Failure to Thrive in child

HISTORY:

Failure to thrive for ‍ ‍hoursdays

Weight: ‍th percentile

Height: ‍th percentile

Head circumference: ‍th percentile

Treatments tried: ‍none, ‍effectiveineffective

‍poor weight gain

‍slow growth

‍delayed development

‍decreased muscle tone

‍fatigue

‍irritability

‍decreased activity

‍decreased appetite

‍feeding difficulties

‍vomiting

‍diarrhea

‍constipation

‍abdominal pain

‍frequent infections



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Measurements: length: ‍ cm - ‍ perc, weight: ‍ kg - ‍ perc, head circ: ‍ cm - ‍ perc

Head: fontanelles ‍soft, ‍normocephalic

Eyes: -R: ‍normal, -L: ‍normal, ‍

Ears: -R: ‍normal, -L: ‍normal

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normalrednessexudate

Mouth: ‍normal

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Genital: ‍normal, testicles ‍normal, penis ‍normal, Tanner stage ‍

Extremities: ‍normal, ‍normal pulses, cap refill ‍< 3 sec> 3 sec, Barlow ‍negative, Ortolani ‍negative

Skin: ‍no rash

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM

Neurologic: cranial nerves ‍overall intact, global motricity ‍normal for age, muscle tone ‍normal for age, gait ‍age-appropriate

Mental status: ‍alert, ‍, reactive to ‍

Developmental milestones: motor: ‍, communication: ‍, social/emotional: ‍, cognitive: ‍, adaptive: ‍



ASSESSMENT:

‍Failure to thrive ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin, ‍TSH, ‍IGF-1, ‍IGFBP-3

- Urine: ‍urinalysis, ‍urine culture

- Stool: ‍fecal fat, ‍fecal elastase

- Bone age X-ray

- Genetic testing

- Sweat test

- Upper GI series

- Upper GI endoscopy

- Dietary counseling

- High-calorie diet

- Multivitamins

- ‍Iron supplement

- ‍Vitamin D supplement

- ‍Appetite stimulants

- ‍Enzyme replacement therapy

- Gluten-free diet

- Lactose-free diet

- Referral to dietitian

- Referral to pediatrician

- Referral to pediatric gastroenterologist

- Referral to pediatric endocrinologist

- Referral to geneticist

- Referral to social worker

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as vomiting, diarrhea, or irritability

- Go to ER if severe abdominal pain, severe vomiting, or fever