December Week 3

1. Pediatrics in Review – Failure to Thrive: Current Clinical Concepts. March 2011
2.American Family Physician – Failure to Thrive. Sept 2003.

Case #1: A mother brings her previously healthy 18 month old child for a WCC. You review the chart in Centricity before entering the room and become concerned after looking at the growth curves. Her weight is now below the 5th percentile (was near the 25th percentile at prior visits), her length is at the 25th percentile, and her head circumference is at the 50th percentile.
1. What is the definition of FTT?
2. Historically, FTT was classified as organic and nonorganic. How is FTT classified now? Give examples of each.
3. What will be important to elicit in the history?
4. If the child’s physical exam is normal and the history suggests inadequate calories, what would be appropriate suggestions to help increase caloric intake? What is the daily caloric requirement for “catch-up growth”?
5. When should she return for follow-up?
6. Why is it important to address and correct this problem as soon as possible?

Case #2: The same child is followed closely by you on an outpatient basis. Despite attempts at dietary intervention, her weight remains less than the 5th percentile. You also notice that her height has started to drop off the curve as well.
1. What would be the next step?
2. What is the most likely benefit of hospitalizing children who have FTT?
3. When discussing this patient in the attending room, someone mentions the possibility of neglect. In general, what signs during physical exam are concerning for neglect/abuse?