Failure to Thrive
You are seeing a 1 year old boy in your office for a well child examination. This is your first time seeing this child, and on quick perusal of his medical records, you note that he has overall been healthy. However, you note that since his 6 month visit, his rate of growth has dropped. At his 6 month visit, he had been along the 50th percentile for weight (as he had been all along up until that point), but he is now just below the 10th percentile. His length and head circumference remain along the 50th percentile. The child is the youngest of six, and the mother states that meal times are often chaotic, and she’s not always sure how much the child has eaten at each meal.
1) How would you define failure to thrive? What are some of the different definitions? Should all children who shift to a lower growth percentile be diagnosed with failure to thrive?
2) In this case, the child’s weight has been affected but the length and head circumference have not been. What might a symmetric decrease in weight and height suggest? What might short stature but a normal weight suggest? What are important things to look for on physical exam when assessing a child for possible failure to thrive?
3) What are some of the possible sequelae of failure to thrive?
4) What are the three general underlying mechanisms of FTT, and what are some examples of each? What information is important to obtain during your visit to help elucidate the underlying mechanism in this (or any child’s) case?
5) What are some of the other resources/specialists that you could use to help in your evaluation and treatment of a child with failure to thrive?
6) When might hospitalization for failure to thrive be indicated? What are possible complications of aggressive nutritional intervention (i.e., use of nasogastric tube feeding)?
After lengthy discussion with this mommy, you have her go home and keep a three day food diary, and you also instruct her to closely observe the child’s eating patterns and behaviors. She returns and tells you that, to her dismay, she discovered that the older children have been eating off of the youngest child’s plate, and as a result, the infant had not been consuming nearly the amount of calories she had intended.
1) What are some important things to assess and make note of when observing the parent and child during a feeding session?
2) How often should you have this child follow up in your office?
3) How many calories per day should this child be consuming? What are some recommendations you can give this mommy to increase his caloric intake? What should she avoid giving him?
Case by Dr. Shera Schreiber