Failure to Thrive in Children
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Questions and Answers

What defines 'Underweight' in terms of standard deviations?

Measurements that fall below 2 standard deviations under the normal weight for age.

Explain what constitutes 'Stunting' and its significance.

Stunting is defined as measurements falling below 2 standard deviations below height for age, indicating chronic malnutrition.

Identify and describe one micronutrient deficiency associated with fatigue.

Iron deficiency, leading to fatigue, anemia, and decreased cognitive function.

What are the clinical features of 'Kwashiorkor'?

<p>Kwashiorkor is characterized by malnutrition with edema and weight for age between 60-80% of mean weight for age.</p> Signup and view all the answers

How does 'Marasmus' differ from 'Kwashiorkor'?

<p>Marasmus involves severe wasting with weight for age below 60% of mean weight for age, while Kwashiorkor presents with edema.</p> Signup and view all the answers

What causes 'Protein Energy Malnutrition' (PEM) in underdeveloped areas?

<p>Causes include early weaning, delayed introduction of complementary foods, low protein diet, and severe infections.</p> Signup and view all the answers

Describe the term 'Micronutrient Deficiencies' and provide two examples.

<p>Micronutrient deficiencies refer to the lack of essential vitamins and minerals in the diet, examples include iron and iodine deficiencies.</p> Signup and view all the answers

What are the consequences of Vitamin D deficiency in children?

<p>Consequences include poor growth, rickets, and hypocalcemia.</p> Signup and view all the answers

What is 'Marasmic kwashiorkor' and how does it present?

<p>Marasmic kwashiorkor features severe wasting with edema, and weight for age below 60% of mean weight for age.</p> Signup and view all the answers

Outline the impact of delayed introduction of complementary foods on child nutrition.

<p>Delayed introduction can lead to insufficient intake of essential nutrients, contributing to growth failure and malnutrition.</p> Signup and view all the answers

What age range typically sees the manifestation of organic diseases like CKD and CHD?

<p>Between 6 months and 2 years of age.</p> Signup and view all the answers

List three components involved in the nutritional assessment of a child.

<p>Medical history, dietary history, and anthropometric evaluation.</p> Signup and view all the answers

What physical examination signs are associated with Marasmus?

<p>Underweight, growth retardation, and fragile hair.</p> Signup and view all the answers

What nutritional history is crucial when assessing infants for malnutrition?

<p>Breastfeeding pattern and formula preparation.</p> Signup and view all the answers

What is a hallmark symptom of Kwashiorkor?

<p>Pitting edema.</p> Signup and view all the answers

Describe a common skin manifestation in Kwashiorkor.

<p>Flaking paint skin appearance.</p> Signup and view all the answers

What is the initial step in the management of a severely malnourished child?

<p>Treat dehydration and infection.</p> Signup and view all the answers

What laboratory test is prioritized for a child suspected of malnutrition?

<p>Complete Blood Count (CBC).</p> Signup and view all the answers

In anthropometric measurements, what is a key indicator for children under 2 years?

<p>Weight, length, and head circumference (OFC).</p> Signup and view all the answers

What does a waist-to-hip ratio (WHR) indicate?

<p>Body fat distribution and potential health risks.</p> Signup and view all the answers

What physical sign can indicate dehydration in a malnourished child?

<p>Poor skin turgor.</p> Signup and view all the answers

How can muscle wasting be identified in a physical examination?

<p>By observing loss of subcutaneous tissue and muscle mass.</p> Signup and view all the answers

What general principle should be followed during the acute phase of malnutrition treatment?

<p>Look for and treat life-threatening complications.</p> Signup and view all the answers

What might be a noticeable hair characteristic in a child with Kwashiorkor?

<p>Flag sign or easy pluckability.</p> Signup and view all the answers

What role does social history play in assessing a malnourished child?

<p>It provides context for potential environmental and economic factors affecting nutrition.</p> Signup and view all the answers

Flashcards

Failure to Thrive

A condition where a child's growth is significantly below what is expected for their age, resulting in a low weight-for-age value.

Marasmus

A type of malnutrition characterized by severe wasting (thinness) and low weight-for-age, often occurring in children who are not getting enough calories and protein.

Kwashiorkor

A type of malnutrition characterized by severe wasting (thinness) and edema (swelling), often occurring in children who are not getting enough protein.

Marasmic Kwashiorkor

A severe form of malnutrition characterized by severe wasting (thinness) and edema (swelling), with weight for age below 60% of the mean weight for age.

