Failure to Thrive PDF

Failure to thrive Khalaf Hussien Gargary MD MBChB DCH CABP FAAP Professor of Pediatrics Consultant Pediatrician September 15th, 2022 H i f  Protein energy malnutrition Definitions crosstwo major centileor...

Failure to thrive Khalaf Hussien Gargary MD MBChB DCH CABP FAAP Professor of Pediatrics Consultant Pediatrician September 15th, 2022 H i f  Protein energy malnutrition Definitions crosstwo major centileor within shortperiod arowfdnt.ie Underweight 3 → PGM acute –Measurements that fall below 2 standard deviations under the normal weight for age. Stunting PEM a Short = → Chronic –Measurements that fall below 2 standard deviations below height for age. Wasting 1 →Chronic PEM –Measurements that fall below 2 standard deviations below weight for height.  Protein energy malnutrition Micronutrient Deficiencies irreversible Iron: fatigue, anemia, decreased cognitive function, glossitis and nail changes all reversible except IQ Iodine: Goiter, developmental delay, and MR Intellectual disability N osteoma Vitamin D: poor growth, rickets, and hypocalcemia 00 Vitamin A: night blindness, xerophthalmia, poor growth, and hair changes oatmeal 85120kcal weight Folate: Glossitis, anemia lounceofmilk 204091 tagJ  Protein energy malnutrition in underdeveloped world fafrica) Clinical forms of PEM → it is more common often due to → in our locality , it is organic diseases Marasmus Garasmus –Severe wasting ,weight for age below 60% of mean weight for age Tm t Marasmic kwashiorkor knasting –Severe wasting in the presence of edema , weight for age below 60 of mean weight for age Kwashiorkor –Malnutrition with edema , weight for age 60-80% of mean weight for age 0  Protein energy malnutrition Causes of PEM 6M 2years excurive Early weaning < 6 months Zyers IT Delayed introduction of complementary food Low protein diet Severe or frequent infections. organic diseases ( CKD , CHD. - - - - - ) Usually manifest between 6 months and 2 years of age  Protein energy malnutrition Nutritional assessment Medical and dietary history Anthropometric evaluation and physical examination Anthropometric measurements included weight, height, body mass Laboratory measurements index (BMI), body circumference (OFC, arm, waist, hip and calf), waist Weight, length & OFC < 2 years to hip ratio (WHR), elbow amplitude si Weight, height & BMI > 2 years. OFC not needed and knee-heel length….. unless clearly micro/macrocephalic  Protein energy malnutrition Medical and dietary history Medical history – review of acute and chronic illnesses – history of preexisting nutrient deficiencies microhut d – social history (poverty, domestic violence, parental employment ) Social class Dietary history – quantity and quality of current intake – in infants history of breast feeding pattern formula preparation volume consumed feeding techniques  Protein energy malnutrition Marasmus History months Years decreased caloric intake over months to years physical examination –impression: cachectic, severely ill, “little old man” irritable, apathetic, hungry –underweight, growth retardation –hair sparse, brittle, easily pulled out –Corneal opacity  Protein energy malnutrition marasmus.mu Marasmus YnYne skin check over bony –Poor skin turgor Cfp for dehydration so , always prominence ) –nails fragile , thin and fissured –loss of subcutaneous tissue –muscle wasting –abdominal distension (muscular hypotonia) –Rectal prolapse (loss of perianal fat) r –vital signs: hypothermia, hypotension, bradycardia Anthropometry: wasting or stunting, weight for height and height for age is less than 60% of the mean average r O  Protein energy malnutrition Marasmus Marasmus Marasmic kwashiorkor gristery  Protein energy malnutrition Kwashiorkor months History Whs adults –decreased calorie intake over weeks to months can , occur in Physical Examination –may look well nourished, even “fat”, apathetic, irritable, anorexic –moon facies, pitting edema hallmark –overall fatness of malnutrition → Period –thin upper arm ↓ color, youpulled out " –Hair changes: flag sign , hypochromtrichia , easy pluckability , sparseness , silkiness ,easily fractured  A Protein energy malnutrition Kwashiorkor –Skin changes:flaking paint , pellagra like,reticular ,greasy pavement ,mozaeic , fissures, ulcerations Some area al –mucosal thining, mild anemia hypo/hype pigmentation –fragile and thin nails –Hepatomegaly (steatosis) 0 Apolipoproteins much no feet accumulate - –Vital signs: hypothermia, hypotension Anthropometry –usually underweight; occasional fat appearance  Protein energy malnutrition Kwashiorkor CanCrum Or is 11 Maris - necrosis ofskin  Protein energy malnutrition History and physical examination followed by investigations FIRST LINE CBC EEP SECOND LINE ESR, CRP Serum AA Ianyloidosis -> UA/Cx, Urine analysis & culture Ur organic acids organic -> acideia Cr, glucose, LFTs Ca Mantoux test -TB TFT -> hypothyroid Abd US Sweat Chloride If -> CXR qo Celiac serology ummmm Head US GSE ECG/Eho  Protein energy malnutrition Assessment of severely malnourished child treat these first, because I they fetal very im are Dehydration Infection most of common cause death Intake of food & drinks & degree of anorexia Chypoglycemic) o ha ⑭  Protein energy malnutrition General principles of treatment Acute or stabilization phase - Rehabilitation phase Week 1 week 2-6 Day 1-2 Day 3-7 Look for & treat Freet fatal complications Hypoglycemia Hypothermia Dehydration Infection Specific treatment for all children Electrolytes Micronutrients Initial feeding Feeding to achieve catch-up growth  Protein energy malnutrition Stabilization or acute phase Correction of shock & dehydration –IVF if shocked –ORS (low osmolarity with extra potassium) Life threatening complications: –Hypoglycemia (