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Franceschi R, Rizzardi C, Maines E, Liguori A, Soffiati M, Tornese G. Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting. Ital J Pediatr 2021; 47:62. [PMID: 33691756 PMCID: PMC7945305 DOI: 10.1186/s13052-021-01017-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background Failure to thrive is a common reason for referral to paediatric services. Malnutrition or inadequate caloric intake is the most common cause, while organic form is unlikely in children who are asymptomatic and healthy on examination. By this study we evaluate the application of a cost-effective flow chart that helps the clinician in a hospital setting discern accurately organic and non-organic failure to thrive. Methods Conduct a prospective single-center study in children up to 2 years of age with growth faltering. The pediatricians used a practical flow chart, took the medical history, created a growth chart, performed clinical examinations, and requested blood test and consultations in a step by step approach. Results Among the 74 subjects included in the study, the diagnosis of organic failure to thrive was reached by 42%. Gastrointestinal and genetic diagnoses were the most frequent. Patients with organic failure to thrive had significantly lower gestational age and birth weight. Age at diagnosis and Z-score weight were lower in organic than in non-organic forms. Most patients with non-organic forms (88%) did not undergo in-depth blood test or specialist advice. Conclusion The flow chart we presented was accurate for diagnosing children with failure to thrive in a hospital setting and distinct organic and non-organic forms. It was cost-effective to avoid unnecessary blood test or consultations in most non-organic diagnoses.
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Affiliation(s)
- Roberto Franceschi
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Caterina Rizzardi
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Alice Liguori
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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2
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Naumenko DJ, Dykes J, O'Connor GK, Stanley Z, Affara N, Doel AM, Drammeh S, Dunger DB, Faal A, Ong KK, Sosseh F, Prentice AM, Moore SE, Bernstein RM. A Novel method for the identification and quantification of weight faltering. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175:282-291. [PMID: 33386624 PMCID: PMC8247282 DOI: 10.1002/ajpa.24217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/16/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022]
Abstract
Objective We describe a new method for identifying and quantifying the magnitude and rate of short‐term weight faltering episodes, and assess how (a) these episodes relate to broader growth outcomes, and (b) different data collection intervals influence the quantification of weight faltering. Materials and methods We apply this method to longitudinal growth data collected every other day across the first year of life in Gambian infants (n = 124, males = 65, females = 59). Weight faltering episodes are identified from velocity peaks and troughs. Rate of weight loss and regain, maximum weight loss, and duration of each episode were calculated. We systematically reduced our dataset to mimic various potential measurement intervals, to assess how these intervals affect the ability to derive information about short‐term weight faltering episodes. We fit linear models to test whether metrics associated with growth faltering were associated with growth outcomes at 1 year, and generalized additive mixed models to determine whether different collection intervals influence episode identification and metrics. Results Three hundred weight faltering episodes from 119 individuals were identified. The number and magnitude of episodes negatively impacted growth outcomes at 1 year. As data collection interval increases, weight faltering episodes are missed and the duration of episodes is overestimated, resulting in the rate of weight loss and regain being underestimated. Conclusions This method identifies and quantifies short‐term weight faltering episodes, that are in turn negatively associated with growth outcomes. This approach offers a tool for investigators interested in understanding how short‐term weight faltering relates to longer‐term outcomes.
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Affiliation(s)
- Daniel J Naumenko
- Growth and Development Lab, Department of Anthropology, University of Colorado Boulder, Boulder, Colorado, USA.,Health and Society Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - James Dykes
- Health and Society Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - G Kesler O'Connor
- Department of Applied Mathematics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Zofia Stanley
- Department of Applied Mathematics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Nabeel Affara
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Andrew M Doel
- Department of Women and Children's Health, King's College London, London, UK
| | - Saikou Drammeh
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - David B Dunger
- Department of Paediatrics, University of Cambridge School of Clinical Medicine, Cambridge, UK.,Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Abdoulie Faal
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge School of Clinical Medicine, Cambridge, UK.,MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Fatou Sosseh
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, UK.,MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Robin M Bernstein
- Growth and Development Lab, Department of Anthropology, University of Colorado Boulder, Boulder, Colorado, USA.,Health and Society Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, USA
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Riolina A, Hartini S, Suparyati S. Dental and oral health problems in elementary school children: A scoping review. PEDIATRIC DENTAL JOURNAL 2020. [DOI: 10.1016/j.pdj.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Hubbard GP, Fry C, Sorensen K, Casewell C, Collins L, Cunjamalay A, Simpson M, Wall A, Van Wyk E, Ward M, Hallowes S, Duggan H, Robison J, Gane H, Pope L, Clark J, Stratton RJ. Energy-dense, low-volume paediatric oral nutritional supplements improve total nutrient intake and increase growth in paediatric patients requiring nutritional support: results of a randomised controlled pilot trial. Eur J Pediatr 2020; 179:1421-1430. [PMID: 32170451 PMCID: PMC7413916 DOI: 10.1007/s00431-020-03620-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
Children with or at risk of faltering growth require nutritional support and are often prescribed oral nutritional supplements (ONS). This randomised controlled trial investigated the effects of energy-dense paediatric ONS (2.4 kcal/ml, 125 ml: cONS) versus 1.5 kcal/ml, 200 ml ONS (sONS) in community-based paediatric patients requiring oral nutritional support. Fifty-one patients (mean age 5.8 years (SD 3)) with faltering growth and/or requiring ONS to meet their nutritional requirements were randomised to cONS (n = 27) or sONS (n = 24) for 28 days. Nutrient intake, growth, ONS compliance and acceptability, appetite and gastro-intestinal tolerance were assessed. Use of the cONS resulted in significantly greater mean total daily energy (+ 531 kcal/day), protein (+ 10.1 g/day) and key micronutrient intakes compared with the sONS group at day 28 and over time, due to high ONS compliance (81% of patients ≥ 75%), maintained intake from diet alone and improved appetite in the cONS group, compared with the sONS group. Although growth increased in both intervention groups, results were significant in the cONS group (weight (p = 0.007), height (p < 0.001) and height z-score (p = 0.006)).Conclusions: This study shows that use of energy-dense (2.4 kcal/ml) low-volume paediatric-specific ONS leads to improved nutrient intakes, growth and appetite in paediatric patients requiring oral nutrition support compared with standard energy density ONS.Trial registration: The trial is registered at clinicaltrials.gov , identification number NCT02419599. What is Known: • Faltering growth is the failure of children to achieve adequate growth at a normal rate for their age and requires nutritional support, including the use of oral nutritional supplements (ONS). • Energy-dense, low-volume ONS have benefits over standard ONS in adults. What is New: • This is the first RCT to investigate the effects of energy-dense, low-volume ONS (2.4 kcal/ml, 125 ml) in children with faltering growth, showing significant improvements in total nutrient intake and increased growth. • Energy-dense, low-volume ONS can play a key role in the management of faltering growth.