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Protein-Energy Malnutrition (PEM)

A type of malnutrition characterized by low weight-for-age, often due to a lack of calories and protein.

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Micronutrient Deficiencies

A lack of essential nutrients in the diet, such as iron, iodine, vitamin D, and vitamin A.

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Iron Deficiency

A condition caused by iron deficiency, leading to fatigue, anemia, and cognitive problems.

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Iodine Deficiency

A condition caused by iodine deficiency, leading to an enlarged thyroid gland (goiter), developmental delay, and intellectual disability.

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Vitamin D Deficiency

A condition caused by a deficiency of vitamin D, leading to poor growth, bone problems (rickets), and calcium imbalances.

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Vitamin A Deficiency

A condition caused by a deficiency of vitamin A, leading to night blindness, eye problems, poor growth, and hair changes.

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Stabilization Phase

This phase aims to stabilize the child's condition and correct any life-threatening complications.

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Nutritional Assessment

The assessment of a child's growth status, nutritional intake, and medical history to identify risks and develop a plan for treatment.

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Body Mass Index (BMI)

This measurement is used to assess a child's overall weight-to-height ratio, giving an idea of their body mass.

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Stunting

The decrease in body weight and height compared to age-related norms, indicative of inadequate nutrition.

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Wasting

Severe weight loss due to malnutrition, most commonly associated with Marasmus.

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Flag Sign

A sign of Kwashiorkor, characterized by a characteristic reddish hair color with a distinct lighter band at the root, due to protein deficiency.

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Edema

Fluid imbalance leading to excessive water retention, often associated with Kwashiorkor.

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Hepatomegaly

An enlarged liver due to fatty deposits, typically seen in Kwashiorkor.

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Rehabilitation Phase

The period in treatment where the focus shifts from stabilization to long-term recovery, allowing for catch-up growth and improvement in overall health.

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Life-Threatening Complications

Critical medical conditions that require immediate attention to save the child's life, often complicating the treatment of severe malnutrition.

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Hypoglycemia

A common complication of PEM, characterized by low blood sugar levels, requiring prompt intervention.

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Hypothermia

Lower than normal body temperature, often a sign of dehydration or infection, and a frequent finding in PEM.

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Dehydration

A critical problem in PEM where the body's fluid balance is disrupted, requiring immediate rehydration to prevent organ damage.

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Study Notes

Failure to Thrive

  • Failure to thrive is a condition where a child's growth is significantly slower than expected for their age.
  • It's categorized by several measurements, including stunting, wasting, and underweight.

Stature-for-age percentiles

  • Growth charts display the expected height for different age groups and percentiles (e.g., 5th, 25th, 50th, 75th, 90th, 95th, 97th).
  • These charts help identify children whose development falls significantly below or above averages.
  • Data is displayed for both girls and boys, ages 2 to 20 years.

Protein Energy Malnutrition (PEM)

  • PEM encompasses a range of conditions caused by inadequate protein and energy intake, often seen in developing countries.
  • Underweight: A measurement below 2 standard deviations from the normal weight for a given age.
  • Stunting: A measurement below 2 standard deviations below height for age.
  • Wasting: A measure below 2 standard deviations below weight for height.
  • Understanding these definitions helps differentiate the types of malnutrition
  • PEM frequently results in multiple nutritional deficiencies.

Micronutrient Deficiencies

  • Iron: Anemia, fatigue, poor cognitive function, glossitis (inflammation of the tongue), and nail changes are all symptoms.
  • Iodine: Goiter (enlarged thyroid gland), developmental delays, and intellectual disability are signs.
  • Vitamin D: Poor growth, rickets, and hypocalcemia (low calcium levels).
  • Vitamin A: Night blindness, xerophthalmia (eye dryness), poor growth, and hair abnormalities are some signs.
  • Folate: Glossitis and anemia are prominent symptoms.
  • Understanding these micronutrient deficiencies is critical in managing malnutrition.

Clinical Forms of PEM

  • Marasmus: Severe wasting(loss of muscle mass), with weight for age below 60% of the average.
  • Kwashiorkor: Severe malnutrition with edema, weight for age between 60-80% of the average.
  • These are significant distinctions in the clinical presentation of malnutrition.

