Failure To Thrive Research Articles

Improving Care of Children Admitted to the Hospital With Failure to Thrive (FTT) (QI Abstract)

While FTT in children is ideally managed in the outpatient setting, continued failed weight gain may necessitate hospital admission. While this cohort was admitted to our institution for FTT, prior to our intervention only 75% of children had weights recorded at least daily. Aim Statement Our primary goal was to record daily weights for 100% of children throughout admission within one year of implementation. Our secondary aims included decreasing length of stay (LOS), improving malnutrition diagnosis, and establishing an outpatient provider prior to discharge. Interventions Following the IHI Model for Improvement, we established a multidisciplinary team of physicians, nutritionists, nurses, and members of our child advocacy team who unanimously agreed on our primary aim and established measurable secondary aims important to an FTT admission. We created resident, nursing, and family-based bundles for improvement. Thus far, we have implemented the resident bundle, including standardized orders, an admission questionnaire, and a discharge checklist. Measures Through a RedCap survey, we record data on every child admitted for FTT including, but not limited to, length of stay, successful collection of daily weights, final diagnosis, identification of an outpatient provider, and documentation of conversation with outpatient provider prior to discharge. We retroactively collected the same data on all FTT admissions for one year prior to resident bundle roll-out as a baseline.

Multicystic dysplastic kidney and related epidemiologic factors

Introduction: Multicystic dysplastic kidney (MCDK) is a sporadic developmental abnormality caused by abnormal differentiation of the metanephric that is present as a flank mass in infancy. It may lead to renal dysfunction or death as a result of oligohydramnios or respiratory failure. Objectives: This research had aimed to find a probable related link between the MCDK and epidemiologic factors. Patients and Methods: A total of 120 children were evaluated in this case-control research. The case and control groups included 60 children with MCDK and 60 children without MCDK, respectively. Examinations, interviews and questionnaires carried out by the project and diagnosis by a physician. We analyzed our results data using chi-square and student t test as appropriate. Results: The result of this study did not show significant relationship between epidemiological factors such as age, place of residence for families, sex, family education/occupation/ income, body mass index (BMI), stunted growth, slow growth, good growth, milk intake, water intake, failure to thrive (FTT) and MCDK. Conclusion: This study showed that epidemiological factors do not have a significant effect on the occurrence of MCDK disease.

Factors Affecting Malnutrition and Failure to Thrive in Children Under 2 Years of Age in Shahroud, Iran, in 2015

Background: Malnutrition and failure to thrive (FTT) is a delay or a halt in children’s growth, which leads to serious compilations if it is left untreated. Malnutrition due to its prevalence is the most important nutritional disease in developing countries and has the most prevalence among infants and preschool children. This study aimed at rating and determining the effective factors of malnutrition incidence and growth delay among 0 to 24 months children. Methods: To identify children under 2 years of age, we referred to health centers and health stations in the city of Shahroud (Northeast of Iran) in 2015. Using cluster sampling, 706 children were surveyed. Anthropometric indices with international reference standards were compared. The values obtained for less than 2 standard deviations as stunting, underweight, wasting, and FTT were defined. All statistical analyses were performed using SPSS software with significance level set at 0.05. Results: The results indicated the existence of malnutrition in the region. Based on the findings, the percentage of underweight, wasting, stunting and ratio of head circumference with age was determined to be 1.7%, 5.4%, 9.5%, and 8.6%, respectively; and considering the category of growth disorder, Type 1, 2, and 3 were, respectively, 1.7%, 5.2% and 3.1%. Factors affecting malnutrition included age, birth weight, birth spacing, and the mother’s BMI at child birth. Conclusions: Tracking the status of children with growth disorder and malnutrition, offering appropriate interventions, considering the nutrition status of mothers during pregnancy, and providing appropriate nutritional counseling are of prime importance to attend to this problem.

