8/2/2016

FailuretoThrive(FTT)PediatricsMerckManualsProfessionalEdition

PROFESSIONAL VERSION
MerckManualProfessionalVersion

EssentialsoftheHistoryforFailuretoThrive

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Growth
chart

Measurements,includingthosetakenatbirthifpossible,shouldbeexaminedtodeterminethetrendingrowthrate.Becauseofwidenormal
variations,diagnosisoffailuretothriveshouldnotbebasedonasinglemeasurement,exceptwhenundernutritionisobvious.

Diethistoryshouldbedetailed,includingfeedingscheduleandtechniquesforthepreparationandfeedingofformulaoradequacyofbreast
milksupply.Assoonaspossible,parentsshouldbeobservedfeedingtheinfanttoevaluatetheirtechniqueandtheinfantsvigorofsucking.
Diethistory
Aninfantwhotireseasilyduringfeedingmayhaveunderlyingcardiacorpulmonarydisease.Enthusiasticburpingorrapidrockingofthe
(3days)
infantduringfeedingmayresultinexcessiveregurgitationorevenvomiting.Adisinterestedparentmaybedepressedorapathetic,
suggestingapsychosocialenvironmentthatislackingstimulationforandinteractionwiththeinfant.
Assessment
ofthe
Abnormalitiesofurineorstoolandfrequentemesisshouldtriggeraninvestigationtodetectunderlyingrenaldisease,malabsorption
childs
syndrome,pyloricstenosis,orgastroesophagealreflux.
elimination
pattern
Medical
Ofconcernisanyevidenceofintrauterinegrowthrestrictionorprematuritywithgrowthdelaythathasnotbeencompensated
historyand
developmentaldelayunusual,prolonged,orchronicinfections(eg,TB,parasitic,HIV)neurologic,cardiac,pulmonary,orrenaldisease
birth
illnessorhospitalizationandpossiblefoodintolerance.
history

Family
history

Includedisinformationaboutfamilialgrowthpatterns,especiallyinparentsandsiblingstheoccurrenceofdiseasesknowntoaffectgrowth
(eg,cysticfibrosis)andaparentsrecentphysicalorpsychiatricillnessresultingininabilitytoprovideconsistentstimulationand
nurturance.

Social
history

Attentionisfocusedonfamilycomposition,socioeconomicstatus,desireforpregnancywithandacceptanceofthechild,andstresses(eg,
jobchanges,familymoves,separation,divorce,deaths,otherlosses).
2016 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA

http://www.merckmanuals.com/professional/pediatrics/miscellaneousdisordersininfantsandchildren/failuretothriveftt

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