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Affiliation(s)
| | | | | | - Catherine Casewell
- Department of Nutrition and Dietetics, Ashford and St Peter’s Hospitals NHS Foundation Trust, Chertsey, UK
| | - Lydia Collins
- Department of Nutrition and Dietetics, Cumbria Partnership NHS Foundation Trust, Whitehaven, UK
| | - Annaruby Cunjamalay
- Department of Nutrition and Dietetics, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - Michelle Simpson
- Department of Nutrition and Dietetics, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - Amanda Wall
- Department of Nutrition and Dietetics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Elmarie Van Wyk
- Department of Nutrition and Dietetics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Matthew Ward
- Department of Nutrition and Dietetics, Cwm Taf University Health Board, Prince Charles Hospital, Merthyr Tydfil, UK
| | - Sophie Hallowes
- Department of Nutrition and Dietetics, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Hannah Duggan
- Department of Nutrition and Dietetics, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Jennifer Robison
- Department of Nutrition and Dietetics, Lewisham and Greenwich NHS Trust, London, UK
| | - Helen Gane
- Department of Nutrition and Dietetics, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Lucy Pope
- Department of Nutrition and Dietetics, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Jennifer Clark
- Department of Nutrition and Dietetics, Airedale NHS Foundation Trust, Keighley, UK
| | - Rebecca J. Stratton
- Nutricia Ltd, Medical Affairs, Trowbridge, UK ,Faculty of Medicine, University of Southampton, Southampton, UK
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5
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Hackman JV, Hruschka DJ. Disentangling basal and accrued height‐for‐age for cross‐population comparisons. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 171:481-495. [DOI: 10.1002/ajpa.23990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/28/2019] [Accepted: 12/13/2019] [Indexed: 11/07/2022]
Affiliation(s)
| | - Daniel J. Hruschka
- School of Human Evolution and Social Change Arizona State University Tempe Arizona
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6
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Selbuz S, Kırsaçlıoğlu CT, Kuloğlu Z, Yılmaz M, Penezoğlu N, Sayıcı U, Altuntaş C, Kansu A. Diagnostic Workup and Micronutrient Deficiencies in Children With Failure to Thrive Without Underlying Diseases. Nutr Clin Pract 2019; 34:581-588. [PMID: 30644589 DOI: 10.1002/ncp.10229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES AND STUDY Failure to thrive (FTT) is an interruption in the normal pattern of growth. We aimed to evaluate the clinical characteristics, underlying etiologies, diagnostic workup, and frequency of micronutrient deficiencies (MDs) in children with FTT. METHODS This retrospective study was done with 729 children (319 male, mean age 6.8 ± 5.5 years) with FTT (weight for age <3rd percentile) who had visited the Pediatric Gastroenterology outpatient clinic between 2011 and 2016. Children who had previously known chronic diseases, inadequate intake, or inadequate absorption were excluded. Acute malnutrition was considered if weight-for-age z-scores were below -2 and height-for-age z-scores were above -2, and chronic malnutrition was defined if height-for-age z-scores were below -2. RESULTS The malnutrition rate was 57.1% (acute: 37.8%, chronic: 19.3%). Of children, 98.7% had laboratory evaluation. We found that 1.1% of laboratory tests, 0.4% of imaging studies, 27% of endoscopic findings, and biopsy results led to a specific diagnosis, equating to a total of 1.3% of diagnostic workup leading to a diagnosis related to FTT. The causes of FTT were inadequate nutrition (61.4%), psychiatric and behavioral disorders (17.2%), endocrinologic disorders (9%), recurrent infections (6.4%), gastrointestinal diseases (1.9%), and cardiac disorders (0.1%). Vitamin A and D deficiencies were the most common MD. CONCLUSION We showed that the most common cause of FTT is "purely nutrition" FFT because of inadequate caloric intake, and extensive diagnostic workup is rarely helpful to reveal the etiology. These results implicate the importance of clinical evaluation and anthropometry to evaluate a child with FTT.
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Affiliation(s)
- Suna Selbuz
- Ankara University, Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara, Turkey
| | | | - Zarife Kuloğlu
- Ankara University, Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara, Turkey
| | - Mustafa Yılmaz
- Ankara University, Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara, Turkey
| | - Nilay Penezoğlu
- Ankara University, Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara, Turkey
| | - Ufuk Sayıcı
- Ankara University, Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara, Turkey
| | - Cansu Altuntaş
- Ankara University, Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara, Turkey
| | - Aydan Kansu
- Ankara University, Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara, Turkey
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Abstract
Traditionally, nutritional risk has been defined by growth failure, with clinical intervention indicated when a child falls below the third to fifth percentile on growth charts. Although the velocity of linear growth and weight gain during the first years are unparalleled at any other time of life, this period is also unique for other reasons. Nutrition not only supports increased bone length, muscle mass, and tissue growth, but also continued development of several highly metabolic organs such as the gastrointestinal tract, the immune system, the cardiorespiratory system, the kidneys, and the central nervous system. Just as growth depends on consistent nutrients, so too does organ development, especially the brain. The undernourished child may exhibit compromised optimal development and future cognitive performance, irrespective of weight status. It is often challenging in early childhood to ensure that a child is receiving high-quality nutrition. Primary care clinicians are positioned to identify the child with potential nutritional risk and design an appropriate intervention that promotes optimal development. [Pediatr Ann. 2018;47(11):e465-e469.].
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8
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Mosli RH. Evaluation of growth chart use among clinicians in Saudi Arabia: Is there a need for change? Int J Pediatr Adolesc Med 2018; 5:55-59. [PMID: 30805534 PMCID: PMC6363271 DOI: 10.1016/j.ijpam.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/13/2018] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To identify types of growth charts and practices employed by clinicians to assess pediatric patients in Saudi Arabia; To assess clinicians' interpretation and comprehension of growth charts. METHODS This is a Cross-sectional study including 105 pediatricians and dietitians residing in Saudi Arabia. Participants completed an online questionnaire which assessed: region of residence, work facility, typical practices in pediatric patient assessment, and ability to correctly interpret and comprehend growth chart data. Data were analyzed using descriptive and chi-square statistics. RESULTS Majority of respondents (70.5%) reported typically using either the CDC or WHO growth charts. Only 52.4% reported always using growth charts and discussing weight status of pediatric patients during annual/regular visits, and 54.3% reported discussing the patient's weight status with his/her caregiver(s) under all circumstances. Only 23.8% correctly answered the interpretation question, while 50.5% correctly answered the comprehension question. A higher percentage of clinicians residing in the Southern, Central, and Western regions reported that they always or often discuss the patient's weight status with his/her caregiver(s) (100%, 89.2% and 81.4%, respectively) (P value = 0.004). Clinicians who worked in private hospitals only, and who typically used the Saudi growth charts were least likely to report that they always or often discuss the patient's weight status with his/her caregiver(s) (50% and 61.5%, respectively) (All Ps < .05). CONCLUSION Growth chart utilization among clinicians in Saudi Arabia needs further evaluation. Clinicians residing in the Northern and Eastern regions, who worked in private hospitals only, and who typically used the Saudi growth charts showed poorer practices with regards to growth chart utilization.
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9
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Smith C, McCabe H, Macdonald S, Morrison L, Prigg R, Trace S, Livingstone J, Callan J, Cotton J, Hubbard G, Stratton RJ. Improved growth, tolerance and intake with an extensively hydrolysed peptide feed in infants with complex disease. Clin Nutr 2018; 37:1005-1012. [DOI: 10.1016/j.clnu.2017.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 12/30/2022]
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10
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Esteller E, Villatoro JC, Agüero A, Lopez R, Matiñó E, Argemi J, Girabent-Farrés M. Obstructive sleep apnea syndrome and growth failure. Int J Pediatr Otorhinolaryngol 2018; 108:214-218. [PMID: 29605357 DOI: 10.1016/j.ijporl.2018.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from tonsillectomy and adenoidectomy to recover and normalize their growth rate.