Causes of PEM

  • Early weaning (discontinuation of breastfeeding before the optimal age), delayed introduction of complementary foods.
  • Low protein diets, severe/frequent infections, and organic diseases (e.g., kidney diseases).
  • Knowledge of these causes can be instrumental in preventative measures.

Nutritional Assessment

  • Medical and dietary history: Understand past illnesses and current nutritional intake (breastfeeding, formula, etc.)
  • Anthropometric evaluation and physical examination: Assess height, weight, body mass index (BMI), and other vital signs.
  • Laboratory measurements: Analyzing blood, urine, etc., for essential components.

Medical and Dietary History

  • Obtain a detailed medical history, including acute and chronic illnesses, preexisting nutrient deficiencies, social history (poverty, violence, etc.), and current dietary habits.
  • Evaluate the patient's quantity and quality of current intake, breast feeding patterns in infants, formula preparation, volume consumed, and feeding techniques.

Marasmus

  • Characterized by significant weight loss over months or years.
  • Child may appear severely ill, apathetic, irritable, hungry, and have sparse, brittle hair.
  • Physical examination may reveal growth retardation, underweight status, corneal opacity, and other symptoms.

Marasmus—Physical Examination

  • Poor skin turgor is typical.
  • Nails become thin, frail, and fissured.
  • Muscle wasting is apparent.
  • Abdominal distention, and subcutaneous tissue loss are key signs.
  • Recal prolapse, hypothermia, hypotension, and bradycardia are vital signs observed.
  • Anthropometry typically reveals wasting and stunting, with weight and height significantly below the average expected.

Kwashiorkor

  • Significant weight loss over weeks to months.
  • May seem well-nourished, yet apathetic, irritable, and anorexic.
  • Characterized by moon face, pitting edema, and overall fatness.
  • Physical examination reveals changes in hair (flag sign, hypochromotrichia, easily plucked, sparseness, silkiness, and fragility).
  • Additional signs include thin upper arms, edema, and often mucosal thinning.

Kwashiorkor—Physical Examination

  • Skin changes, such as flaking, pellagra-like skin, skin fissures, and/or ulcerations, are noted.
  • Mucosal thinning, mild anemia are evident.
  • Fragile/thin nails, hepatomegaly (enlarged liver), and symptoms suggestive of hypothermia and hypotension may also be present.
  • Notably, anthropometry frequently reveals underweight, though with an occasional fat appearance.

History and Physical Examination Followed by Investigations

  • First-line investigations: Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urine analysis, culture, creatinine (Cr), and blood glucose levels.
  • Second-line investigations: Serum amino acids, organic acid testing, liver function tests (LFTs), Mantoux test, abdomen, chest, head ultrasound, and electrocardiogram (ECG) assessments.
  • Other investigations may be needed depending on specific clinical situation.

Assessments of Severely Malnourished Children

  • Priority areas include dehydration, infection, and the intake of food and drinks.

General Treatment Principles

  • Initial acute phase involves correcting shock, dehydration, and other life-threatening conditions like hypoglycemia and hypothermia.
  • Electrolyte imbalances need prompt attention.
  • Micronutrient deficiencies are addressed in consultation with proper investigations
  • Feeding is carefully reintroduced gradually

Stabilization Phase

  • Treatment focuses on addressing shock, dehydration, hypoglycemia, and hypothermia
  • Crucial in establishing a stable condition for subsequent stages
  • Includes appropriate IV fluids, oral rehydration salts, micronutrients, and electrolytes, and treating accompanying infections.

Rehabilitation Phase

  • The rehabilitation phase involves weight gain of at least 10 grams per kilogram of body weight per day initially to avoid cardiac failure.
  • Treatment should focus on slowly increasing the energy & protein intake.
  • Aiming for a height-to-weight ratio of 90% of the average is the recovery benchmark

Nutritional Rehabilitation Phenomena

  • Pseudo-tumor cerebri: A self-limiting condition with vomiting as a key symptom indicating increased intracranial pressure, requiring careful medical attention
  • Nutritional recovery syndrome: Signs like hirsutism, gynecomastia, and abdominal distension indicate hormone recovery following a period of malnutrition.
  • Encephalitis-like syndrome: A severe form requiring significant medical attention, which might be fatal.

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Failure to Thrive PDF

Description

Explore the factors contributing to failure to thrive in children, including growth measurements like stunting, wasting, and underweight. Understand the importance of stature-for-age percentiles and the impact of protein energy malnutrition. This quiz highlights methods to assess children's growth and development effectively.

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