Doctorese babble -- Failure To Thrive

FTT

   1.     Definition

a.     Crossing two percentile lines vertically or horizontally – 5^th and 95^th are 2 STDs

b.     Weight drops first, then height follows – if HC drops  pathological

c.     Also if Consistently below 3^rd percentile or 80^th percentile on weight vs. height

d.     Premies should be age-corrected up to two years

   2.     Causes

a.     Achondroplasia

b.     Trisomy 21

c.     GH deficiency

                                               i.     Williams’

                                             ii.     Turner’s

                                            iii.      

d.     Nutrition

                                               i.     1 oz = 30mL

                                             ii.     Should be getting 100ml/kg/day

                                            iii.     4 kg = 400mL/8 = 50mL = 1.5 oz q8hr

                                            iv.     Normal 60-80 kcal/day – Enfamil = 20kcal/oz

                                             v.     Premies/FTT/SGA/Withdrawal/Heart defects /Fast metabolism/ short bowel/ malabsorption all require increased energy needs -- 24 kcal/oz – can sometimes result in diarrhea -- discharge with Enfacare = 22kcal/oz

   3.     Inorganic

a.     Non-pathological – zero nutrition

b.     Observe a feeding

c.     15/min breast

d.     MCC of non-accidental abuse -- neglect

   4.     Organic

a.     Decreased food

                                               i.     TEF

                                             ii.     Pyloric stenosis

                                            iii.     Cleft palate/lip – special nipple

                                            iv.     Pierre Robin’s Sydrome

                                             v.     Oral-motor dysfunctions

b.     Increased metabolism

                                               i.     CHD

                                             ii.     Malabsorption syndrome

1.     Celic

2.     CF

                                            iii.     Short-bowel

                                            iv.     Small L-colon

                                             v.     Lactose intolerance

1.     Soy milk

2.     Galactosemia -- increased bilirubin

                                            vi.     Milk protein allergy – Neosure and Neoko? – rash/hives/diarrhea/melena

                                          vii.     Milk protein intolerance – only bloating and discomfort

c.     Increased excretion

d.     blaj

   5.     Infection

a.     IUGR – ToRCH -- symmetrical SGA

b.     Candida

c.     HIV ***

d.     Any other infection

   6.     Metabolic conditions

a.     Anion gap metabolic acidosis

b.     Neurological symptoms 

   7.     Neurological disorder

   8.     Lead toxicity – testing at 9 months

a.     Anemia

b.     Basophilic stippling

c.     Constipation

d.     Dust is MC source

e.     Screaming is capillary stick

   9.     Hg poisoning à fish 

   10.  Renal tubule acidosis

a.     Distil tubule

b.     Proximal tubule -- lost water and proteins – do UA  

   11.  ARPKD

   12.  Renal agensis

   13.  Reflux à hydronephrosis -- especially boys

   14.  Endocrine

a.     Hypothyroidism

                                               i.     Macrogloassia impedes swallowing

                                             ii.     Impacts metabolism

b.     Hypothalamus

   15.  Evaluation

a.     Watch a feeding

b.     Newborn screen

c.     Growth chart

d.     CMP/BMP – CBC (Infection) – glucose

e.     UA

f.      Pb

g.     HIV

h.     ToRCH titers

i.      Pre-ablumin – good indicator of feeding

   16.  Treatment

a.     Normal food à catch-up 100-120 kcal/kg -- 120ml/kg replacement – replace slowly

                                               i.     Refeeding syndrome – decreases PO4

                                             ii.     < 6 mo à increase 10-20g/day weight – weigh without diapers on the same scale at the same time