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Affiliation(s)
- E Esteller
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain; Medicine Department, Universitat Internacional de Catalunya, Spain.
| | - J C Villatoro
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain
| | - A Agüero
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain
| | - R Lopez
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain
| | - E Matiñó
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain; Medicine Department, Universitat Internacional de Catalunya, Spain
| | - J Argemi
- Universitat Internacional de Catalunya, Spain
| | - M Girabent-Farrés
- Physical Therapy Department (Biostatistics Unit), Universitat Internacional de Catalunya, Spain
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Valla FV, Berthiller J, Gaillard-Le-Roux B, Ford-Chessel C, Ginhoux T, Rooze S, Cour-Andlauer F, Meyer R, Javouhey E. Faltering growth in the critically ill child: prevalence, risk factors, and impaired outcome. Eur J Pediatr 2018; 177:345-353. [PMID: 29243190 DOI: 10.1007/s00431-017-3062-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/01/2017] [Accepted: 11/29/2017] [Indexed: 12/26/2022]
Abstract
UNLABELLED Low body mass index (BMI) z score is commonly used to define undernutrition, but faltering growth allows for a complementary dynamic assessment of nutritional status. We studied the prevalence of undernutrition and faltering growth at admission in the pediatric intensive care (PICU) setting and their impacts on outcome. All (685) consecutive children (aged 0 to 18 years old) admitted in a single-center PICU over a 1-year period were prospectively enrolled. Nutritional status assessment was based on anthropometric measurements performed at admission and collected from medical files. Undernutrition was considered when z score BMI for age was < - 2SD. Faltering growth was considered when the weight for age curve presented a deceleration of > - 1 z score in the previous 3 months. Undernutrition was diagnosed in 13% of children enrolled, and faltering growth in 13.7% mostly in children with a normal BMI. Faltering growth was significantly associated with a history of underlying chronic disease, and independently with extended length of PICU stay in a multivariate analysis. CONCLUSION Assessment of nutritional status in critically ill children should include both undernutrition and faltering growth. This study highlights that faltering growth is independently associated with suboptimal outcome in PICU. What is Known: • Malnutrition, defined according to BMI-for-age z score, is correlated with poor outcome in the critically ill child. • In this setting, nutritional assessment should consist not only of a static assessment based on BMI-for-age z score but also of a dynamic assessment to identify recent faltering growth. What is New: • Critically ill children frequently present with faltering growth at admission. • Faltering growth is a newly identified independent associated factor of suboptimal outcome in this setting (extended length of stay).
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Affiliation(s)
- Frédéric V Valla
- Paediatric Intensive Care Unit, Hôpital Universitaire Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69677, Lyon-Bron, France.
| | - Julien Berthiller
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, Hospices Civils de Lyon, 69677, Bron, France
| | - Bénédicte Gaillard-Le-Roux
- Paediatric Intensive Care Unit, Réanimation Pédiatrique, Hôpital Mère enfants, CHU de Nantes, 38 Boulevard Jean Monnet, 44093, Nantes cedex, France
| | - Carole Ford-Chessel
- Service diététique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69677, Lyon-Bron, France
| | - Tiphanie Ginhoux
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, Hospices Civils de Lyon, 69677, Bron, France
| | - Shancy Rooze
- Paediatric Intensive Care Unit, Hôpital Universitaire des enfants Reine Fabiola, Avenue JJ Crocq 15, 1020, Brussels-Laeken, Belgium
| | - Fleur Cour-Andlauer
- Paediatric Intensive Care Unit, Hôpital Universitaire Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69677, Lyon-Bron, France
| | - Rosan Meyer
- Department Paediatrics, Imperial College London, St. Mary's Campus, London, W2 1NY, UK
| | - Etienne Javouhey
- Paediatric Intensive Care Unit, Hôpital Universitaire Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69677, Lyon-Bron, France
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12
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Park SG, Choi HN, Yang HR, Yim JE. Effects of zinc supplementation on catch-up growth in children with failure to thrive. Nutr Res Pract 2017; 11:487-491. [PMID: 29209459 PMCID: PMC5712499 DOI: 10.4162/nrp.2017.11.6.487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/13/2017] [Accepted: 09/28/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES Although globally the numbers of children diagnosed with failure to thrive (FTT) have decreased, FTT is still a serious pediatric problem. We aimed to investigate the effects of zinc supplementation for 6 months on growth parameters of infants and children with FTT. SUBJECTS/METHODS In this retrospective study, of the 114 participants aged between 4 months and 6 years, 89 were included in the zinc supplementation group and were provided with nutrition counseling plus an oral zinc supplement for 6 months. The caregivers of the 25 participants in the control group received nutrition counseling alone. Medical data of these children, including sex, age, height, weight, serum zinc level, and serum insulin-like growth factor 1 (IGF1) level were analyzed. RESULTS Zinc supplementation for 6 months increased weight-for-age Z-score and serum zinc levels (5.5%) in the zinc supplementation group of underweight category children. As for stunting category, height-for-age Z-score of the participants in the zinc supplementation group increased when compared with the baseline, and serum zinc levels increased in the normal or mild stunting group. Serum IGF1 levels did not change significantly in any group. Thus, zinc supplementation was more effective in children in the underweight category than those in the stunted category; this effect differed according to the degree of the FTT. CONCLUSION These findings suggest that zinc supplementation may have beneficial effects for growth of infants and children with FTT, and zinc supplementation would be required according to degree of FTT.
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Affiliation(s)
- Seul-Gi Park
- Department of Food and Nutrition, Changwon National University, 20 Changwondaehak-ro, Uichang-gu, Changwon, Gyeongnam 51140, Korea
| | - Ha-Neul Choi
- Department of Food and Nutrition, Changwon National University, 20 Changwondaehak-ro, Uichang-gu, Changwon, Gyeongnam 51140, Korea
| | - Hye-Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi 13620, Korea
| | - Jung-Eun Yim
- Department of Food and Nutrition, Changwon National University, 20 Changwondaehak-ro, Uichang-gu, Changwon, Gyeongnam 51140, Korea
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13
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Factors Affecting Malnutrition and Failure to Thrive in Children Under 2 Years of Age in Shahroud, Iran, in 2015. HEALTH SCOPE 2017. [DOI: 10.5812/jhealthscope.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Infant Mandibular Distraction for Upper Airway Obstruction: A Clinical Audit. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e812. [PMID: 27536491 PMCID: PMC4977140 DOI: 10.1097/gox.0000000000000822] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/20/2016] [Indexed: 11/26/2022]
Abstract
Background: Mandibular distraction osteogenesis (MDO) is an effective method of treating upper airway obstruction (UAO) in micrognathic infants. The short-term outcomes include relief of UAO, avoidance of tracheostomy, and prompt discharge from hospital. However, it is a significant surgical procedure with potential associated morbidities. This study describes a cohort of infants managed using MDO over a twelve-year period. Methods: A retrospective chart review was undertaken for children who had MDO before the age of 5 years between 2000 and 2012. This was followed by a clinical review of the same cohort specifically looking for dental anomalies, nerve injuries, and scar cosmesis. Results: Seventy-three children underwent MDO at a mean age of 2 months [interquartile range (IQR), 1.7–4.2] for nonsyndromic infants and 3.3 months (IQR, 2.1–7.4) for those with syndromes. Infants were discharged from hospital, on average, 15 days after procedure. After MDO, of the 9 who were previously tracheostomy dependent, 5 (56%) were decannulated within 12 months and none of the nontracheostomy-dependent children required further airway assistance. The majority of children required supplemental feeding preoperatively but, 12 months postoperatively, 97% of the nonsyndromic infants fed orally. Thirty-nine children (53%) were reviewed clinically [median age, 5.1 y (IQR, 3.9–6.5)] with 18 being syndromic. Many of the mandibular first permanent and second primary molars had developmental defects, but there was a low rate of neurosensory deficit and good scar cosmesis. Conclusions: This study contributes further to the evidence base underpinning the management of micrognathic infants with UAO.
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Skoblo GV, Trushkina SV. [Mental health disorders in the first years of life: disorders mostly related with psychogenic factors]. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [PMID: 28635739 DOI: 10.17116/jnevro2016116121130-136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the literature review the authors present current data on the clinical features, prevalence and general approaches to treatment and prevention of mental disorders related with environmental factors in early childhood. A quite new class of the disorders, which are specific for early childhood: attachment disorders, clinical specifics of posttraumatic stress disorder, clinical manifestations of sleep disorders and feeding disorders is considered. It is emphasized that disturbed parent-child relations can be one of the predictors of early mental disorders in children. The modern models of psychotherapy for children of early age are presented.