Joubert Syndrome: A Rare Case Report From Saudi Arabia

Joubert syndrome (JS) is a rare genetic disorder. We report a 15-month-old girl who presented with developmental delay, decrease vision, failure to thrive and history of two hospital admissions with respiratory distress and recurrent aspiration pneumonia due to gastroesophageal reflux disease. On examination, she had facial dysmorphism, nystagmus, retinopathy and hypotonia. Brain magnetic resonance imaging revealed cerebellar vermis hypoplasia, abnormally thick superior cerebellar peduncles, a “batwing” configuration of the fourth ventricle, and the characteristic molar tooth sign of mid-brain suggestive of JS. Patient was referred to the genetic department outside our hospital where the diagnosis of JS was confirmed. In conclusion, awareness of the characteristic clinical and radiological findings in JS will help in early diagnosis, appropriate counseling and proper rehabilitation. J Med Cases. 2017;8(6):180-182 doi: https://doi.org/10.14740/jmc2832w

GDF15 is a heart‐derived hormone that regulates body growth

The endocrine system is crucial for maintaining whole‐body homeostasis. Little is known regarding endocrine hormones secreted by the heart other than atrial/brain natriuretic peptides discovered over 30 years ago. Here, we identify growth differentiation factor 15 (GDF15) as a heart‐derived hormone that regulates body growth. We show that pediatric heart disease induces GDF15 synthesis and secretion by cardiomyocytes. Circulating GDF15 in turn acts on the liver to inhibit growth hormone (GH) signaling and body growth. We demonstrate that blocking cardiomyocyte production of GDF15 normalizes circulating GDF15 level and restores liver GH signaling, establishing GDF15 as a bona fide heart‐derived hormone that regulates pediatric body growth. Importantly, plasma GDF15 is further increased in children with concomitant heart disease and failure to thrive (FTT). Together these studies reveal a new endocrine mechanism by which the heart coordinates cardiac function and body growth. Our results also provide a potential mechanism for the well‐established clinical observation that children with heart diseases often develop FTT.

Failure to Thrive in Infants and Toddlers

Failure to thrive (FTT) is a broad term that is used to document an abnormal pattern of weight gain over time. There is no single definition for FTT, but all proposed definitions use anthropometric parameters such as weight gain or weight for length. The term FTT has been falling out of favor, and the term weight/growth faltering is becoming more common to describe this clinical entity. The underlying problem in FTT is inadequate usable calories. The primary mechanisms leading to FTT are impaired absorption, increased metabolic demands, and inadequate caloric intake. Inadequate caloric intake is the most common of these mechanisms, although FTT is often a combination of the three. The diagnostic evaluation of FTT must take into account the multifactorial nature of this clinical sign. A comprehensive history is essential for diagnosis and should include specific questions about the child’s living situation and feeding habits. The physical examination must include accurate weight and length measurements. Clinicians should look for signs of abuse or neglect, dysmorphic features, abnormal skin or nail findings, digital clubbing, or other signs of chronic disease. Laboratory investigations are rarely revealing in FTT but should be considered if there is a high index of suspicion for underlying disease. Treatment in FTT favors a multidisciplinary approach. The primary goal of treatment is restoration of normal growth velocity. Children with FTT are at increased risk for growth and cognitive problems in later childhood, although the clinical significance of these findings is not well understood. The mainstay of treatment is increasing calories in the diet. Enteral feeding, orally or via a tube, is always preferred over parenteral feeding due to a better safety profile, ease of feeding, and lower cost. Parenteral nutrition is an acceptable way to meet caloric needs in infants and children when enteral nutrition is not possible. Children with FTT and malnutrition should be monitored closely for refeeding syndrome, which results from fluid and electrolyte shifts in malnourished children. In general, FTT can be treated on an outpatient basis with close follow-up. Indications for hospitalization include severe malnutrition/dehydration and concern for child endangerment. Key words: enteral feeding, failure to thrive, growth charts, nutrition, parenteral nutrition, poor weight gain, tube feeding, weight loss

Chiari Malformation Type 1 as Cause of Recurrent Pneumonia with Failure to Thrive

Diagnosing the cause of recurrent pneumonia with failure to thrive (FTT) can be difficult. A nine months age presented with recurrent pneumonia and failure to thrive. Investigation for the same led to the diagnosis of Chiari 1 malformation. Screening for latent neurological disorders should be done in such patients.J Nepal Paediatr Soc 2016;36(3):288-290

The Prevalence of Celiac Disease in Children with Unexplained Failure to Thrive in South West of Iran

