A failure to thrive is at a constant weight prior to below the 3rd to 5th percentile for age, with an increasing weight loss below the 3rd to 5th percentile for age or a weight loss of 2 standard deviations within a short time. The cause may be medical or environmental. Both causes lead to inadequate food intake. The goal is to achieve a suitable diet again.
A failure to thrive is at a constant weight prior to below the 3rd to 5th percentile for age, with an increasing weight loss below the 3rd to 5th percentile for age or a weight loss of 2 standard deviations within a short time. The cause may be medical or environmental. Both causes lead to inadequate food intake. The goal is to achieve a suitable diet again. Etiology The physiological basis for failure to thrive of any etiology is insufficient nutrition and is divided into the organic failure to thrive the nonorganic failure to thrive, organic symptoms (GS) The growth disorder is caused by an acute or chronic disorder associated with food intake, absorption, metabolism or excretion interferes or increased energy requirement (s. Some causes of organic GS). Also diseases of an organ system may be the cause. Some causes of organic GS mechanism disorder Decreased nutrient intake cleft lip or palate CNS disorder (eg. As cerebral palsy) Gastroesophageal reflux disease parasites pyloric stenosis rumination malabsorption celiac disease Cystic fibrosis disaccharidase (z. B. lactase deficiency) Inflammatory bowel disease short bowel Restricted metabolism chromosomal abnormality (eg . as down’s syndrome, Turner’s syndrome) fructose Intolera nz galactose-1-phosphate uridyl transferase deficiency Inborn errors of metabolism Elevated excretion diabetes mellitus proteinuria increased energy demand bronchopulmonary dysplasia Cystic fibrosis congestive heart failure hyperthyroidism infection Nonorganic GS Up to 80% of the children with a growth disorder have no obvious organic growth debilitating diseases. In most cases, a growth disorder environmental causes are (z. B. lack of food), social deprivation and neglect. A nutritional deficiency can be caused by: impoverishment ignorance about feeding techniques incorrectly prepared baby food (eg excessive dilution in order to stretch because of financial difficulties.) Insufficient supply of breast milk, for. B. because the mother is under stress, is fed exhausted or bad Nonorganic GS often reflect a complex disturbed interaction between the child and the caregiver resist. In some cases, the psychological impact of the non-organic GS similar to the one Hospitalism – a syndrome that is observed in children who suffer from depression due to a lack of stimulus. The unstimulated child becomes depressed, apathetic, and ultimately anorexic. The stimulation may be lacking because the caregiver is depressed or apathetic no parenting skills has feels inadequate or dissatisfied towards the child defensive or hostile feelings has been influenced by real or perceived external stresses such. B. Requirements of other children in a large or chaotic family, from a failed marriage, from a great human loss or financial difficulties Not all non-organic GS is a bad support the cause. Even the temperament of the child, his abilities and his reactions affect the care and education patterns of the caregiver. Common configurations are found in so-called child-parent mismatches, where the child’s not pathological needs can not be adequately met by the parents. These parents would, however, with another child with other claims or same child no difficulties in circumstances other with the Versorgung.Gemischte GS children with mixed GS, so a mixture of organic and non-organic causes, often difficult environmental conditions or impaired communication with the Parents. In children with mixed GS, the organic can overlap with the non-organic causes. Children with severe malnutrition due to an organic GS and medical illnesses can develop. Diagnosis Frequent weight checks Thorough medical, family and social history to date nutrition laboratory tests children with an organic GS can be noticeable, depending on the underlying disease at any age. In most children with a non-organic GS this will appear before the first year of life, with many even before 6 months. The age should be recommended on weight, height, head circumference and growth standards and growth standard treatments such as those of the WHO and the Centers for Disease Control and Prevention (CDC), checked. (For children aged 0-2 years, s. WHO Growth Charts for children 2 years and older s. CDC Growth Charts). To premature babies have reached the age of 2, they must be classified by gestational age. The weight is the most sensitive parameter for the nutritional status. If the cause of a GS is insufficient caloric intake, the percentile for weight falls before it does the Längenperzentile. Growth disturbances along the percentile curves are caused by severe and long-existing malnutrition. A simultaneous drop in length and percentile for weight indicates a primary disorder of growth. At a protein malnutrition, the brain is usually spared (s. Protein-energy malnutrition (PEU)) so that a slower growth in head circumference occurs later, and shows a very heavy or very long-standing malnutrition. Children who are underweight, may possibly be smaller and shorter than their peers and may be presented with irritability or crying, lethargy or drowsiness and constipation. GS go with physical delays (z. B. belated sitting and learning to walk), delays in social skills (eg. As delayed interaction and learning