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Affiliation(s)
- G V Skoblo
- Mental Health Research Center, Moscow, Russia
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Xue Y, Lee E, Ning K, Zheng Y, Ma D, Gao H, Yang B, Bai Y, Wang P, Zhang Y. Prevalence of picky eating behaviour in Chinese school-age children and associations with anthropometric parameters and intelligence quotient. A cross-sectional study. Appetite 2015; 91:248-55. [PMID: 25934087 DOI: 10.1016/j.appet.2015.04.065] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/15/2015] [Accepted: 04/22/2015] [Indexed: 01/24/2023]
Abstract
Previous studies have demonstrated the importance of eating behaviour regarding dietary variety and nutrient intake of children. However, the association between picky eating and growth of children is still a topic of debate. This study sought to estimate the prevalence of picky eating and to identify possible associations with the growth of school-age children in China. In this survey, 793 healthy children aged 7-12 years were recruited from nine cities and rural areas in China using a multi-stage cluster sampling method. Data collected included socio-demographic information and parents' perceptions of picky eating using a structured questionnaire, nutrient intake using 24-hour dietary recall, weight and height using body measurements, and intelligence using the Wechsler Intelligence Scale for Children. Blood samples were collected and analysed for minerals. The prevalence of picky eating reported by parents was 59.3% in children. Compared with non-picky eaters, picky eaters had a lower dietary intake of energy, protein, carbohydrates, most vitamins and minerals, and lower levels of magnesium, iron, and copper in the blood (p < 0.05), and also had a 0.184 z-score lower in height for age (95% CI: -0.332, 0.036; p = 0.015), a 0.385 z-score lower in weight for age (95% CI: -0.533, -0.237; p < 0.001), a 0.383 z-score lower in BMI for age (95% CI: -0.563, -0.203; p < 0.001), and scored 2.726 points higher on the intelligence test (95% CI: 0.809, 4.643; p = 0.006) when adjusted for children's birth weight and food allergy, mothers' education, and family income. Picky eating behaviour towards meat, eggs and vegetables showed negative associations with growth. Picky eating behaviour is prevalent in school-age children in China and may have a negative effect on growth.
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Affiliation(s)
- Yong Xue
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Eva Lee
- School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ke Ning
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yingdong Zheng
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Defu Ma
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Hongchong Gao
- School of Clinical Medicine, Capital University of Medical Sciences, Beijing 100069, China
| | - Baoru Yang
- Food Chemistry & Food Development, Department of Biochemistry, University of Turku, Turku 20014, Finland; Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Ying Bai
- Dairy Research Institute, Inner Mongolia Mengniu Dairy (Group) Co. Ltd, Hohhot 011500, China
| | - Peiyu Wang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yumei Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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Hughes I, Harris M, Cotterill A, Garnett S, Bannink E, Pennell C, Sly P, Leong GM, Cowell C, Ambler G, Werther G, Hofman P, Cutfield W, Choong CS. Comparison of Centers for Disease Control and Prevention and World Health Organization references/standards for height in contemporary Australian children: analyses of the Raine Study and Australian National Children's Nutrition and Physical Activity cohorts. J Paediatr Child Health 2014; 50:895-901. [PMID: 24953978 DOI: 10.1111/jpc.12672] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
AIM (i) To compare the Centers for Disease Control and Prevention (CDC) reference and World Health Organization (WHO) standard/reference for height, particularly with respect to short stature and eligibility for growth hormone (GH) treatment by applying them to contemporary Australian children; (ii) To examine the implications for identifying short stature and eligibility for GH treatment. METHODS Children from the longitudinal Raine Study were serially measured for height from 1991 to 2005 (2-15-year-old girls (660) and boys (702) from Western Australia). In the cross-sectional Australian National Children's Nutrition and Physical Activity survey (2-16-year-old boys (2415) and girls (2379) from all states), height was measured in 2007. Heights were converted to standard deviation scores (SDSs) based on CDC and WHO. RESULTS Means and standard deviations of height-SDS varied between CDC and WHO definitions and with age and gender within each definition. However, both identified similar frequencies of short stature (<1st centile for GH eligibility), although these were very significantly less than the anticipated 1% (0.1-0.7%) of the Australian cohorts. Mean heights in the Australian cohorts were greater than both the WHO and CDC means. CONCLUSIONS Neither CDC nor WHO height standardisations accurately reflect the contemporary Australian child population. Australian children are taller than the CDC or WHO height means, and significantly less than 1% of Australian children are defined as being short using either CDC or WHO. This study suggests there may be a case for an Australian-specific standard/reference for height.
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Affiliation(s)
- Ian Hughes
- OZGROW, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
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Frequency and intensive care related risk factors of pneumothorax in ventilated neonates. Pulm Med 2014; 2014:727323. [PMID: 24876958 PMCID: PMC4020163 DOI: 10.1155/2014/727323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/25/2014] [Accepted: 04/07/2014] [Indexed: 11/25/2022] Open
Abstract
Objectives. Relationships of mechanical ventilation to pneumothorax in neonates and care procedures in particular are rarely studied. We aimed to evaluate the relationship of selected ventilator variables and risk events to pneumothorax.
Methods. Pneumothorax was defined as accumulation of air in pleural cavity as confirmed by chest radiograph. Relationship of ventilator mode, selected settings, and risk procedures prior to detection of pneumothorax was studied using matched controls. Results. Of 540 neonates receiving mechanical ventilation, 10 (1.85%) were found to have pneumothorax. Respiratory distress syndrome, meconium aspiration syndrome, and pneumonia were the underlying lung pathology. Pneumothorax mostly (80%) occurred within 48 hours of life. Among ventilated neonates, significantly higher percentage with pneumothorax received mandatory ventilation than controls (70% versus 20%; P < 0.01). Peak inspiratory pressure >20 cm H2O and overventilation were not significantly associated with pneumothorax. More cases than controls underwent care procedures in the preceding 3 hours of pneumothorax event. Mean airway pressure change (P = 0.052) and endotracheal suctioning (P = 0.05) were not significantly associated with pneumothorax. Reintubation (P = 0.003), and bagging (P = 0.015) were significantly associated with pneumothorax. Conclusion. Pneumothorax among ventilated neonates occurred at low frequency. Mandatory ventilation and selected care procedures in the preceding 3 hours had significant association.
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Abstract
In this paper we set out to explore the prevalence of child undernutrition found in community studies in affluent societies, but a preliminary literature review revealed that, in the absence of a gold standard method of diagnosis, the prevalence largely depends on the measure, threshold and the growth reference used, as well as age. We thus go on to explore describe the common clinical ‘syndromes’ of child undernutrition: wasting, stunting and failure to thrive (weight faltering) and how we have used data from two population-based cohort studies, this paper to explore how much these different ‘syndromes’ overlap and the extent to which they reflect true undernutrition. This analysis revealed that when more than one definition is applied to the same children, a majority are below the lower threshold for only one measure. However, those with both weight faltering and low BMI in infancy, go on in later childhood to show growth and body composition patterns suggestive of previous undernutrition. In older children there is even less overlap and most children with either wasting or low fat seem to be simply growing at one extreme of the normal range. We conclude that in affluent societies the diagnosis of undernutrition is only robust when it relies on a combination of both, that is decline in weight or BMI centile and wasting.
