Endocrinology Book

http://www.fpnotebook.com/

Failure to Thrive Evaluation

Advertisement

  1. See Also
    1. Failure to Thrive
    2. Failure to Thrive Causes
    3. Failure to Thrive Management
  2. Determine Growth Patterns
    1. Expected Weight gain (g/day)
      1. Age 0 to 3 months: 26-31 grams weight gained per day
      2. Age 3 to 9 months: 13-18 grams weight gained per day
      3. Age 9 to 14 months: 10-11 grams weight per day
      4. Age 15 to 24 months: 7-9 grams weight per day
    2. Plot weight, height and Head Circumference
      1. Correct premature infant gestational age (<24 months)
      2. 35% of Small for Gestational Age infants <5% at age 4
  3. Feeding history
    1. Dietary intake
      1. Consider detailed 1-3 day diary of dietary intake
      2. Quality and Quantity of food
      3. Does the child feed themself (e.g. spoon, cup)
      4. Psychosocial events around feeding time
        1. Is the child distracted or not supervised?
        2. Are there food battles or food refusal?
      5. Discuss food preparation (e.g. formula too dilute)
      6. Beverages (e.g. Milk, juice, water, soda)
    2. Stool habits (e.g. frequency and consistency)
    3. Consider dietary or nutrition consultation
    4. Pica history
    5. Nursing or Breast Feeding history
      1. Infequent brief feedings
      2. Maternal ingestion of milk suppressant
        1. Alcohol
        2. Diuretics
      3. Inadequate milk supply
      4. Nipple problems
      5. Inadequate milk let down
      6. Poor suck
      7. Maternal malnutrition
      8. Maternal exhaustion or Major Depression
  4. Social History
    1. Interference with adequate caretaking
    2. Risk factors
      1. Economic stress
      2. Disorganized family
      3. Social isolation
      4. Parental depression
      5. History of parent loss
      6. Overworked parent
      7. Alcohol Abuse or Drug Abuse
      8. Consider physical, psychological or marital problems
  5. Past Medical History
    1. Birth: Gestational age, birth weight, complications
    2. Chronic medical conditions (e.g. Anemia, Asthma)
    3. Acute illness (Otitis Media, Gastroenteritis)
  6. Family History
    1. Short stature
    2. Failure to Thrive in siblings
    3. Mental illness
  7. Observe interaction between parent and child
    1. Feeding and non-feeding times
    2. Decreased, inconsistent, or nonmutual interactions
    3. Maladaptive parent-child feeding interactions
    4. Consider 10-14 day observation in hospital
  8. Assess for developmental delay
    1. Gross Motor function from neuromuscular weakness
    2. Social skills and Expressive Language
      1. Gaze avoidance
      2. Minimal smiling
      3. Non-responsive to people
      4. Inappropriately friendly to strangers
      5. Bizarre behavior
      6. Apathy
      7. Poor hygiene
  9. Physical Examination
    1. See Growth Assessment
    2. Height Measurement in Children
    3. Weight Measurement in Children
    4. Head Circumference
    5. Decrease in skin fold thickness and Subcutaneous fat
      1. Suggests malnutrition
    6. Dysmorphic features
  10. Labs
    1. Normal in 98% of Failure to Thrive
      1. Consider obtaining only if no improvement
      2. Sills (1978) Am J Dis Child 132:967
    2. Initial labs
      1. Urinalysis
      2. Urine Culture
      3. Chemistry panel
      4. Complete Blood Count
    3. Specific Labs if indicated
      1. Stool for fat content, Ova and Parasites
      2. Erythrocyte Sedimentation Rate (ESR)
      3. Serum Calcium
      4. Seum Phosphate
      5. Serum Albumin
      6. Beta Carotene
  11. Radiology
    1. Skeletal XRay of hands and wrist for bone age

Navigation Tree