Background Celiac disease (CD), considered as a common chronic and genetic diseases that caused by hypersensitivity to gluten. Failure to thrive (FTT), is one of three major clinical features of CD during childhood. The current study aimed to determine the prevalence of celiac disease in children with unexplained FTT in South West of Iran. Materials and Methods This cross‑sectional study was conducted on 433 children 9-month to 6 years old that diagnosed as unexplained FTT referred to Abuzar Children's Hospital, Ahvaz, South West of Iran, in 2014. In this study, we examined the serum levels of anti-transglutaminase antibody (anti-tTG) in children with unexplained FTT. Data were analyzed using SPSS version 16.0 software. Results The results showed that the prevalence of CD in children with unexplained FTT in was 8.8%. The mean scores of children's anti-tTG serum levels in both gender and age groups, showed no significant difference (P> 0.05). Conclusion At current study, the prevalence of CD in children with FTT was 8.8%. Since the CD is an important cause of unexplained FTT in children, the early screening and diagnosis and dietary management can be decrease the risk for long-term complications in these children.

Hospitalization for Failure to Thrive: A Prospective Descriptive Report.

Failure to thrive (FTT) is a common symptom leading to hospitalization of children. Most literature describing this population is from 30 years ago. Since that time the hospitalized population has become more medically complex. We aimed to describe children hospitalized for FTT in a tertiary care pediatric hospital. We prospectively collected demographic, anthropometric, evaluation, and outcome data for 92 consecutive children admitted with FTT. The majority of children grew with behavioral interventions alone (primary nonorganic FTT) and had negative evaluation (n = 63). Children with primary organic FTT had longer hospital stays (7 vs 4 days; P < .001) and lower daily weight gain (35 vs 58 g/d; P < .001). Laboratory, radiological, and endoscopic evaluation rarely led to a diagnostic etiology of FTT in hospitalized children. We conclude that children hospitalized with FTT should be observed for weight gain prior to pursuing diagnostic investigation.

Failure to Thrive: Crohn’s Disease Presenting as Avoidant/Restrictive Food Intake Disorder (ARFID) in a Young Child

Failure to thrive (FTT) is a state of insufficient nutritional intake that limits growth and development in children. FTT can be a diagnostic challenge for pediatricians. In the United States, FTT is prevalent in 5 to 10 percent of children in primary care settings.1 With a broad differential diagnosis causing FTT, including both organic and inorganic causes,2 pediatricians can have difficulty diagnosing and treating children with mixed etiologies. This report highlights how delays in obtaining the correct diagnoses and performing appropriate interventions can have significant consequences, including malnutrition, developmental delay, and psychosocial sequelae in a child. In this case, a child with FTT was initially diagnosed and treated for an inorganic cause, anorexia nervosa (AN), with an additional etiology of Crohn’s disease not recognized until several years of unsuccessful treatment for the AN. This report highlights the fact that behavioral and psychological components, including a fear of eating and refusal to try a variety of foods, may be consistent with a presentation of Crohn’s disease. It also emphasizes the need to continually re-evaluate diagnoses in young children, particularly when they are not responding to prescribed interventions.

Helicobacter pylori infection is not associated with failure to thrive: a case control study.

PurposeThe long-term impact of Helicobacter pylori infection is complex, and concerns about the need for eradication exist. We conducted this case control study to investigate the association between H. pylori infection and failure to thrive (FTT).Patients and methodsFrom January 2009 to December 2011, 53 children with FTT group and matched children with the same sex and age and similar socioeconomic status without FTT (control group) were enrolled. A questionnaire was administered to the parents/guardian, and a 13C-urea breath test was performed to detect H. pylori infection.ResultsWe found that the total prevalence of H. pylori infection was 29.2% and that there was no association between FTT and H. pylori infection (FTT group: 32%; control group: 26.4%; P=0.67). Short stature was more common in the FTT group and abdominal pain in the control group (FTT group: 37.7%; control group: 11.3%; P=0.003). In a comparison between the H. pylori-positive and -negative groups, abdominal pain (87.1% vs 64%; P=0.032) and the frequency of endoscopy (74.2% vs 32%; P<0.001) were significantly more common in the H. pylori-positive group.ConclusionWe found that children with H. pylori infection are at an increased risk for abdominal pain and that FTT is not associated with H. pylori infection. The decision for eradication should be evaluated carefully and individualized.