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Nützenadel W. Failure to thrive in childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:642-9. [PMID: 22025931 PMCID: PMC3198227 DOI: 10.3238/arztebl.2011.0642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 12/28/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Failure to thrive impairs children's weight gain and growth, their defenses against infection, and their psychomotor and intellectual development. METHODS This paper is a review of pertinent articles that were published from 1995 to October 2010 and contained the terms "failure to thrive", "underweight", "malnutrition", "malabsorption", "maldigestion" and "refeeding syndrome". The articles were retrieved by a search in the PubMed and Cochrane Library databases. RESULTS In developed countries, failure to thrive is usually due to an underlying disease. The degree of malnutrition is assessed with anthropometric techniques. For each patient, the underlying disease must be identified and the mechanism of failure to thrive understood, so that proper medical and nutritional treatment can be provided. Nutritional treatment involves either giving more food, or else raising the caloric density of the patient's food. Liquid formulas can be given as a supplement to normal meals or as balanced or unbalanced tube feeds; they can be given orally, through a nasogastric tube, or through a gastrostomy tube. Severely malnourished children with poor oral intake should be treated with parenteral nutrition. To avoid refeeding syndrome in severely malnourished children, food intake should be increased slowly at first, and phosphate, magnesium, and potassium supplements should be given. CONCLUSION The proper treatment of failure to thrive in childhood consists of treatment of the underlying illness, combined with nutritional treatment that addresses the mechanism of the accompanying failure to thrive.
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Affiliation(s)
- Walter Nützenadel
- Klinikum Mannheim GmbH, Universitätsklinikum, Klinik für Kinder- und Jugendmedizin.
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Jeong SJ. Nutritional approach to failure to thrive. KOREAN JOURNAL OF PEDIATRICS 2011; 54:277-81. [PMID: 22025919 PMCID: PMC3195791 DOI: 10.3345/kjp.2011.54.7.277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 05/27/2011] [Indexed: 11/27/2022]
Abstract
Failure to thrive (FTT) is a term generally used to describe an infant or child whose current weight or rate of weight gains is significantly below that expected of similar children of the same age, sex and ethnicity. It usually describes infants in whom linear growth and head circumference are either not affected, or are affected to a lesser degree than weight. FTT is a common problem, usually recognized within the first 1-2 years of life, but may present at any time in childhood. Most cases of failure to thrive involve inadequate caloric intake caused by behavioral or psychosocial issues. The most important part of the outpatient evaluation is obtaining an accurate account of a child's eating habits and caloric intake. Routine laboratory testing rarely identifies a cause and is not generally recommended. FTT, its evaluation, and its therapeutic interventions are best approached by a multi-disciplinary team includes a nutritionist, a physical therapist, a psychologist and a gastroenterologist. Long term sequelae involving all areas of growth, behavior and development may be seen in children suffering from FTT. Early detection and early intervention by a multi-disciplinary team will minimize its long term disadvantage. Appropriate nutritional counseling and anticipatory guidance at each well child visit may help prevent some cause of FTT.
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Affiliation(s)
- Su Jin Jeong
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Richards J, Hackett A, Duggan B, Ellis T, Forrest D, Grey P. An evaluation of an attempt to change the snacking habits of pre-school children using social marketing. Public Health 2009; 123 Suppl 1:e31-7. [DOI: 10.1016/j.puhe.2009.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 06/17/2009] [Accepted: 07/03/2009] [Indexed: 10/20/2022]
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Collet E, Diebold P, Paccaud D, de Ribaupierre S, Rilliet B. [A 6-week-old infant with failure to thrive: insidious presentation of group B streptococcal ventriculitis]. Arch Pediatr 2009; 16:360-3. [PMID: 19243927 DOI: 10.1016/j.arcped.2008.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 06/07/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
Abstract
Failure to thrive is frequently seen in breastfed infants. The most common diagnosis is insufficiency of breast milk in an otherwise healthy child. However, several differential diagnoses need to be considered. Progressive feeding difficulties and failure to thrive can be the first manifestation of group B streptococcal ventriculitis. This rare disease does not present with acute symptoms of sepsis or meningitis but evolves insidiously with no fever. Diagnosis is therefore often delayed and made only when intracranial hypertension develops. Cerebrospinal fluid (CSF) culture confirming the group B streptococcal infection and cerebral imaging are the necessary investigations for diagnosis. To our knowledge, only 10 cases have been previously reported.
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Affiliation(s)
- E Collet
- Service de pédiatrie, hôpital du Chablais, 1860 Aigle, Suisse.
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Skovgaard AM, Olsen EM, Christiansen E, Houmann T, Landorph SL, Jørgensen T. Predictors (0-10 months) of psychopathology at age 11/2 years - a general population study in The Copenhagen Child Cohort CCC 2000. J Child Psychol Psychiatry 2008; 49:553-62. [PMID: 18341552 DOI: 10.1111/j.1469-7610.2007.01860.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidemiological studies of mental health problems in the first years of life are few. This study aims to investigate infancy predictors of psychopathology in the second year of life. METHODS A random general population sample of 210 children from the Copenhagen Child Birth Cohort CCC 2000 was investigated by data from National Danish registers and data collected prospectively from birth in a general child health surveillance programme. Mental health outcome at 1(1/2) years was assessed by clinical and standardised measures including the Child Behavior Check List 1(1/2)-5 (CBCL 1(1/2)-5), Infant Toddler Symptom Check List (ITSCL), Checklist for Autism in Toddlers (CHAT), Bayley Scales of Infant Development (BSID II), Mannheim Eltern Interview (MEI), Parent Child Early Relational Assessment (PC ERA) and Parent Infant Relationship Global Assessment Scale (PIR-GAS), and disordered children were diagnosed according to the International Classification of Diseases (ICD-10) and Diagnostic Classification Zero to Three (DC: 0-3). RESULTS Deviant language development in the first 10 months of life predicted the child having any disorder at 1(1/2) years, OR 3.3 (1.4-8.0). Neuro-developmental disorders were predicted by deviant neuro-cognitive functioning, OR 6.8 (2.2-21.4), deviant language development, OR 5.9 (1.9-18.7) and impaired social interaction and communication, OR 3.8 (1.3-11.4). Unwanted pregnancy and parents' negative expectations of the child recorded in the first months of the child's life were significant predictors of relationship disturbances at 1(1/2) years. CONCLUSIONS Predictors of neuro-developmental disorders and parent-child relationship disturbances can be identified in the first 10 months of life in children from the general population.
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Affiliation(s)
- A M Skovgaard
- Child and Adolescent Psychiatric Centre, University Hospital of Copenhagen, Glostrup, Denmark.
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Black MM, Dubowitz H, Krishnakumar A, Starr RH. Early intervention and recovery among children with failure to thrive: follow-up at age 8. Pediatrics 2007; 120:59-69. [PMID: 17606562 DOI: 10.1542/peds.2006-1657] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to examine the impact of a randomized, controlled trial of home visiting among infants with failure to thrive on growth, academic/cognitive performance, and home/classroom behavior at age 8. METHODS Infants with failure to thrive (N = 130) or adequate growth (N = 119) were recruited from pediatric primary care clinics serving low-income, urban communities. Eligibility criteria included age <25 months, gestational age >36 weeks, birth weight >2500 g, and no significant medical conditions. Evaluation included anthropometries, Bayley scales, maternal anthropometries, demographics, negative affect, IQ, and the Home Observation for Measurement of the Environment scale. Infants with failure to thrive were treated in an interdisciplinary growth and nutrition clinic and randomized into clinical-intervention-plus-home-intervention or clinical-care-only groups. The home-visiting curriculum promoted maternal sensitivity, parent-infant relationships, and child development. Follow-up visits were conducted by evaluators who were unaware of the children's growth or intervention history. At age 8, the evaluation included anthropometries, the Wechsler Intelligence Scale for Children III, and the Wide Range Achievement Test, Revised. Mothers completed the Child Behavior Checklist and teachers completed the Teacher Report Form. ANALYSIS Multivariate analyses of variance were used to examine differences in growth, cognitive/academic performance, and home/school behavior, adjusted by maternal education, public assistance, and, when appropriate, infant Bayley score, maternal BMI, height, negative affect, IQ, and Home Observation for Measurement of the Environment scores. RESULTS Retention was 74% to 78%. Children in the adequate-growth group were significantly taller, heavier, and had better arithmetic scores than the clinical-intervention-only group, with the clinical-intervention-plus-home-intervention group intermediate. There were no group differences in IQ, reading, or mother-reported behavior problems. Children in the clinical-intervention-plus-home-intervention group had fewer teacher-reported internalizing problems and better work habits than the clinical-intervention-only group. CONCLUSIONS Early failure to thrive increased children's vulnerability to short stature, poor arithmetic performance, and poor work habits. Home visiting attenuated some of the negative effects of early failure to thrive, possibly by promoting maternal sensitivity and helping children build strong work habits that enabled them to benefit from school. Findings provide evidence for early intervention programs for vulnerable infants.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, 737 W Lombard St, Room 161, Baltimore, MD 21201, USA.
