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Medicine Notes Paediatrics Notes

Failure To Thrive Notes

Updated Failure To Thrive Notes

Paediatrics Notes

Paediatrics

Approximately 40 pages

An overview of the common paediatric conditions - from neonates to developmental delay and all the common childhood-specific illnesses organised by body system. Includes tips on history taking and examination along with investigations and management. Concise yet thorough enough for finals examinations. Colour coded including diagrams...

The following is a more accessible plain text extract of the PDF sample above, taken from our Paediatrics Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Failure to thrive

Concern about growth is usually raised when

  • Weight is below 2nd centile

  • Height is below 2nd centile

  • Or weight/height cross down two centiles

Failure to thrive implies growth failure and also failure of emotional and developmental progress

Weight faltering

  • Always consider psychosocial problems

    • Eating disorders, home issues disturbed attachment

  • Often result of caring parents who create stressful earing environment

Causes of failure to thrive

Classified into organic and non-organic

Organic Non-Organic

Inadequate intake

  • Impaired suck/swallow (CP, cleft palate)

  • Chronic illness leading to anorexia (Crohns, renal failure, CF, liver disease)

Inadequate retention

  • Vomiting, GORD

Malabsorption

  • Coeliac, CF, CMPI, short gut syndrome post NEC

Failure to utilize nutrients

  • Syndromes (T21, IUGR, extreme prematurity, storage disorders)

Increased requirements

  • Thyrotoxicosis, CF, malignancy, chronic infection (immunodeficiency), renal failure, heart disease

Inadequate intake

  • Inadequate availability of food

  • Feeding problems – insufficient breastmilk or poor feeding technique

  • Meal time behavior

  • Low socioeconomic status

Psychosocial deprivation

  • Poor maternal-infant interaction

  • Maternal depression

  • Poor maternal education

Neglect or child abuse

  • Factitious illness, deliberate underfeeding

Need to study the growth chart in combination with a history and examination of the child

History

  • Detailed dietary history

    • A food diary is useful

  • Feeding, including details of exactly what happens during mealtimes

  • Is the child well? Do they have lots of energy?

  • Any other symptoms such as

    • Lethargy, D+V, cough

  • Was the child premature or did they have IUGR or other problems at birth?

  • Growth of family members and any illnesses in the family

  • Child’s development

  • The home situation

Extended history

  • Information about the family from

    • Health visitor

    • GP

    • Any other professionals involved with the family

Examination

Focus is on identifying whether there is any evidence of organic disease

  • Dysmorphic features

  • Distended abdomen, thin buttocks, irritability – coeliac disease

  • Respiratory signs and malabsorption – cystic fibrosis

  • Evidence of chronic illness

Investigations

  • Should be focused after a thorough examination

Investigation Significance of abnormality

FBC

U+E

LFT

TFT

CRP

Ferritin

Immunoglobulins

Anti-gliadin antibodies

Urine dip and MC+S

Stool microscopy and culture

Karyotype in girls

Chest xray and sweat test

Anaemia, infection, inflammation, immune deficiency

Renal failure,...

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