Pediatrics Failure to Thrive Overview

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Questions and Answers

What does the examination of hair and nails often indicate?

Nutritional deficiencies (correct)

Circulatory issues

Presence of infectious diseases

Hormonal imbalances

Why is a thorough abdominal examination particularly important in children with failure to thrive (FTT)?

It assesses for signs of appendicitis

It checks for abdominal muscle strength

It helps diagnose gastroesophageal reflux disease

It may reveal organomegaly indicating metabolic disorders (correct)

What does a careful neurologic examination aim to identify in relation to caloric requirements?

Presence of seizures

Increased or decreased muscle tone (correct)

Developmental delays

Cranial nerve abnormalities

Which laboratory finding is commonly cited as a marker of recent protein nutrition but has significant limitations?

Prealbumin levels Signup and view all the answers

What physical examination finding could indicate conditions such as panhypopituitarism in children?

Undescended testicles Signup and view all the answers

What is the expected feeding frequency for neonates in the first week of life during breastfeeding?

At least 8 times in a 24-hour period Signup and view all the answers

What is a common sign that a breastfeeding infant might be failing to thrive?

Sleeping through the night Signup and view all the answers

How soon should mothers expect their milk to come in after childbirth for successful breastfeeding?

By day 3 or 4 Signup and view all the answers

What caloric intake should caregivers assume when assessing formula for infants?

20 cal/oz Signup and view all the answers

Which feeding technique could indicate deeper issues in a parent-child relationship?

Bottle propping during feeding Signup and view all the answers

What is the average calorie content of baby food per jar?

40 to 120 calories per jar Signup and view all the answers

What is an alarming weight loss percentage for an infant that would prompt a follow-up evaluation for dehydration?

Greater than 10-12% Signup and view all the answers

How many wet diapers should a breastfed baby have each day to indicate successful breastfeeding?

At least six wet diapers Signup and view all the answers

What is an important sign of a successful breastfeeding session in infants?

The infant empties the mother's breast and appears content. Signup and view all the answers

Which method is most reliable for assessing a child's dietary intake?

A 72-hour diet diary with emphasis on the first 48 hours Signup and view all the answers

What would be an indicator of chronic undernutrition in a child?

Low weight with short height and normal head circumference Signup and view all the answers

How much juice should a child consume daily to avoid affecting their nutrient intake?

< 12 oz Signup and view all the answers

What physical characteristic might indicate a child is suffering from Failure to Thrive (FTT)?

Decreased subcutaneous fat and muscle wasting Signup and view all the answers

What is the first step a primary care provider should take regarding an infant's nutritional assessment?

Observe the infant during breastfeeding. Signup and view all the answers

Which of the following statements about physical examination of children is correct?

Weight, length or height, and head circumference are all necessary measurements. Signup and view all the answers

What is a common feeding issue for infants who may not be gaining weight adequately?

Infants are not being breastfed correctly. Signup and view all the answers

Study Notes

Failure to Thrive - Clinical Findings

Failure to thrive (FTT) diagnosis requires a comprehensive, long-term growth curve.
In acute undernutrition, weight gain slows, but height velocity remains stable. This leads to a thin child of normal height.
Chronic undernutrition results in stunting, affecting both height and weight.
Growth charts show that healthy children can cross percentile lines up to 39% of the time between birth and 6 months of age and 15% of the time between 6 and 24 months. Children with length above the 50th percentile rarely have endocrine disease.

History

A detailed medical history and physical examination are vital for identifying organ dysfunction, potential causes of growth failure (poor suck, cleft palate, etc.).
Recurrent infections, immune deficiencies (HIV), and cardiac problems warrant investigation.
Chronic conditions, like diarrhea, indicate malabsorption and require attention.
Developmental history, a history of intercurrent illnesses and delay in reaching milestones are also important for diagnosis.
History of specific prenatal exposures (infections, drug exposure) and low birth weight increase the risk of growth problems.
Infants exposed to conditions like rubella, cytomegalovirus, syphilis, toxoplasmosis, or malaria in utero are at higher risk for low birth weight, length, and head circumference. These features predict poor catch-up growth potential.
Feeding history is crucial. Volume and frequency of feedings, formula preparation, and feeding issues (poor suck, regurgitation, bottle propping) are key.
Breastfeeding mothers must be educated before discharge about expectations.
Neonates should typically feed at least 8 times per 24 hours and not sleep through the night.
24-hour/72-hour diet recall is essential for accurate assessment of dietary intake in older children.

Physical Examination

Physical examination complements growth charts. Weight, length/height, and head circumference should be assessed in all children.
Objective findings of nutritional state including decreased subcutaneous fat and muscle wasting.
Careful assessment of nail beds and hair, and skin for scaling/cracking (indicators of deficiencies).
Presence of eczema points towards allergic diathesis or eosinophilic enteritis, a potential problem in undernourished children.
Abdominal examination important to screen for organomegaly, which can indicate an underlying metabolic condition.
Neurological assessment can detect subtly increased or decreased muscle tone, consistent with cerebral palsy or difficulties with oral motor skills.

Laboratory Findings

Laboratory evaluation may be crucial if clinical examination shows abnormalities not reflected in diet history.
Tests for organ issues, genetic disorders and inborn errors of metabolism are important.
Serum albumin, though not a reliable indicator of recent undernutrition, is a marker of nutritional status. Prealbumin is a better marker of recent protein nutrition.
Reduced lymphocyte count could suggest malnutrition. Assessment of iron levels important. Elevated lead levels warrant investigation given lead exposure potential affecting absorption of iron.
Evaluate for infectious diseases (like TB, HIV), and conditions such as celiac disease, particularly when solid foods have been introduced.

Differential Diagnosis

Family history is essential for differentiating constitutional growth delay from FTT.
The calculation of midparental height is helpful in differentiating growth-related problems from genetic predisposition.

Treatment

Nutritional support is the cornerstone of treatment.
Children with FTT might require 1.5-2 times the usual daily caloric intake to achieve catch-up growth.
Increased protein intake may be needed in severe malnutrition.
High-calorie formulas and foods, heavy cream, and other high-calorie additions to regular diets may be necessary.
Dietary management should require input from a dietitian.
Some medications such as iron and zinc supplementation, and vitamin D replacement might be considered as necessary nutritional support.

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Description

Explore the clinical findings and history related to failure to thrive (FTT) in pediatrics. This quiz investigates the implications of acute and chronic undernutrition, as well as the importance of growth charts and medical histories in assessing growth failures. Enhance your understanding of key diagnostic factors affecting children's health.