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Dimmock D, Kobayashi K, Iijima M, Tabata A, Wong LJ, Saheki T, Lee B, Scaglia F. Citrin deficiency: a novel cause of failure to thrive that responds to a high-protein, low-carbohydrate diet. Pediatrics 2007; 119:e773-7. [PMID: 17332192 DOI: 10.1542/peds.2006-1950] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The proband was born at 36 weeks, appropriate for gestational age, to nonconsanguineous white parents. There was no evidence of hyperbilirubinemia or intrahepatic cholestasis in the neonatal period, and she had normal newborn screen results. She presented with 3 episodes of life-threatening bleeding and anemia. The diagnostic evaluation for her bleeding diathesis revealed an abnormal clotting profile with no biochemical evidence for hepatocellular damage. She was incidentally noted to have severe growth deceleration that failed to respond to 502 kJ/kg (120 kcal/kg) per day of protein-hydrolyzed formula. An extensive diagnostic workup for failure to thrive, which was otherwise normal, included plasma amino acid analysis that revealed hyperglutaminemia and citrulline levels within the reference range. Testing of a repeat sample revealed isolated hypercitrullinemia. No argininosuccinic acid was detected. Her ammonia level and urine orotic acid were within the reference ranges. Subsequent plasma amino acid analysis exhibited a profile suggestive of neonatal intrahepatic cholestasis caused by citrin deficiency with elevations in citrulline, methionine, and threonine. Western blotting of fibroblasts demonstrated citrin deficiency, and a deletion for exon 3 was found in the patient's coding DNA of the SLC25A13 gene. On the basis of the experience with adults carrying this condition, the patient was given a high-protein, low-carbohydrate diet. The failure to thrive and bleeding diathesis resolved. When compliance with the dietary prescription was relaxed, growth deceleration was again noted, although significant bleeding did not recur. This is the first report of an infant of Northern European descent with citrin deficiency. The later age at presentation with failure to thrive and bleeding diathesis and without obvious evidence of neonatal intrahepatic cholestasis expands the clinical spectrum of citrin deficiency. This case emphasizes the importance of continued dietary control and growth monitoring in children with neonatal intrahepatic cholestasis caused by citrin deficiency and identifies a new metabolic entity responsible for failure to thrive.
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Affiliation(s)
- David Dimmock
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
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Abstract
Perspective on the paper by Olsen et al (see page 109)
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Affiliation(s)
- N J Spencer
- School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK.
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Abstract
Perspective on the paper by Lucas et al(see page 120)
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Affiliation(s)
- Charlotte M Wright
- Department of Child Health, Glasgow University, Peach Unit, Yorkhill Hospitals, Glasgow, UK.
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Bonuck K, Parikh S, Bassila M. Growth failure and sleep disordered breathing: a review of the literature. Int J Pediatr Otorhinolaryngol 2006; 70:769-78. [PMID: 16460816 DOI: 10.1016/j.ijporl.2005.11.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 11/22/2005] [Accepted: 11/25/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE While otolaryngologists consider growth failure an absolute indication for tonsillectomy and adenoidectomy (T&A), they may not be accustomed to screening for poor growth, and thus unlikely to consider it when recommending a T&A. This paper will (a) familiarize otolaryngologists with the definition, prevalence, and etiology of growth failure and (b) review the published findings that examine the inter-relationship among sleep disordered breathing, growth failure, and adentonsillar hypertrophy in children. METHODS This paper is divided into three sections. The first section presents a brief overview of growth failure for the otolaryngologist. The second section reviews the evidence base linking sleep disordered breathing, growth failure, and adenotonsillar hypertrophy in children. The anthropometric outcomes of children presenting for T&A, or having sleep symptoms assessed, are presented. The third section presents pilot data (n=28) on the prevalence of growth failure and sleep disordered breathing among children presenting for T&A at our institution. RESULTS Among children presenting for T&A or having sleep symptoms assessed, growth failure was at least twice the expected rate in six of eight published studies. Across these six studies, this rate ranged from a low of 6% of children <3rd percentile for weight and 6% <3rd percentile for height in one study, to a high of 52% who were <3rd percentile in weight in a second study, and 44% who were <or= 5th percentile for height in a third. Among children presenting for T&A at our own institution, 14% were <or=5th percentile in height, and 11% were <or=5th percentile in weight. Among children under 6 years of age, 21% were either <or= 5th percentile in weight and/or height. CONCLUSIONS Published studies, as well as our own pilot data support the hypothesis that SDB, secondary to adenotonsillar hypertrophy increases the risk of growth failure in children. Adenotonsillar hypertrophy and sleep disordered breathing may be unrecognized risk factors in the etiology of growth failure. Otolaryngologists can play an important role in identifying growth failure, and referring children to the appropriate specialists.
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Affiliation(s)
- Karen Bonuck
- Department of Epidemiology and Population Health, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2490, USA.
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Wright CM, Parkinson KN, Drewett RF. The influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive): data from a prospective birth cohort. Arch Dis Child 2006; 91:312-7. [PMID: 16397011 PMCID: PMC2065961 DOI: 10.1136/adc.2005.077750] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To study the influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive) in the first year of life. METHODS The Gateshead Millennium Baby Study is a population birth cohort in northeast England studied prospectively from birth, via parental questionnaires and a health check aged 13 months. Data were collected on maternal education, deprivation, eating attitudes, and depression, using the Edinburgh Post Natal Depression Scale (EPDS) at 3 months. Weight gain was assessed using change in weight SD score, conditional on birth weight (Thrive Index); weight faltering was defined as conditional weight gain below the 5th centile. RESULTS Of 923 eligible infants born at term, 774 (84%) had both weight and questionnaire data. Replicating a previous finding, both the highest and the lowest levels of deprivation were associated with weight faltering; this was independent of the type of milk feeding. No relation was found with maternal educational status. Maternal eating restraint was unrelated to weight gain. Infants of mothers with high depression symptom scores (EPDS >12) had significantly slower weight gain and increased rates of weight faltering up to 4 months (relative risk 2.5), especially if they came from deprived families, but by 12 months they were no different from the remainder of the cohort. CONCLUSIONS In this setting, social and maternal characteristics had little influence on infants' weight gain, apart from a strong, but transient effect of postnatal depression.
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Affiliation(s)
- C M Wright
- Department of Child Health, University of Glasgow, UK.