Hypophosphatemia Dependent Rickets with Failure to Thrive (FTT) in a 4- Years Old Child: a Case Report

BackgroundRickets is a disorder due to impaired metabolism of bone mineralization which caused by low concentrations of extra-cellular calcium or phosphate. In children, hypophosphatemic rickets (HR) happen malabsorption of phosphate and increasing of renal tubular loss.Case Presentation We present the case of a 4-year-old girl who had medical history of HR with failure to thrive (FTT). Child hospitalized several times due to osteomalacia and leg fractures. In physical examinations, there were obvious signs of rickets such as bow legs and hands, deviations of the wrist and chest pigeon. The results of blood tests showed low level of Phosphorus; but the level of calcium was normal. Radiography showed deformity of wrists and hands. ConclusionHR should be considered as one of the childhood disorders which impairs metabolism of bone mineralization and cause osteomalacia and bones fractures. If HR undiagnosed and remedies poor during childhood, in older ages would reveal automatic fractures and mineralization defects.

Failure to Thrive: Bad Nutrition as a Double-Edged Sword - A Case Report

Introduction: Failure to thrive (FT) is a condition often seen by General Practitioners, characterized by a weight below the 5th percentile repeatedly or a weight deceleration crossing 2 major percentile lines. The majority of FT is due to inadequate caloric intake, mostly caused by behavioural/social issues. The diagnosis is clinical and demands thorough investigation of feeding habits and exclusion of other organic causes. Differential diagnosis includes prenatal or chronic illness, infections or digestive disorders, which should be investigated and sought on physical examination and additional testing.Case description: 3 year old girl with FT and microcephaly. History of social problems that caused visits from Social Services. Support from Nutrition Department was provided. The physical examination was consistently normal and other symptoms were denied, without improvement on the weight. The initial investigation was normal, but, on a secondary level, sweat testing showed high Chloride (66 mEq/L) levels.Discussion: The prognosis of FT depends on its severity, duration and subjacent cause. In this case, the biggest suspicion is malnourishment due to social problems. The positive chloride value often diagnoses Cystic Fibrosis, but it can also be a false positive caused by anorexia/bad nutrition. Malnourishment is a double-edged sword because of its ability to mask chronic illness, meaning either a cause or a result of it.Conclusion: Identifying the problem underneath remains challenging due to our lack of control or knowledge of the real eating habits of our patients. A multidisciplinary approach is mandatory, as the effects of FT on cognitive development are unclear.

Effects of zinc supplementation on catch-up growth in children with failure to thrive.

BACKGROUND/OBJECTIVESAlthough globally the numbers of children diagnosed with failure to thrive (FTT) have decreased, FTT is still a serious pediatric problem. We aimed to investigate the effects of zinc supplementation for 6 months on growth parameters of infants and children with FTT.SUBJECTS/METHODSIn this retrospective study, of the 114 participants aged between 4 months and 6 years, 89 were included in the zinc supplementation group and were provided with nutrition counseling plus an oral zinc supplement for 6 months. The caregivers of the 25 participants in the control group received nutrition counseling alone. Medical data of these children, including sex, age, height, weight, serum zinc level, and serum insulin-like growth factor 1 (IGF1) level were analyzed.RESULTSZinc supplementation for 6 months increased weight-for-age Z-score and serum zinc levels (5.5%) in the zinc supplementation group of underweight category children. As for stunting category, height-for-age Z-score of the participants in the zinc supplementation group increased when compared with the baseline, and serum zinc levels increased in the normal or mild stunting group. Serum IGF1 levels did not change significantly in any group. Thus, zinc supplementation was more effective in children in the underweight category than those in the stunted category; this effect differed according to the degree of the FTT.CONCLUSIONThese findings suggest that zinc supplementation may have beneficial effects for growth of infants and children with FTT, and zinc supplementation would be required according to degree of FTT.

