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Non-organic faltering growth - Coggle Diagram
Non-organic faltering growth
Intro
FTT = description NOT a dx
sub-optimal weight gain in infants + toddlers
can be organic or non-organic
both can be present
under 5% will have an organic cause
non-organic traditionally believed to be a/w psychosocial + environmental deprivation
weight of infants only helpful if plotted on centile chart
concern if weight falls across 2 centile lines
Causes
abuse
neglect
socioeconomic deprivation
maternal depression/eating disorder
mother has poor understanding of baby's needs
poor housing
poverty
inadequate social support
lack of extended family
feeding problems
insufficient breast milk
poor technique
incorrect preparation of formula
insufficient/unsuitable food
lack of regular feeding times
infant is difficult to feed - resists/disinterested, messy, throws food
problems with money, shopping, cooking food, famine
poor maternal-infant bond
factitious disorder (deliberate underfeeding)
Dx
get detailed dietary hx with a food diary
ask what happens @ mealtimes
look for other sx - diarrhoea, vomiting, cough, lethargy
was child premature/have IUGR?
growth of other family members?
psychosocial problems @ home?
examine for signs of organic disease
dysmorphic features
distended abdo
thin buttocks
misery
chest deformity
clubbing
HF
signs of nutritional deficiencies
further info from GP/health visitor
FBC + serum ferritin to identify Fe deficient anaemia
usually secondary to inadequate fe intake
Outcome
many continue to undereat, lasting deficit common, tend to remain underweight
usually gradual improvement in preschool yrs
development impairment only short term
Tx
usually carried out in primary care
health visitor can assess eating behaviour @ home
direct practical advice
3 meals a day, regular times
variety of food, increase energy density e.g. add cheese
give praise, don't force feed
paed dietician can recommend strategies for increasing intake
SALT for feeding disorders
maybe clinical psychologist + social services
nursery placement can alleviate stress @ home
hosp admission only necessary in children under 6mo with severe FTT requiring active refeeding