on 06-Mar-2020 (Fri)

1. GROWTH
   1. Failure to Thrive: cross 2 %-tiles, wt <3%-tile, <80% ideal body wt

• A 14yo ♂ with 1y Hx of FTT. He is pale and has diffuse abdominal pain. What are possible causes? What are 5 tests you would do to narrow your differential?

• DDx: non-organic, celiac, IBD, CF, T1DM, haematologic, malignancy, liver disease, obstructive uropathy
• Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca²⁺, Vit ADE

• 14yo at 3^rd %ile weight + 10^th %ile height is not eating well. What are 3 possible causes?

• See above

• A full term baby presents with an eating disorder (i.e. FTT). What is your DDx?

• ↓intake: non-organic, GERD, structural, CNS, genetic
• ↓absorption: CF, CMPA, short gut, biliary atresia, GI
• ↑loss: gastroenteritis
• ↑demand: cardiac, ↑THY, infection, respiratory
• Ineffective use: inborn error of metabolism
  2. Obesity

• 14yo ♂ with weight of 67 kg, height 150cm.

• Calculate BMI: 29.8 kg/m²
• 4 complications of obesity: HTN, dyslipidemia, OSA, SCFE, nonEtOH fatty liver
• 3 tests to perform for obesity: lipids, GLUC, HbA1c, ALT/AST, liver U/S

Newborn Growth Parameters
Weight
• At birth = 3.0‐3.5kg (avg)
• Normal to lose up to 10% of birth weight in first 4‐7 days
o BUT should return to birth weight no later than 10‐14 days
• Doubles birth weight by 4‐6 months; triples birth weight by 1 year
• Quadruples birth weight by 2 years
Head Circumference
• At birth = 35cm (avg)
o <32cm 􀃆 small head = small brain until proven otherwise
• May be inaccurate at birth due to caput succedaneum, molding
• 0‐3mths = +2cm/mth
• 3‐6mths =+1cm/mth
• 6‐12mths = +0.5cm/mth
Height
• At birth = 50cm (avg)
• Doubles height by 4 years
• Measure recumbent length until 2 years, then standing height

Normal Growth Velocity


Growth Charts
• Critical to use gender and age appropriate growth charts
• In 2010, the CPS, RCFPC and the Dieticians of Canada, recommended
the use of the 2006 WHO Growth Standards and Reference charts
• WHO Growth Standards based on longitudinal data from solely breast
fed for first six months, healthy children from diverse ethnic and
geographic backgrounds; use BMI after age 10.
• Growth charts are also available for premature infants and certain
syndromes
• Use corrected age up to 2 years for plotting premature infants

Failure to Thrive
Definition
• Weight < 3%ile (the further below the curve the more likely to be
pathologic in origin)
• Weight falls across major %ile lines
• Weight < 80% of ideal body weight*
* use appropriate growth charts for gender and certain genetic conditions
Factors Affecting Physical Growth
• Genetics
• Intrauterine factors
• "Internal time clock"
• Nutrition
• Endocrine hormones
• Chronic infections/diseases
• Psychosocial factors
Etiology
• Inadequate intake: insufficient provision of food, vomiting, oro‐motor
dysfunction
• Inadequate absorption: pancreatic insufficiency, celiac disease
• Increased utilization: chronic diseases, hyperthyroidism
• Ineffective utilization: chromosomal disorders
• Increased losses: chronic diarrhea, urinary losses
Differential Diagnosis
Nonorganic/
Psychosocial
Most common cause of FTT, often seen in conjunction with organic FTT
Specific ...