Prevalence of Failure to Thrive in Iranian Children with Chronic Kidney Disease

Introduction: Malnutrition and inflammation are considered risk factors of morbidity, hospitalization, and mortality in chronic kidney disease (CKD) children. The aim of this study was to determine the prevalence and severity of failure to thrive (FTT) in children with moderate to severe CKD. Materials and Methods : This cross-sectional study was conducted in 84 children with CKD (30 female, 54 males) aged 2-16 years old from June 2014 to June 2015.The inclusion criteria were eGFR less than 90 ml/min/1.73m 2 , being healthy in the month before the visit, and lack other chronic diseases except CKD. Anthropometric data including the body mass index, height, weight, and mid upper arm circumference were collected. Protein wasting energy was scored and the severity of failure to thrive was estimated using Gomez and Jelliffe classifications. P-values less than 0.05 were considered significant Results: Glomerulopathy and hereditary tubulopathy were the main causes of underlying disease. About 79% of CKD children had FTT and the rate increased with a decline in the renal function (p-value 0.05). A quarter of the patients with FTT were classified as no PWE and vice versa. Conclusion: The majority of the children with moderate to severe chronic kidney disease had failure to thrive and protein wasting energy. There was no correlation between inflammatory markers and the severity of CKD or the presence of failure to thrive. Keywords : Failure to Thrive; Renal Insufficiency; Chronic; Child.

Nutritional rehabilitation for children with congenital heart disease with left to right shunt.

El-Koofy N, Mahmoud AM, Fattaouh AM. Nutritional rehabilitation for children with congenital heart disease with left to right shunt. Turk J Pediatr 2017; 59: 442-451. Children with congenital heart disease (CHD) are prone to malnutrition. We aimed to assess the nutritional status of infants with CHD and evaluate the role of nutritional counseling. A cohort study included 50 patients with acyanotic CHD causing increased pulmonary blood flow consecutively enrolled from the cardiology clinic in Cairo University Children Hospital. The patients were subjected to clinical evaluation, nutritional assessment with detailed nutritional history, anthropometric measurements and subjective global assessment (SGA) score and complete blood count, serum albumin and total protein assessment. Degree of failure to thrive (FTT) was assessed and nutritional counselling was offered to those patients; followed up for 3 months then re-evaluated. The mean age was (8.6±4.8 months) with male: female ratio 1:1. The overall prevalence of malnutrition was 62%. Fourteen patients had mild FTT and 17 patients had severe FTT [47.1% with mild heart failure (HF) and 47.1% had moderate or severe HF]. All patients with moderate to severe HF had severe FTT and 80% of those with mild HF had severe FTT. Anemia was present in 96% of the patients. Patients with moderate or severe FTT had more severe degree of HF (p < 0.001), more complications (p < 0.001), more frequent hospital admission (p < 0.001) and less optimum breast feeding (p < 0.001). It was found that 76.5% of those with moderate to severe FTT were formula fed (p 0.002) and significantly lower rate of optimum weaning among (p 0.037). There was significant improvement in the anthropometry, the SGA and degree of FTT, level of albumin with decrease in the percent of anemia among the included patients after nutritional rehabilitation. Malnutrition represents serious problem to children with CHD. Nutritional assessment and proper counseling help to improve the nutritional status of those patients.

Failure to thrive: как расшифровать, что делать?

Failure to thrive: как расшифровать, что делать?

Clinical and laboratory study of infants and children with Bartter syndrome attending Alexandria University Children’s Hospital (10 years experience)

Background Bartter syndrome (BS) is a group of inherited, salt-losing tubulopathies presenting as metabolic alkalosis with normotensive hyperreninemia and hyperaldosteronism. It is a consequence of abnormal function of the kidneys, which become unable to properly regulate the volume and composition of body fluids because of defective reabsorption of NaCl in loop of Henle. A first consequence of the tubular defect in BS is polyuria, which is responsible for particular complications of pregnancy − that is, polyhydramnios and premature delivery. Low potassium levels in the blood may result from overactivity of the renin–angiotensin II–aldosterone hormone system that is essential in controlling blood pressure. To date, at least five genes have been linked to BS, and they characterize five types of BS. Aim The aim of this work is to study the clinical and laboratory data of infants and children with BS attending Alexandria University Children’s Hospital during a 10-year period (January 2004–December 2013). Participants and methods A retrospective analysis of children diagnosed with BS attending Alexandria University Children’s Hospital during a 10-year period (January 2004–December 2013) was carried out. On the basis of the clinical, biochemical features, and ultrasonographic findings, 20 children were diagnosed with BS. Their demographic, clinical, biochemical, and hormonal profiles were analyzed. Follow-up data and outcomes were recorded. Results The majority of cases had perinatal history of polyhydraminos. All cases had high urinary chloride in spot urine analysis. The mainstay of treatment in BS is potassium supplementation and indomethacin. Correction of hypokalemia and hyperprostaglandinemia are mandatory for improving the symptoms (vomiting, polyuria) and chronic sequalae such as FTT and growth retardation. Conclusions According to this study, BS should be suspected in any child with a history of failure to thrive and metabolic alkalosis. Early diagnosis and treatment with NSAIDs are life-saving.

