Nonaccidental trauma and failure to thrive.

Charts were reviewed of 140 children who were discharged from Denver General Hospital (DGH) with diagnoses of nonaccidental trauma or failure to thrive. These children were all enrolled in a neighborhood health program. It was found that boys and girls were affected equally and that most of these children were under 3 years of age. In relation to their representation in the Neighborhood Health Program, more white children were abused or failed to thrive than children from other racial groups. A disproportionate number of children had birth weights under 2,500 gm as compared to children born at DGH. Young parents who were raised in disrupted families were involved in child abuse more frequently than were individuals from more stable families. Bruising was the most frequent injury and was most prevalent among boys under 3 years of age. Fractures were the second most common injury and occurred equally among boys and girls. There appeared to be a seasonal variation in the incidence of abuse.     

��ͯ�����ϰ�

??Failure to thrive??FTT?? is a condition commonly seen by primary care pediatrician. Many children with FTT are not identified unless careful attention is paid to plotting growth parameters at routine checkups. It is a signal of undernutrition.But the etiology of FTT is seldom the results of a single causative medical??genetic or socioeconomic factor. There is increasing recognition that in many children the cause is multifactorial and includes biologic??psychosocial??and environmental contributors. The prolonged malnutrition can negatively affect a child’s future growth and cognitive development and behavioral problem and learning difficulties are identified in a significant portion of FTT population. A thorough history and physical examination is the best guide to establishing the etiology of the FTT and directing further evaluation and management.The approach to nutritional rehabilitation in FTT requires individualization. Prompt multidisciplinary interventions are important for preventing malnutrition and developmental sequelae.     

The developmental sequelae of nonorganic failure to thrive

The developmental sequelae of infant failure to thrive (FTT) were examined in an unreferred group of 6-year-olds with a history of severe nonorganic growth retardation, sampled from a 1-year birth cohort in an inner-city area of South London. Children who failed to thrive in infancy (weight below the third centile for at least 3 months) and their pairwise matched comparisons were originally studied at 15 months, and 42 cases and 42 controls (89.5% of the sample) were followed up. At 6 years, previously growth-retarded children were considerably smaller than matched comparisons, in terms of body mass index (BMI), and height and weight for age Z scores. History of FTT explained substantial variance in weight and BMI at 6 years, with maternal height also contributing to variation in height for age. Child cognitive functioning at 6 years was examined using the McCarthy Scales: cases had more limited quantitative and memory skills than comparisons, but there was no intergroup variation in general cognitive performance. In contrast to analyses of physical development, failure to thrive did not account for cognitive functioning; maternal IQ was the sole significant predictor of performance on all indices of child cognitive abilities. At 15 months, earlier growth faltering was linked to limitations in mental development, but these findings were not confirmed by the follow-up data: the timing of FTT was not related to cognitive abilities at 6 years. Results correspond to past research indicating that nonorganic failure to thrive is associated with persistent limitations in physical stature. There was little evidence of cognitive disadvantage for case group children at school age, suggesting that the adverse effects of early malnutrition on cognitive functioning appear to diminish over time.     

Severe failure to thrive in infant

Failure to thrive in an infant has multiple etiologies and at times, is only manifestation of underlying serious disease. Bartter syndrome is a rare disease that manifests as failure to thrive. It can be diagnosed by a careful history, physical examination, and abnormal electrolyte pattern. It can be alleviated by appropriate management, whereas failure to recognize early can be life threatening. A case of severe failure to thrive in an infant due to neonatal form of Bartter syndrome, its manifestations, management, and outcome is presented in this article.     

Behavior in nonorganic failure to thrive

Twenty-one infants with failure to thrive were examined, shortly after hospital admission, for a set of eight noninterpersonal and six interpersonal behaviors identified as possibly being associated with nonorganic failure to thrive. The infants selected for study exhibited some of the target behaviors early in the course of hospitalization, and all were subsequently diagnosed as having nonorganic failure to thrive. The target behaviors include inactivity; irritability; posturing; lack of affect; rumination; excessive thumbsucking; disproportionate use of hands and fingers rather than arms, legs, and trunk; crying when approached; lack of or decreased vocalization; lack of cuddling; poor eye contact; lack of response to a human stimulus; and indifference to separation. Abnormal interpersonal behaviors were more common than abnormal noninterpersonal behaviors. Identification of these target behaviors may be valuable in diagnosing nonorganic failure to thrive, avoiding the necessity for expensive organic evaluations and providing for earlier social assessment and intervention.     

Anthropometric indices of failure to thrive

AIMS—To compare five anthropometric methods of classifying failure to thrive in order to ascertain their relative merits in predicting developmental, dietary, and eating problems.METHODS—The five anthropometric methods were compared in 83 children with failure to thrive.RESULTS—The methods were inconsistent in classification of severity, and no one method was superior in predicting problems.CONCLUSIONS—Weight alone, being the simplest, is still the most reasonable marker for failure to thrive and associated problems.     

A potential danger of bedclothes covering the face

Investigations of infants dying unexpectedly have reported up to 28% being found completely under bedding. No detailed physiological studies looking at the possibilities of asphyxia in this situation are available. The aim was to determine the potential for asphyxia under different types and thicknesses of bedding. A mechanical model of a 3-month-old infant's respiratory system was used. Bedding was positioned over the head in a supine position, and inspired carbon dioxide recorded. With a fixed respiratory rate and tidal volume, carbon dioxide accumulation increased with increasing layers of blankets. Up to 8.3% inspired carbon dioxide was recorded with more than four layers of blankets. A cotton sheet between the face and blankets reduced the accumulation by half. An infant found dead under bedding may have been exposed to an asphyxial stress. Suffocation from rebreathing trapped, expired gases can be a cause of death in this situation.     

Long-term effects of nonorganic failure to thrive

Fourteen children admitted to the hospital at an average age of 12.5 years previously were reviewed in comparison with a group of children matched for age, sex, social class, and ethnic group. The children in the study group were smaller in height and weight, than children in the comparison group. They had lower scores on the verbal intelligence scale of the Wechsler Intelligence Scale for Children--Revised, poorer language development, and less well-developed reading skills. They had lower social maturity and a higher incidence of behavioral disturbances. There were no differences between the study and comparison groups in family size, maternal age, family health, social isolation, and mothers' childhood experiences. The study group mothers had less knowledge about their children's education, were more anxious, and had a tendency toward concrete thinking. To prevent the long-term adverse effects of nonorganic failure to thrive, a more active, practical, and long-term program, begun at the time of presentation, is recommended.     

Recognising failure to thrive in early childhood.

The maximum weight centile achieved by a child between 4 and 8 weeks of age was found to be a better predictor of the centile at 12 months than the birth weight centile. Children whose weight deviated two or more major centiles below this maximum weight centile for a month or more showed significant anthropometric differences during the second year of life from those who showed no such deviation. It is suggested that this leads to a logical and practical definition of failure to thrive.     

Anthropometric indices of failure to thrive.

AIMS: To compare five anthropometric methods of classifying failure to thrive in order to ascertain their relative merits in predicting developmental, dietary, and eating problems. METHODS: The five anthropometric methods were compared in 83 children with failure to thrive. RESULTS: The methods were inconsistent in classification of severity, and no one method was superior in predicting problems. CONCLUSIONS: Weight alone, being the simplest, is still the most reasonable marker for failure to thrive and associated problems.