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Faltering weight (failure to thrive) (Aetiology (Developmental CP (poor…
Faltering weight
(failure to thrive)
Pathophysiology
Normal weight changes
Infants large at birth will drop centile (catch down growth)
and small infants will move up (catch up growth)
Mechanisms
Inadequate intake of food
Inadequate retention
Malabsorption
Failure to use nutrients
Increased requirements
Aetiology
Developmental
CP (poor swallow)
Orofacial deformity
Extreme prematurity
Functional
Poor mother-child bonding
Maternal depression
Neglect, child abuse
Metabolic
GORD
CKD
CLD
Idiopathic
Inadequate food (feeding issues, difficult to feed)
Autoimmune
Coeliac, IBD, cows milk protein allergy
Congenital
CF, Chr disorders
Metabolic disorders
Endocrine
Hypothyroidism/hyperthyroidism
Infection
HIV
Neoplastic
Malignancy
Vascular
Congenital heart disease
Diagnosis
Examination
General
Dysmorphic features, any heart signs,
abdominal distension/tenderness
Investigations
Bloods
FBC (anaemia, malignancy), ESR/CRP (inflammation),
U+E (renal disease), bone profile, LFT (liver disease),
TFTs (thyroid disease), B12, folate, Coeliac serology
Immunoglobulins (immunodeficiency)
Karyotyping (Turners)
Bedside
Obs
Measurements (height/length, weight, HC
using WHO Growth Charts)
Anthropometry (weight, height,
mid upper arm circ, skinfold thickness)
Sweat test (CF)
Imaging
CXR: CF
History
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Meds, allergies
POH
Bloods, scans, growth (IUGR), gestation (preterm),
delivery, complications
FH
Malabsorption, other illnesses
PC/HPC
Poor growth, weight loss,
What being fed (breast/formula), how often, how are they feeding, age at weaning, type of food eaten, routines/behaviours
stools/urine (vomiting, diarrhoea etc.)
SH
Living arrangements, siblings,
parental wellness
Management
Conservative
Information and advice
Food diaries (type of food, amount, timing)
MDT (GP, health visitor, dietician, SALT)
Admit for refeeding if severe faltering <6m
Medical
Supplements
Indication: deficiency e.g. Fe, vit D
Refeeding
Indication: severe, <6m
MOA: enteral, parenteral
Complications
If prolonged and severe, can result in
reduced height/length and developmental delay
Definition
Suboptimal weight gain
in infants/young children
(falling across two centiles)
Epidemiology
Rare, 0.5% after 4m age