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Boonstra VH, Arends NJT, Stijnen T, Blum WF, Akkerman O, Hokken-Koelega ACS. Food Intake of Children with Short Stature Born Small for Gestational Age before and during a Randomized GH Trial. Horm Res Paediatr 2006; 65:23-30. [PMID: 16357487 DOI: 10.1159/000090376] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 10/19/2005] [Indexed: 11/19/2022] Open
Abstract
Parents of short children born SGA often report that their children have a serious lack of appetite and a low food intake. In this study we investigated food intake, by using a standardized 7-day food questionnaire, in 88 short SGA children before start of GH treatment. The intake was compared with the recommended daily intake (RDI) of age-matched children. We also compared the food intake of GH-treated children (n=62) with randomized controls (n=26) after 1 year of GH treatment. In addition, we evaluated the effect of food intake and GH treatment on body composition and serum levels of IGF-I, IGFBP-3 and leptin. Our study shows that caloric intake, fat and carbohydrate intake of short SGA children aged 5.9 (1.6) years was significantly lower compared to the RDI for age-matched children. One year of GH treatment resulted in a significant increase of caloric, fat, carbohydrate and protein intake compared to baseline. Compared to randomized controls, caloric, carbohydrate and protein intake increased significantly after 1 year of GH treatment. Short SGA children had significantly lower SDS scores for LBM, fat mass, skinfold (SF) and BMI compared to age-matched references. They also had significantly lower serum IGF-I, IGFBP-3 and leptin levels. GH treatment resulted in a significant increase of height, LBM, BMI, IGF-I and IGFBP-3 SDS and a significant decrease of SF SDS and leptin SDS. In conclusion, our study shows that short SGA children have indeed a lower food intake than age-matched controls. During GH treatment the food intake increased significantly compared to baseline in contrast to the randomized control group.
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Affiliation(s)
- V H Boonstra
- Division of Endocrinology, Department of Pediatrics, Sophia Children's Hospital/Erasmus University, Rotterdam, The Netherlands.
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Sachs M, Dykes F, Carter B. Weight monitoring of breastfed babies in the United Kingdom--interpreting, explaining and intervening. MATERNAL & CHILD NUTRITION 2006; 2:3-18. [PMID: 16881910 PMCID: PMC6860829 DOI: 10.1111/j.1740-8709.2006.00019.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Weighing infants in their first 6 months is an important aspect of growth monitoring and a common activity of child health care services worldwide. During the same 6 months, support for establishing breastfeeding and the promotion of continued exclusive breastfeeding are important activities of health professionals. Parents and health professionals may perceive conflicts between achieving both robust growth and continuing breastfeeding. In this narrative review, the literature on weighing breastfed babies in the United Kingdom is examined. A companion paper examined issues of growth charts, scales and weighing frequency and accuracy. This paper considers issues of interpretation of the plotted weight values for individual breastfed babies, noting the complexities of growth patterns, which may lead to difficulties of accurate identification of those individuals whose growth merits further investigation. Little attention has been given to issues of explaining the interpreted growth curves to parents and this issue is explored and noted as of importance for further study. Research evidence on choosing appropriate interventions to improve the growth of breastfed babies is reviewed. The paucity of such evidence leads to suggestions for future study. This review gathers together a wide range of literature from many different perspectives, with the hope of informing weight monitoring practice so that this can both identify infants whose weight may be of concern, and who may need appropriate intervention, and support continued breastfeeding.
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Affiliation(s)
- Magda Sachs
- Maternal and Infant Nutrition and Nurture Group, MAINN, Faculty of Health, University of Central Lancashire, Preston, Lancashire, UK.
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Abstract
AIMS To ascertain the long term outcomes in children diagnosed as having failure to thrive (FTT). METHODS Systematic review of cohort studies. Medline, Psychinfo, Embase, Cinahl, Web of Science, Cochrane, and DARE databases were searched for potentially relevant studies. INCLUSION CRITERIA cohort studies or randomised controlled trials in children <2 years old with failure to thrive defined as weight <10th centile or lower centile and/or weight velocity <10th centile, with growth, development, or behaviour measured at 3 years of age or older. RESULTS Thirteen studies met the inclusion criteria; eight included a comparison group, of which five included children identified in community settings. Two were randomised controlled trials. Attrition rates were 10-30%. Data from population based studies with comparison groups and which reported comparable outcomes in an appropriate form were pooled in a random effects meta-analysis. Four studies report IQ scores at follow up and the pooled standardised mean difference was -0.22 (95% CI -0.41 to -0.03). Two studies reported growth data as standard deviation scores. Their pooled weighted mean difference for weight was -1.24 SDS (95% CI -2.00 to -0.48), and for height -0.87 SDS (95% CI -1.47 to -0.28). No studies corrected for parental height, but two reported that parents of index children were shorter. CONCLUSIONS The IQ difference (equivalent to approximately 3 IQ points) is of questionable clinical significance. The height and weight differences are larger, but few children were below the 3rd centile at follow up. It is unclear to what extent observed differences reflect causal relations or confounding due to other variables. In the light of these results the aggressive approach to identification and management of failure to thrive needs reassessing.
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Affiliation(s)
- M C J Rudolf
- Community Paediatrics, East Leeds Primary Care Trust and University of Leeds, Leeds, UK.
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Sachs M, Dykes F, Carter B. Weight monitoring of breastfed babies in the UK - centile charts, scales and weighing frequency. MATERNAL & CHILD NUTRITION 2005; 1:63-76. [PMID: 16881882 PMCID: PMC6860946 DOI: 10.1111/j.1740-8709.2005.00018.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Weighing infants during their first 6 months is an important focus of growth monitoring and a common activity of child health care services worldwide. In these same months, health workers provide support for breastfeeding and promote continued exclusive breastfeeding. The literature on the practice of weighing breastfed babies is reviewed, as it applies to the United Kingdom. The shape of the growth curves for breastfed babies differs from that of formula-fed infants and also from centile charts previously in use. The World Health Organization commitment to the production of a new growth reference has generated discussion of the implications of charts in use. The country-specific charts in use in the UK are examined and the data used to construct them discussed with reference to clinical use for breastfed infants. Recent UK discussions on charts, as well as on the frequency of routine weighing for babies in the community are considered, and the available evidence on the accuracy of weighing in practice is noted. The choices made in constructing different charts; the physical condition of scales and their use in practice have implications for plotted growth. This paper aims to present a wide range of evidence available in this area in order to encourage debate on practice. A companion paper will discuss issues of interpretation, conveying information to parents, and interventions.
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Affiliation(s)
- Magda Sachs
- Department of Midwifery Studies, University of Central Lancashire, Preston, UK.
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Russell BJ, White AV, Newbury J, Hattch C, Thurley J, Chang AB. Evaluation of hospitalisation for indigenous children with malnutrition living in central Australia. Aust J Rural Health 2005; 12:187-91. [PMID: 15588260 DOI: 10.1111/j.1440-1854.2004.00602.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of hospital admissions for indigenous children with malnutrition in a rural/remote Australian centre. DESIGN Retrospective review of the medical records. SETTING Rural secondary hospital. SUBJECTS Remote and rural indigenous children aged less than four years managed for malnutrition in Alice Springs Hospital (ASH). MAIN OUTCOME MEASURE The primary outcome measure was weight gain during hospitalisation and posthospitalisation. Secondary outcome measures were yield of investigations, diagnoses made, treatments given, social interventions, readmission rate and nosocomial infection. RESULTS Median age of the 55 children was 15.1 months. Median weight change was 1.5 g day(-1)prior to hospitalisation, 36.7 g day(-1)during and 9 g day(-1)two months following hospitalisation (P < 0.05). Investigations performed had high yields (80% of children had a treatable organic contributor to malnutrition). Nosocomial infection occurred in 21 (38%) children. Readmission occurred at an average of 1.9 times per child (range 0-5), 34 (37%) occurred within three months and 48 (52%) within six months. CONCLUSION In rural Indigenous children with malnutrition, hospitalisation was effective in re-establishing growth and defining organic contributors to malnutrition. However, the high readmission rate and nosocomial infection mandates that alternative models to nutritional rehabilitation, in addition to a broad psychosocial and public health approach to prevention and management of malnutrition, is required.