ability) and, in older children, with delayed puberty associated. Normally, when the lack of weight gain should be noted a medical history is collected (including diet history; Basic Long history for GS) held a nutrition counseling and weight of the child be monitored closely. If a child despite outpatient therapy does not increase enough weight hospitalization is appropriate to enable all necessary observations and diagnostic procedures in a very short time can be performed. If the history and physical examination give no indication of a specific pathophysiological cause of the growth failure, there is no clinical feature, by which an organic could be distinguished from a non-organic GS. Since the non-organic GS is not a diagnosis of exclusion, the treating physician should look the same on the underlying physical causes and to problems in the person himself, the family, the family-child relationship, support the psychosocial etiology of GS. At best, the collection of this data is a joint venture that involves the attending physician, nurses, social workers, dietitians, a specialist in developing neurology and psychiatrist or psychologist. The child’s eating habits have to be observed in the presence of caregivers and parents, whether at home or stationary conditions. Parental involvement in the search for the causes is extremely important. It boosts self-confidence and prevents parents blame is assigned who are frustrated anyway and feel guilty because they are unable to feed their children properly. The family should be asked, as often and as long as we come possible to visit. You should have the feeling of being welcome, and the staff should support their efforts to feed the child, to provide toys and ideas, promote the games and other interactions between parent and child. Comments on parental inadequacy, irresponsibility or other possible causes of the GS should be avoided. However, the adequacy of parental behavior and parental responsibility should be judged. There is a suspicion of neglect or abuse, social workers should be turned on immediately. Sometimes, however, support measures are sufficient to meet the needs of parents for support and information (z. B. food stamps, child care and education of the parents). During hospitalization, careful observation of the interaction of the child with persons should take place in the area and self-stimulatory behavior (swings, hit her head against the wall) are recorded. Some children with non-organic GS were described as being particularly vigilant and contact shy, and they prefer to deal with inanimate objects, if they ever get in touch. Although not organic GS occur more often in neglect than abuse, the child (child abuse s.) Should be carefully examined for signs of abuse. A routine check of the level of development to be carried out in any case, however, if displayed on a detailed investigation should follow. Children in hospital, which increase with the proper feeding techniques and the proper preparation of infant formula and a reasonable caloric intake on weight have, in all likelihood a non-organic GS. Basic Long history for GS post comments growth table measurements, possibly including those at birth should be checked to determine the course of growth. Because of the wide normal variations, a diagnosis of GS should not be based on a single measurement, unless malnutrition is obvious. Previous diet (last 3 days) The diet history should detail record all details, including information about feeding times and the applied techniques of production and feeding of infant formula or breastfeeding technique. As soon as possible, parents should be observed here as they feed the child to assess their technology and the absorbency of the infant. An infant who tired easily during feeding, may have a cardiac underlying disease or lung disease. Enthusiastic burping or fast rockers of the child during feeding can lead to excessive belching or even vomiting. A disinterested parent may be depressed or apathetic, suggesting a psychosocial environment that can be ignored with the child of stimulation and interaction. Assessment of the child’s digestive processes abnormalities in urine or stool and frequent vomiting should initiate studies on underlying disorders such as kidney disease, malabsorption syndrome, pyloric stenosis or gastroesophageal reflux. Drug history and information about the birth of any evidence of intrauterine growth retardation or premature birth with a growth delay that could not be compensated is in the process of interest. Also, delays in development, unusual, long-lasting or chronic infections (eg. As tuberculosis, parasites, HIV), neurological, cardiac, pulmonary or renal disorders, diseases or hospitalization and possible food intolerances should be consulted. Family history to family history includes information about family growth patterns, in particular parents and siblings, known diseases that affect growth (z. B. cystic fibrosis), a recent past or acute physical or psychiatric illness of a parent and the resulting inability to continuous stimulation and to give attention. Social environment The attention is paid to family composition, their socioeconomic status, the desire for pregnancy and acceptance of the child. Here is asked about causes of a particular load such. As job change, relocation, separation, divorce, deaths and other losses. Tests detailed laboratory tests in children with GS are usually useless. When a thorough history and physical examination suggest no particular reason, most experts recommend limited follow-up examinations