Makindo Medical Notes

Related Subjects: |Causes of Short Stature in Children |Causes of Male Infertility |Causes of Tall Stature in Children |Marfan syndrome |Klinefelter Syndrome |Turner's syndrome (Children)

⚠️ Failure to thrive (FTT), or faltering growth, can result from social, medical, and feeding issues — often overlapping. Always support parents and investigate thoroughly.

📖 Introduction

• FTT = insufficient weight gain or inappropriate weight loss in infancy/early childhood.
• Defined using centile spaces on UK WHO growth charts.
• Most often applied to children <2 years of age.

📏 FTT Defined As

• ⬇️ Fall across 1+ centile space if birth weight < 9th percentile.
• ⬇️ Fall across 2+ centile spaces if birth weight 9th–91st percentile.
• ⬇️ Fall across 3+ centile spaces if birth weight > 91st percentile.
• 📉 Current weight < 2nd percentile for age (any birth weight).

🍼 Background

• Weight loss in early days is normal → should regain by 3 weeks.
• Loss >10% of birth weight = dehydration until proven otherwise → assess and treat.
• Failure to regain by 3 weeks → consider referral to paediatrics.

💡 Main Points

• FTT = slow physical development → risk of short stature, behavioural issues, developmental delay.
• Causes: inadequate intake, malabsorption, ↑ metabolic demand, chronic disease.
• Severe cases → neglect or abuse may be contributory.
• Early intervention prevents long-term consequences.

🔍 Causes of Failure to Thrive / Poor Growth

• 🍽️ Nutritional
  • Inadequate intake: poor feeding, neglect, dysphagia, food insecurity
  • Malabsorption: coeliac disease, cystic fibrosis, chronic diarrhoea, food allergy, parasites
  • Increased requirements: CHD, CLD, hyperthyroidism, infection, prematurity
• ⚕️ Organic / Medical
  • GI disorders: GERD, Crohn’s, ulcerative colitis, pyloric stenosis
  • Endocrine: hypothyroidism, GH deficiency, diabetes, adrenal insufficiency
  • Chronic infections: HIV, TB, recurrent UTIs, chronic otitis media, parasites
• 🧠 Psychosocial
  • Neglect/abuse: food withheld, hostile environment
  • Parent–child interaction: maternal depression, poor bonding, misreading feeding cues
• 🧬 Genetic / Developmental
  • Syndromes: Down, Turner, Prader–Willi, metabolic disorders, cleft palate
  • Developmental delays: cerebral palsy, global delay → feeding difficulty

🔍 General Assessment

• 📊 Plot weight/height/head circumference on growth chart.
• 👨‍👩‍👧 Midparental height calculation.
• 🍼 Observe feeding behaviour, intake volume/frequency.
• 📝 Food diary.
• 🏠 Consider psychosocial and environmental context.

🧩 Clinical Signs

• Persistent underweight / poor weight gain.
• Short stature for age.
• 🛌 Irritability, fatigue, lethargy.
• 😐 Lack of social responsiveness.
• 🚶 Delayed motor milestones.
• 📚 Learning and behavioural problems (later).

🧪 Investigations

• FBC, U&E, LFT, urine dipstick (UTI).
• Anti-TTG ± IgA (coeliac screen).
• Directed tests: lead levels, sweat test, endocrine panel depending on suspicion.

💊 Management

• 🍼 Support breastfeeding, formula if needed.
• 🥗 Dietitian input, supplements, high-calorie feeds.
• 👨‍👩‍⚕️ Multidisciplinary approach (paeds, dietetics, social work).
• 🏥 Hospitalise if severe / unsafe / refractory.
• 🚑 NG feeding if severe malnutrition or poor oral intake.
• ⚠️ Safeguarding: consider neglect/abuse if concerns raised.

📚 References

• NICE Guidance: Faltering Growth