FTT

Hx :
• Personal data : name , age .
• CC (not gaining proper WT)
• HPI :
- Onset, course, duration
- Current WT , previous WT
• Prenatal hx :
- Age of mother , gravida para
- Any pregnancy complication : infection , bleeding
- Maternal malnutrition , smoking , depression
• Neonatal hx :
- GA , birth WT ,SVD or SC , NICU admission .
- Apgar score and ventilation
- Growth parameters : length , WT , HC
- Congenital anomalies or feeding problems , jaundice , sepsis
Postnatal hx :
• Vaccination hx
• Developmental hx
• Nutritional hx :
- detailed feeding hx from infancy through this period
milk :
- breast feeding or formula feeding
- when he was started on formula, how the mother prepare it .
- formula type, amount, number of feeding q how many hours
solids :
- age of weaning
- use of baby food and table food
- beverage consumption : juice , soda
- composition of food , healthy or not
- how many meals per day , snack
- family routine mealtime, daycare routine
- any special restriction in food
- any difficulty in feeding, sucking , chewing , swallowing

• ROS:
- Constitutional : Fever , loss of Wt &appetite , night sweat
- GIT : appetite ,chocking , dysphagia, vomiting , abdominal pain , gases , abdominal
distention , diarrhea or constipation, stool character :appearance , color associated
blood mucus or fat , volume , frequency , perianal irritation .
 - Resp :Breathing abnormalities , snoring , apnea , recurrent respiratory infection , ear
discharge.
- Neurological abnormalities , night blindness , ataxia , convulsion ,
- Skin infection , skin rash , pallor , bruising

• Past medical hx: previous hospital admission, recurrent respiratory, bacterial or viral infection, ,
exposure to TB GERD , UTI , congenital heart disease .
• Past surgical hx: bowel resection
• Medication hx
• Allergy and BT hx: allergy to milk or certain food , atopy or asthma
• Social hx:
- Family structure, no of siblings
- Financial status
- living environment
- Family stressors
- Smoking and substance abuse
- Education level of parents
- Parent-child relationship

• Family hx :
- familial growth pattern : FTT in siblings
- hx of : celiac disease , IBD , CF , TB , HIV , chronic diarrhea , endocrine problems.
- Parental malnourishment
- hx of psychiatric disorder

• ICEE: idea (nutrition and feeding , dietary beliefs , cultural and religious , basic food and nutrition
need , safe preparation of food, concern , expectation , effect

Examination :
Vitals
growth parmeters : HT , WT , HC
Wt for age and sex below 5th percentile = FTT

Head to toe :
Mental status, Distress, pain
Dysmorphism
Mouth : palate deformities , dental caries , thrush
Ear : ear infection
Neck :thyroid exam
CVS : murmer
Chest : infection
Abdomen : distention , hepatomegaly , mases
Genitalia
CNS : fontanelle , wasting , power and reflex , gait
Extremities: edema
Skin and hair : rash skin changes , bruising , hair color and texture
*Assessment for signs of possible child abuse

Investigation :
initial
- CBC
- urea and electrolytes
- LFTs
- Thyroid function
- Test for celiac antibodies (anti tissue transglutaminase and IGA )
- Urinalysis
Additional as per hx and exam :
- HIV
- Food allergy tests
- ESR , CRP
- Sweat test for cystic fibrosis
- Zinc level
- Metabolic and endocrinology screening
- TB testing
- Stool studies (for reducing substance , odor , color , consistency and fat content)
- Skeletal survey for occult trauma
- Head CT or MRI if micro or macrocephaly
- Bone age study of wrists if constitutionally short stature

Management :

- Explain findings to the parents

- Counselling and educate the parents about the causes of the problem and the
importance of nutrition , breasts feeding
- Identify the underlying cause and correct it (observe feeding )
- Goal is “catch-up” weight gain ,High-calorie diet for catch-up growth ,Calculate
the target ideal WT , catch up caloric requirement ,
- Advice about healthy food 3 meals , 3 snacks (no snacks between meals ), offer
solids before liquids in mealtime to avoid early satiety , limit fruit juices and
carbonated drink , avoid junky food , use high calorie rich nutrient food , keep
mealtime routine ,allow one hour without food or drink to stimulate appetite ,
consider fortifying calories with extra oils and carbohydrates , increase protein
intake , consider vitamins and mineral supplements .
- Referral to: health educator , dietitian , General pediatrics , dentist , social
worker if needed
- Family support financially and socially
- Schedule a follow up to monitor the pt and monitor growth velocity
- Admit pt in cases e.g. if severely malnourished , if suspected child abuse , if
failed outpatient management , if there is serious underlying condition .
Done by Bashaer Jahlan , FM R2