Definition
-Definition of FTT: Weight below the 5th percentile for sex and corrected age/weight for length below the 5th percentile/ BMI for age below the 5th percentile OR a fall in weight by two major percentiles on a growth curve (AAFP 2016). Other authorities go with 2 percentile as cut off.
Diagnosis
-Will search for causes of undernutrition, including neglect, family food insecurity, and underlying medical conditions, GERD.
-Inadequate caloric intake is the most common cause of FTT but will also keep inadequate nutrient absorption or increased metabolism in the differential.
-If malnutrition continues, it will affect weight, length, and head circumference (development of cognitive skills as well) in that order. Will watch.
Treatment
-Will review nutrition and provide proper nutrition and family support.
-Weekly f/u for weight checks.
-Will consider subspecialist consultation or hospitalization if necessary in the future.
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WHO growth charts are recommended for children up to two years of age. Centers for Disease Control and Prevention growth charts are recommended for patients two to 20 years of age.
“Gastroesophageal reflux accounts for a significant number of cases of failure to thrive, crib death, and recurrent pneumonia. Features of gastroesophageal reflux include a history of recurrent pneumonia, a low growth curve, a family history of sudden infant death syndrome, and normocytic anemia. A sweat chloride level of 20 mEq/L rules out cystic fibrosis. Normal serum calcium excludes DiGeorge’s syndrome. The battered child generally presents with more than just a single recurring medical problem. b-Thalassemia would be indicated by a microcytic anemia.”ABFM
Rudolph CD, Rudolph AM, Lister G, et al (eds): Rudolph’s Pediatrics, ed 22. McGraw-Hill, 2011, pp 1405-1409.
2) Kliegman RM, Stanton BF, Geme JW III, et al (eds): Nelson Textbook of Pediatrics, ed 20. Elsevier Saunders, 2016, pp 1787-1791.
Resources:
http://www.aafp.org/afp/2016/0815/p295.html