Failure to Thrive in child

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of failure to thrive

Weight: ‍th percentile

Height: ‍th percentile

Head circumference: ‍th percentile

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍poor weight gain

‍slow growth

‍delayed development

‍decreased muscle tone

‍fatigue

‍irritability

‍decreased activity

‍decreased appetite

‍feeding difficulties

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍frequent infections



Contributing factors:

‍low socioeconomic status

‍parental neglect

‍parental mental health issues

no history of: ‍failure to thrive, ‍premature birth, ‍low birth weight, ‍chronic diseases, ‍genetic disorders, ‍metabolic disorders





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Metrics: length: ‍ cm - ‍th perc, weight: ‍ kg - ‍th perc, BMI: ‍ - ‍th perc

Head: fontanelles ‍soft, ‍normocephalic

Eyes: conjunctiva/sclera ‍normalinjection, lids/lashes ‍normalerythema, ‍PERRL, extraocular movements ‍intact, red reflex ‍present, corneal light reflex ‍symmetrical, fix and follow test ‍intact

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normal, ‍palate intact, ‍redness

Mouth: mucosa ‍normal, dentition ‍normal

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Genitourinary: external genitalia ‍normal, testes ‍descended, penis ‍normal, Tanner stage ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Skin: ‍rashlesions on ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍grossly intact, overall motricity ‍normal for agelimb weakness, muscle tone ‍normal for age, gait ‍appropriate for age, reflexes ‍intact 2+

Mental status: ‍alert, ‍, reactive to ‍

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





ASSESSMENT:

‍Failure to thrive ‍likelysuspectedpossible

DDx: nonorganic failure to thrive, organic failure to thrive, inadequate caloric intake, malabsorption syndromes, chronic infections, gastroesophageal reflux disease, chronic liver disease, cystic fibrosis, congenital heart disease, metabolic disorders, endocrine disorders, genetic syndromes, immunodeficiency, anemia, intestinal parasites, celiac disease, food allergies/intolerances, neglect or abuse, psychosocial issues, parental misunderstanding of nutritional needs, feeding disorder of infancy





PLAN:

Investigations:

- 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

Treatments:

- Dietary counseling

- High-calorie diet

- Multivitamins

- ‍Iron supplement

- ‍Vitamin D supplement

- ‍Appetite stimulants

- ‍Enzyme replacement therapy

- Gluten-free diet

- Lactose-free diet

Further care:

- 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

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