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Failure to Thrive and Diarrhoea - Coggle Diagram
Failure to Thrive and Diarrhoea
Failure to thrive
When a child's rate of growth fails to meet the potentiall expected for a child of that age
Clinical features
Inadequate wight gain
Sustained weight loss
Presistent downward crossing of centiles
Typically occurs <3yrs old bu tcan happen at any age
Exceptions
Linear growth failure =/= FFT
Linear gorwth may accompant FFT
IF linear growth failure occurs secondary to TFF occurs late
Cause
Protein / calorie marasmus
Increased REquirement / Expenditure
Chronic infx
Chronic respiratory / cardiac disease
Chronic inflmmation
Malignancy
Hyperthryoidism
Decreased Intake / Increased losses
Malabsorption
Gord
Cystic fibrosis
Investigation
Exam
Weight, height, head circumference centile chart
Thigh and buttock bulk and wasting
Antrhopomety - triceps skin folds / mid upper arm circumference
Dietary hx
Calorie Requirements
100 kcal/kg for 2st 10kg
50kcal/kg for 2nd 10kg
20kcal/kg every kg above 20kg
66kcal/ml in formula / breat milk
Refeeding
NG
gastrostomy
Aim for daily kacl intake based on
estimated expected weight
Energy Balance equation
Cals Ingested = Energy expended (TEE) + Energy lost
FFT
REduced intake of calories
Increased expenditure
Increased losses
Vomiting
Malabsorption
FTT Causes
Inadequate Intake
Neglect
Psychosocial (disturbed maternal-infant reloationship)
Chronic disease / Iatrogenic (anorexia)
Eating disorder
Neuromuscular disorders
Poverty
Increasd Requirements / expenditure
Chronic infx
Chronic respiratory / cardiac disease
Chronic inflammation
Malignancy
Hyperthyroidism
Often Multifactorial
CF - decreased intake + increased losses (malabsorption) + increased reqiurements
Increaed losses
Malabsorption
GORD
Diarrhoea
Persistent Vomiting
GI
GI reflux
GI reflux disease (eosophagitis)
Eosinophilic esophagitis
Peptic ulcer
Coeliac disease
Intestinal obstruction (Doudenal web in T21)
Non-GI
Raised ICP
Medications
Metabolic disease
UTI (babies
GOR vs GORD
GOR
Effortless "non-projectile"
Spit up / posset
Normal
Managment
Reassure
Watch weight gain
Feed the baby
Fat Malabsorption
Digestive Phase of Fat Absroption
Cholestatic liver disease
eg. Biliary atresia
Pancreatic insufficiency
eg CF / Shwachmas
Loss of Intestinal Length
Congenital short gut
Multiple atresias
Surgical short bowel syndrome
Gastroschisis
Mid gut volvulus
NEC
Loss of GI surface area
Coeliac
Immune enteropathy
Congenital enteropathies
Small bowel bacterial overgrowth
Fat Transport
Abetalipoproteinemia
Lymphangiectasia
Chronic Diarrhoea
Increased volume or liquidity of stool for more than 4 weeks
Normal Stool Patterns ⭐
Breastfed infant
2-5 per day???
Formula fed infant
1-3 per day
6months
1-7 per day
1yr
1-2 per day
Lactase Deficiecy
Congenital - rare
Post infx - common but transient
Adult type - Hypolactasia
Partial
Very rare in caucasian children
Toddlers Diarrhoea
Age
6month - 3years
Appearance
Very voluminous and liquire
Peas and carrots
Management
Probably a motility disturbance
Reassure - does not interfere with toilet training
Coeliac Disease
Pathology
Permanent intolerance of gluten
Morphologicol and functional abnormality of small bowel
T-cell mediated inflammatory repsonse - autoimmune
Epidemiology
Ver high incidence in Ire
Presents at any age - typically late in second yr
Clinical Features
Symptoms
Misery
FTT
Constipation
Vomiting
NONE ! cray
Signs
FFT / short stature
Chronic diarrheoa
Abdomincal distention
Complications of fat soluble vitamin deficiencies
Diagnosis
Serological Testing
EMA antibodies
TTG antibodies
Small bowel biopsy
