?
Which factor is MOST important when evaluating dietary history of a child with suspected Failure to Thrive?
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Which of the following is NOT a typical finding on physical examination associated with Failure to Thrive?
Which of the following is NOT a typical finding on physical examination associated with Failure to Thrive?
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Which of these is NOT an accurate statement relating to growth charts?
Which of these is NOT an accurate statement relating to growth charts?
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Which of the following BEST describes the initial effect of malnutrition on growth in children with Failure to Thrive?
Which of the following BEST describes the initial effect of malnutrition on growth in children with Failure to Thrive?
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What might a symmetric pattern of FTT (proportional weight, height/length, and head circumference deficiencies) suggest?
What might a symmetric pattern of FTT (proportional weight, height/length, and head circumference deficiencies) suggest?
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Which of the following is LEAST likely to be part of the initial laboratory evaluation for FTT?
Which of the following is LEAST likely to be part of the initial laboratory evaluation for FTT?
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Besides growth parameters, which of the following assessments is MOST important in evaluating FTT?
Besides growth parameters, which of the following assessments is MOST important in evaluating FTT?
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What is the significance of observing a child during feeding in a FTT assessment?
What is the significance of observing a child during feeding in a FTT assessment?
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Which of the following is NOT a common risk factor associated with FTT?
Which of the following is NOT a common risk factor associated with FTT?
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When does stunting typically occur in children with FTT?
When does stunting typically occur in children with FTT?
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What might short stature with preserved weight suggest in a child with suspected FTT?
What might short stature with preserved weight suggest in a child with suspected FTT?
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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
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Outpatient treatment is common, but hospitalization may be necessary for severe malnutrition, underlying diagnoses, or safety concerns.
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Nutritional management is key, adjusting formula or increasing caloric density of foods.
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Dietary recommendations vary according to age and circumstances (e.g. calorie dense foods, formula concentration adjustments, high-calorie supplements).
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Nasogastric tube feedings are utilized when oral intake is inadequate or unsafe.
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Vitamin/mineral supplementation could be required. Important to prioritize the simplest, least costly dietary changes first.
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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.
