Failure To Thrive

Front 1

Define “Failure to Thrive” in pediatrics and recognize the most common clinical presentations and causes of growth failure in children.

Back 1

-Physical sign that child is receiving inadequate nutrition for optimal growth and development
-Consequence of interaction btw environment and child's health, development and behavior
**Chart-based definition in children under 2yo:
--wt of 3-5%ile on more than one occasion
--wt change by two major %ile lines
--weight for length 3-5%ile

Front 2

• Develop an approach to the history and physical examination of a child with failure to thrive, identifying red flags suggestive of organic vs. non-organic causes of growth failure.

Back 2

-History red-flags: chronic illness, "small", poor growth, neuro changes, vomiting, diarrhea, unusual stools

Front 3

• Plot a pediatric patient’s growth data accurately on standard growth charts and recognize abnormal growth patterns in children.

Back 3

*Growth charts are age and sex specific
-- 0-24 mo is WHO -- reflects breast fed and international growth standard
-- 2-5yo is WHO and 2-20yo is CDC (for caucasian, american children)
*Growth Patterns
--Wt falls, THEN length --> inadequate calories
--symmetric falls in ht and wt --> chronic illness, endocrine disorder, genetic abnormality
--early drop off head circumference --> poor brain growth (genetic abnormality)

Front 4

• Understand the value of laboratory and imaging testing in making the diagnosis of failure to thrive vs. other chronic illnesses.

Back 4

-CBC, CMP, Celiac screening, stool studies for malabsorption, sweat chloride

Front 5

• Formulate a management plan for the child with failure to thrive, taking into account the underlying etiology.

Back 5

1-treat underlying condition
2-structured observation of eating and feeding behavior, including family meals
3-Involve specialists
4-behavioral intervention and possible enteral feeding

Front 6

• Describe the effects of growth failure on future development, behavior and cognition.

Back 6

-reduced IQ and school performance
-irreversible develop deficits if early Fe deficiency anemia
-parental neglect/abuse negative psychologically
-depression/anxiety, especially with chronic illness

Front 7

• Understand the causes and complications of “Refeeding Syndrome” and be able to recognize its signs and symptoms.

Back 7

-Hallmark is hypophosphatemia (low ATP when fasting due to decreased metabolic rate)
- when introduce food, phosphate overwhelms system?
-Hypokalemia, hypomagnesemia, hyperglycemia, volume overload/edema, thiamine def and metabolic acidosis can also occur
--GIVE Thiamine BEFORE Glucose!!, monitor electrolytes and heart, start with slow replacement (5-10kcal/kg/d if severe)