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Morning Report

Morning Report. March 10, 2011. Failure to Thrive. Final Common Pathway Medical Psychosocial Environmental Interaction between Environment Health Development Behavior . Failure to Thrive. Definition

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Morning Report

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  1. Morning Report March 10, 2011

  2. Failure to Thrive • Final Common Pathway • Medical • Psychosocial • Environmental • Interaction between • Environment • Health • Development • Behavior

  3. Failure to Thrive • Definition • Failing to grow at a rate consistent with expected standard for infants and toddlers younger than 3 years of age • Wasting • Decreased weight for height • Signals acute malnutrition • Decreased subcutatneous fat • Stunting • Decreased height for age • Sign of chronic undernutrition

  4. Failure to Thrive • Organic • Medical disorder interfering with growth • Malabsorptive disorders • Genetic syndromes • Endocrine disorders • Neurologic dysfunction

  5. Failure to Thrive • Nonorganic • Diagnosis of exclusion • Environmental conditions • Specific examples • Oromotor dyspraxia • Sensory-motor disorder • Feeding disorder of infancy • Family relationship problem • Child neglect • Mental disorder of parent • Multifactorial • Combination of multiple factors

  6. Failure to Thrive • Prevalence • Low weight for age • 4.1% • Low weight for height • 2.5% • Risks • Poverty • Food insecurity • Larger family size • History of child abuse

  7. Failure to Thrive • Pathogenesis • Loss of calories through malabsorption • Increased caloric expenditure • Hyperthyroidism, CHD, chronic pulmonary disease • Inadequate intake of calories • Most common

  8. Failure to Thrive • Presentation • Family is concerned that their child is not growing as well as other children of the same age • Family reports that the child is feeding poorly • Physician notices on PE or growth charts

  9. Failure to Thrive • Evaluation • Complete History • Including complete review of systems • Nutritional history • Feeding behavior history • Documentation of parent-child patterns • FH • SH • History of height and weight trajectories of parents and siblings

  10. Failure to Thrive • Growth chart • Most important • Growth velocity • Physical exam • Neurodevelopmental status

  11. Failure to Thrive • Lab tests • Few tests are recommended • Based on positive findings from history and physical exam • Non-response to dietary therapy • Routine • Iron deficiency • Lead poisoning • TB • Chronic UTI

  12. Failure to Thrive • Address nonmedical problems • Mental health disorders • Child maltreatment • Feeding disorders • Positive reinforcement and pediatrician support are key • Address medical problems • Severe issues • Intense therapy • G-tube feedings

  13. Failure to Thrive • Prognosis • Most show improvement with dietary intervention • Some will show improvement without intervention as development progresses • “Picky eaters” in childhood • Some may have anxiety disorders or autistic spectrum disorders • Cognitive and school outcomes are worse • May be influenced by other environmental factors as well

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