Pediatrics: Failure to Thrive

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Questions and Answers

What is a key element for identifying potential causes of failure to thrive (FTT)?

X-ray imaging

Physical examination (correct)

Psychological evaluation

Genetic testing

In diagnosing failure to thrive, what might be looked for in a complete physical examination?

Abnormal breathing sounds (correct)

Skin rashes

Hearing impairments

Dental caries

Which of the following is NOT mentioned as a possible cause leading to exogenous faltering in developing countries?

Excessive weight gain (correct)

Lack of nutritional awareness

Chronic food insecurity

Other factors beyond caregiver's control

What might make a caregiver hesitant to offer sufficient feedings to a child with severe acid reflux?

Signs of pain during eating Signup and view all the answers

Which of the following could be signs that may be revealed during a physical exam indicative of possible child neglect or abuse?

Bruises inconsistent with the history given Signup and view all the answers

What percentage of failure to thrive cases are non-organic?

>90% Signup and view all the answers

What is the significance of Failure to Thrive (FTT) in children?

It shows insufficient weight gain or inappropriate weight loss. Signup and view all the answers

Which of the following can be a cause of endogenous Failure to Thrive (FTT)?

Milk allergies. Signup and view all the answers

Which of the following physical deformities is mentioned as a cause of Failure to Thrive (FTT)?

Cleft palate. Signup and view all the answers

What condition makes it more difficult for the body to absorb nutrition in children?

Cystic fibrosis. Signup and view all the answers

What has also been associated with Failure to Thrive (FTT) in relation to child nutrition?

Fetal alcohol syndrome (FAS). Signup and view all the answers

How is Failure to Thrive (FTT) defined in children?

By a low weight for age or low rate of weight increase. Signup and view all the answers

What signs might indicate potential vitamin and mineral deficiencies in a child with Failure to Thrive?

Scaling skin, spoon-shaped nails, and neuropathy Signup and view all the answers

Which growth parameter is used to identify 'wasting' in a child with Failure to Thrive?

Deceleration in stature >2 standard deviations from median weight-for-height Signup and view all the answers

At what age is Failure to Thrive typically present?

Before two years of age Signup and view all the answers

What might parents express concern about regarding a child with Failure to Thrive?

Picky eating habits and poor weight gain Signup and view all the answers

What is discouraged as a feeding practice for infants or children with unpleasant eating experiences?

Force feeding Signup and view all the answers

'Stunting' is identified when there is a drop of >2 standard deviations from which growth parameter?

Height-for-age Signup and view all the answers

Study Notes

Failure to Thrive (FTT)

FTT occurs in children whose nutritional intake is insufficient for supporting normal growth and weight gain, typically present before two years of age.
Parents may express concern about picky eating habits, poor weight gain, or smaller size compared to peers of similar age.

Signs and Symptoms

Physicians often identify FTT during routine office visits, when a child's growth parameters are not tracking appropriately on growth curves.
Physical exam findings that can indicate a potential cause of FTT include:
- Scaling skin, spoon-shaped nails, and neuropathy, which may indicate potential vitamin and mineral deficiencies.
- "Wasting" – deceleration in stature >2 standard deviations from median weight-for-height.
- "Stunting" – drop of >2 standard deviations from the median height-for-age.

Causes of FTT

Endogenous (or "organic") FTT

Caused by physical or mental issues with the child itself.
Includes various inborn errors of metabolism.
Problems with the gastrointestinal system, such as excessive gas and acid reflux, can make the child unwilling to take in sufficient nutrition.
Other causes include:
- Cystic fibrosis, diarrhea, liver disease, anemia, or iron deficiency, which make it difficult for the body to absorb nutrition.
- Physical deformities, such as cleft palate and tongue tie.
- Milk allergies can cause endogenous FTT.
- Fetal alcohol syndrome (FAS) has also been associated with FTT.

Exogenous (or "non-organic") FTT

Caused by caregiver's actions.
Includes physical inability to produce enough breastmilk, using only babies' cues to regulate breastfeeding, leading to insufficient feeds.
In developing countries, conflict settings, and protracted emergencies, exogenous faltering may be caused by chronic food insecurity, lack of nutritional awareness, and other factors beyond the caregiver's control.

Diagnosis and Treatment

Patient history, including diet history, is a key element for identifying potential causes of FTT.
Complete physical examination may reveal signs of possible child neglect or abuse.
Treatment considerations include addressing underlying causes, such as acid reflux, and promoting proper feeding practices.

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Description

Explore the signs, symptoms, and workup of Failure to Thrive (FTT) in children, a condition characterized by insufficient nutritional intake for normal growth and weight gain. Learn about the importance of early detection and intervention.