Comparison of clinical aspects and Mantoux test in tuberculosis versus non-tuberculosis superficial lymphadenitis

Objective To investigate the clinical aspects and result of Man-toux test in superficial lymphadenitis caused by Mycobacteriumtuberculosis (MTB) compared to that caused by non-MTB organ-isms.Methods This was a cross sectional study conducted on 86 pa-tients aged between 3 months and 14 year-old with enlargementof the superficial lymph nodes, 43 with tuberculosis superficial lym-phadenitis (TSL) and 43 with non-tuberculosis superficial lymphad-enitis (NTSL). The diagnoses of TSL and NTSL were confirmed byhistopathological examination. Clinical symptoms and Mantoux testwere examined in this study.Results In the TSL group, most children (70%) were in the age of&gt;5-14 year-old, while in the NTSL, most (46%) were 1-5 years old.The most frequent chief complaint in the TSL group was fever(37%), while in the NTSL group, cough (49%) (p=0.004). Failure tothrive and loss of appetite were more frequently found in the TSL(70% and 35%) compared to the NTSL group (0 and 3%) (p=0.004).Most enlarged nodes in TSL were multiple (67%), while in NTSL,solitary (72%) (p&lt;0.001). There were no differences in the locationand distribution of enlarged nodes between the two groups. Thirty-one (72%) children in the TSL group had positive Mantoux test,while in the NTSL group were only 2(5%) (p&lt;0.001).Conclusions Most children with TSL had fever as the chief com-plaint while those with NTSL had cough. Children with TSL hadfailure to thrive, loss of appetite, multiple nodes, and positive Man-toux test more frequently compared to NTSL ones

Is Constipation More Common in Overweight Children?

Introduction: Obesity rates have doubled in children and quadrupled in adolescents in the past 30 years. The most important causes of obesity are sedentary life style and low fiber, high calorie diet which are also putative causes of constipation. Some studies have found a correlation between constipation and obesity while others have been inconclusive. In an effort to understand this relationship we undertook a study to assess if overweight children have a higher risk of constipation as compared to normal weight children. Methods: A retrospective review of charts of new patients seen at Pediatric GI Clinic between 1/1/11 and 12/31/12 was performed. All charts were reviewed with an emphasis on growth curves and final diagnoses. Growth status of each patient was assessed by using standard WHO charts for weight, height, and body mass index (BMI) for age and sex. Obesity was defined as a BMI above 95th percentile, overweight between 85-95th percentile, normal between 3rd-85th percentile and failure to thrive (FTT) below 3rd percentile. For statistical analysis, overweight and obese patients were combined into one single group (overweight). The final diagnosis of constipation was made by the attending Pediatric Gastroenterologist. The incidences of constipation in the overweight and FTT were compared to that in normal children using chi-squared analysis. Results: Out of 1876 (M:F, 941:935) new patients seen during study period, 295 patients were overweight (M:F 146:149, 225 obese), 211 FTT and 1370 normal weight (other GI complaints/diagnoses). Observed and expected incidence of constipation in these groups is reported in Table 1. The data was analyzed by chi-squared analysis for significance of incidence of constipation in three individual categories: obese, normal, and failure to thrive (FTT). There was a higher incidence of constipation in overweight patients than expected (a chi-square value of 25. 137 and a p-value < 0.05, CI 95%). Furthermore, the data showed that the incidence of constipation was lower than expected in FTT (a chi-square value of 15.2 and a p-value < 0.05, CI 95%).Table 1: The Observed vs Expected Total Number of Constipated and Non-Constipated PatientsConclusion: There is a higher incidence of constipation in overweight children. Children with FTT have lower incidence of constipation. An analysis of nutrition and exercise habits amongst patients with constipation, obesity, overweight, and failure to thrive could further reveal associations between constipation and BMI.