as differential diagnostic blood erythrocyte sedimentation rate (ESR) urea nitrogen measurement and serum creatinine and electrolytes mirror urinalysis (including the ability to concentrate and acidification) and culture stool examination to pH, reducing substances, odor, color, consistency and fat content depending on increasingly occurring in a specific population group diseases, a serum-lead levels, an HIV test or a Mantoux test should be performed. Other studies may be indicated such. Thyroxine levels when the weight has dropped more relative to the size than the size in proportion to the weight or the size and weight have decreased at the same time (in this case should also be a growth hormone deficiency is suspected) and a sweat test, if recurrent diseases of the upper or lower respiratory tract, in particular saline welding, excessive appetite, malodorous, voluminous chairs, hepatomegaly or cystic fibrosis family history of a history are known. A study on infectious diseases should be reserved for children with signs of infection (eg., Fever, vomiting, cough, diarrhea), but a urine culture can be helpful because in some children missing with GS due to urinary tract other symptoms and signs. Radiologic studies should be performed only in children who obvious anatomical or functional disabilities have (z. B. pyloric stenosis, gastroesophageal reflux). However, if a cause is suspected endocrine and bone age is determined. Forecast The forecast of organic GS depends on the cause. The majority of children with a non-organic GS with an age of> 1 year will reach a stable weight above the 3rd percentile. Children who develop a GS before the first year of life is over, have a high risk of delaying their cognitive abilities, especially in languages ??and mathematics. Children who are diagnosed at an age of <6 months, when the rate of postnatal brain growth is at its maximum, have the highest risk. Disturbance of general behavior, as observed by teachers and psychiatrists, are found in half of the children. related problems that are specific to the eating habits (slow and finicky eating) or the precipitation behavior, occur in a similar number of children, usually in conjunction with other behavioral or personality disorders. Treatment Adequate nutrition treating the underlying disease Long-term social support The goal of treatment is to achieve by adequate medical and Betreungsmaßnahmen a satisfactory growth. As a rule, an additional calorie intake (about 150% of normal caloric intake) is necessary for the catching-size growth also requires individual medical and social assistance. However, the potential for weight gain among inpatient treatment does not always distinguish between children with an organic or non-organic GS, because all children grow when they are adequately nourished. Some children with a non-organic GS even lose hospitalized in weight, which is only an indication of the complexity of the disorder. In children with organic or mixed GS underlying physical cause should be treated as soon as possible. In children with clearly not organically related and in children with mixed GS for treatment including counseling and emotional support in terms of the factors that have led to an error in the parent-child relationship. Since the treatment requires a long-term social support or psychiatric care often, the team at the hospital can often define only the needs of the family, making the first reconnaissance work and support and establish the necessary contacts with the relevant social institutions. However, parents should understand why they are referred to these sites, and they should, if there are choices that have influence on which sites are involved. If the child is treated in a special clinic, you should seek advice from the referring physician in terms of experience with the local bodies and the professional expertise of the existing on-site care facilities. Before discharge should be a conference attended by the hospital staff, representatives of the social institution that takes over the follow-up, and the family doctor of the child as a regular part of the treatment. The areas of responsibility must be clearly defined and determined if possible in writing and distributed to all participants. Parents should be invited to a debriefing this conference to meet the social worker, ask questions and perhaps can even arrange follow-up appointments. In some cases, the placement of the child in foster care or nursing homes may be required. When it is expected that the child eventually returns to the biological parents, they must receive intensive educational and psychological counseling. The progress of the child must be fully documented. The timing of the return to the biological parents should not depend on the period of separation, but should be determined in terms of their care skills to the observed progress of their parents. Summary A GS should be suspected in children with a significant decrease in the percentile values ??in relation to the growth parameters or a persistently low value (for. Example, under the 3rd to the 5th percentile). An organic GS is a medical disorder (z. B. malabsorption, inborn error of metabolism) due. A non-organic GS is due to psychosocial problems (eg. As neglect, poverty). In addition to the thorough documentation of the medical, social and dietary history caregivers should watch the parents or caregiver during feeding of the child. Hospitalization may be necessary to assess the child to observe the child's reaction to adequate feeding and a diet to include team.