Failure to Thrive
Study guide:
Definition:
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A descriptive term used to describe the malnourished infants who fail to meet the appropriate growth parameters for the their age (growth failure).
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Weight below the 5th percentile for age and sex.
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Weight for age curve falls across two major percentile lines.
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Weight <80% of the expected weight for age.
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Epidemiology:
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It occurs in 5-10% of the children who are treated in the primary healthcare centers.
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It occurs in 3-5% of the children who are found in the referral system.
Causes & Types:

Diagnosis:
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History & physical examination:
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Feeding behavior and frequency.
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Signs of malabsorption (distended abdomen, thin buttocks, etc.).
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Signs of chronic lung disease or heart failure.
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Focus on the growth chart parameters:
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Firstly failure to gain weight But in severe cases length and head circumference will be affected afterward.
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Check for signs of abuse.
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Inappropriate behavior.
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Investigations:
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Initial work up:
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CBC with differential
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ESR
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Electrolyte profile
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Urine analysis
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Stool analysis
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Bone profile
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Specific investigations for the specific cause (e.g. IgA tissue transglutaminase antibodies for celiac disease).
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Management:
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Correct the acute problems:
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Electrolytes
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Infections
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Dehydration
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Nutritional Rehabilitation:
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Goal is catch-up weight and growth parameters with the appropriate age.
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Most cases can be managed with nutrition intervention and feeding behavior modification.
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High Calorie Diet with close Follow-up.
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Parental Behavior Modification.
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Extensive work-up for organic causes.
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Hemodynamically unstable: hypotension, bradycardia, hypothermia etc.
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Signs of physical abuse.
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Failure of outpatient therapy/management.
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Weight below the birth weight at the age of 6 weeks.
Indications:
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Hospitalization:
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Figure 1: Failure to Thrive
References:
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Cvetnic W, Pino E, Koerner C. USMLE step 2 CK pediatrics. [New York]: Kaplan; 2011.
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Shah S, Ronan J, Alverson B. Step-up to pediatrics.
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Kliegman R. Nelson textbook of pediatrics.
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Lissauer T, Clayden G, Craft A. Illustrated textbook of paediatrics. Edinburgh: Mosby; 2012.
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Uptodate.com. Failure to thrive (undernutrition) in children younger than two years: Etiology and evaluation [Internet]. 2016 [cited 2 March 2016]. Available from: http://www.uptodate.com/contents/failure-to-thrive-undernutrition-in-children-younger-than-two-years-etiology-and-evaluation
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S. H. Psychiatric and social factors of failure to thrive. Family Medical Center [Internet]. Familymedicalcenter.blogspot.com. 2016 [cited 2 March 2016]. Available from: http://familymedicalcenter.blogspot.com/2014/01/psychiatric-and-social-factors-of.html
Written by: Asmaa Salem
Reviewed by: Roaa Amer
Lama Al Luhidan
Format editor: Roaa Amer
Web publisher: Bayan Alzomaili
Audio recording:
Read by: Bayan Alzomaili
Directed by: Rana Alzahrani
Audio production: Bayan Alzomaili