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Affiliation(s)
- Beth J Russell
- Child and Youth Program, Ngaanyatjarra Pitjantjatjara Council, Darwin, Northern Territory
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O'Brien LM, Heycock EG, Hanna M, Jones PW, Cox JL. Postnatal depression and faltering growth: a community study. Pediatrics 2004; 113:1242-7. [PMID: 15121936 DOI: 10.1542/peds.113.5.1242] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the association between faltering growth in children and maternal postnatal depression. METHODS Children aged < or =2 years were identified from community child health surveillance records if their weights fell across 2 centile channels on standardized growth charts or fell below the second centile. Mothers of these index children were invited to complete the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale. Those who scored above threshold values on either scale were interviewed with the revised Clinical Interview Schedule. Matched control children were obtained from health visitor records, and records of their weights were obtained. Mothers of control children completed the same questionnaires. RESULTS A total of 196 index children and 567 control children were studied. Significantly more mothers in the index group scored above the threshold for both the Edinburgh Postnatal Depression Scale (33% vs 22%; odds ratio [OR]: 1.71; 95% confidence interval [CI]: 1.16-2.53) and the Hospital Anxiety and Depression Scale (24% vs 13%; OR: 2.08; 95% CI: 1.33-3.25) questionnaires. Furthermore, clinical interviews with these mothers demonstrated that 21% of the index group and 11% of the control group fulfilled criteria for depressive episode (OR: 1.88; 95% CI: 1.21-2.94). CONCLUSIONS Depression in mothers of children with faltering growth during the first 2 years of life is significantly greater than in mothers of children who are gaining weight appropriately. In view of the high rates of maternal depression in children with poor weight gain, clinical management at presentation of either problem should focus on both members of the mother-child dyad and on the interaction between mother and child. These findings have implications for all professionals who work in primary and secondary health care.
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Affiliation(s)
- Louise Margaret O'Brien
- Academic Department of Paediatrics, North Staffordshire Hospital, Stoke on Trent, United Kingdom.
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Patel V, Rahman A, Jacob KS, Hughes M. Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia. BMJ 2004; 328:820-3. [PMID: 15070641 PMCID: PMC383383 DOI: 10.1136/bmj.328.7443.820] [Citation(s) in RCA: 215] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Impaired infant growth, a major problem in South Asia, may require interventions to improve maternal mental health in addition to current interventions targeting infant nutrition
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Affiliation(s)
- Vikram Patel
- London School of Hygiene and Tropical Medicine, and Sangath, Goa, India
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Corbett SS, Drewett RF. To what extent is failure to thrive in infancy associated with poorer cognitive development? A review and meta-analysis. J Child Psychol Psychiatry 2004; 45:641-54. [PMID: 15055382 DOI: 10.1111/j.1469-7610.2004.00253.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Previous empirical studies of the cognitive sequelae of failure to thrive in infancy have led to apparently inconsistent conclusions. METHODS Studies of cognitive abilities in failure to thrive were located through published bibliographies, supplemented by a search through MEDLINE. They were classified (a) into those in which the cases were identified in hospital or other specialist clinics, and those in which they were identified in primary care or by whole population screening; (b) into those that were controlled and those that were not controlled; and (c) into those with a cross-sectional and those with a longitudinal design. Effect sizes in controlled studies were summarised using D statistics for the principal cognitive outcome measure, from the last occasion on which the child was tested if the study was longitudinal. RESULTS In studies with cases identified in hospital or other specialist clinics (52 cases, 36 controls), the pooled effect size (weighted standardised mean difference) for cognitive outcomes was -.85 (95% CI -.41 to -1.30). In studies with cases identified in primary care (552 cases, 573 controls), it was -.30 (95% CI -.18 to -.42). In each longitudinal study testing the same children at different ages, the effect size was smaller when the children were older. To obtain an overall estimate of the long-term cognitive outcome of failure to thrive in infancy, data from controlled studies in which cases were identified in primary care, and restricted to IQ or McCarthy scale scores in older children (502 cases, 523 controls), were used. The weighted mean difference was -.28 (95% CI -.16 to -.41), equivalent to 4.2 IQ points (95% CI 2 to 6). CONCLUSIONS Evidence from reasonably well-controlled studies indicates that failure to thrive in infancy is associated with adverse intellectual outcomes sufficiently large to be of importance at a population level.
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Affiliation(s)
- S S Corbett
- Department of Psychology, University of Durham, UK.
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Court S. The future of paediatric primary care and child health. Arch Dis Child 2004; 89:119-20. [PMID: 14736623 PMCID: PMC1719804 DOI: 10.1136/adc.2003.040659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- S Court
- Community Paediatric Department, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK.
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Affiliation(s)
- D Hall
- Institute of General Practice, Northern General Hospital, Sheffield S5 7AU, UK.
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Armstrong J, Reilly JJ. The prevalence of obesity and undernutrition in Scottish children: growth monitoring within the Child Health Surveillance Programme. Scott Med J 2003; 48:32-7. [PMID: 12774591 DOI: 10.1177/003693300304800202] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess whether anthropometric data, routinely collected as part of the Scottish Child Health Surveillance System (CHSP-PS, pre-school children; CHSP-S, school age children) could provide a means of monitoring/surveillance for obesity and undernutrition at national and health board level. DESIGN A survey of 15 health boards and both surveillance systems to identify the nature of data collected, format of data, and extent to which data were accessible (e.g., via Information and Statistics Division of the Common Services Agency). Measurements of weight and height collected as part of the CHSP-PS and CHSP-S were extracted from ISD. They were then audited and missing values or implausible values quantified, and degree of dispersion of values used as an index of quality of measurements. SETTING Health Board Child Health Surveillance Systems and Information and Statistics Division, Edinburgh. RESULTS Data on height and weight are currently available for 9 health boards for pre-school children and 4 health boards for school age children. This represents coverage of around 80% of the pre-school child population. Analysis of a data extract from the 39-42 month check in 1998/99, used as an example, revealed that 8% of weight and height data were missing, and approximately 1% were implausible measures. Population and health board level estimates of prevalence of obesity and undernutrition were possible and are presented. Data on height and weight are routinely collected in school age children in all health boards, however only four health boards have growth data electronically available via the school CHSP. CONCLUSIONS Growth data routinely collected as part of child health surveillance for Scotland can be used to estimate population prevalence of undernutrition and obesity. These can in turn be used to monitor trends at local and national level, to monitor achievement in relation to public health targets, identify risk factors and high risk groups, and to follow cohorts over time. We describe a system of surveillance for undernutrition and obesity and identify its strengths and weaknesses.
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Affiliation(s)
- J Armstrong
- School of Biological & Biomedical Sciences, Glasgow Caledonian University, Charles Oakley Building, City Campus, Cowcaddens Road, Glasgow G4 OBA.
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Abstract
BACKGROUND Poor infant feeding practices are common causes of nonorganic failure to thrive and may exacerbate the effects of many chronic conditions. It is important therefore that parents receive correct and consistent feeding advice from health professionals. The aim of this study was to determine whether hospital paediatric nursing staff are familiar with the recommendations of the Department of Health (DOH) Weaning Report (DOH, 1994). METHODS A total of 127 members of nursing staff (79%) at Derbyshire Children's Hospital were interviewed. Knowledge of recommended practices for the introduction and use of cow's milk, gluten, milk products, mashed foods, vitamin supplements and drinks was assessed. RESULTS Overall, 42 people (33%) answered all questions correctly. In each clinical area, six outpatient (64%), 19 special care baby unit (61%) and 17 ward (20%) staff provided correct answers to all questions. No significant difference was found between staff at each grade in the number of questions answered correctly. CONCLUSIONS Knowledge of national infant feeding and weaning guidelines was limited suggesting that DOH recommendations are not widely understood or recognized. Further nutrition education and local dissemination of information is required if nurses are to continue to advise parents on aspects of infant feeding.
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Affiliation(s)
- A Williams
- Department of Nutrition & Dietetics, Southern Derbyshire Acute Hospital, NHS Trust, Derby City General Hospital, UK.
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Abstract
Optimal growth and development are the primary objectives of pediatric nutrition. Dietary habits and food choices to support both oral health and systemic health are similar. Each emphasizes structured meal patterns and food choices. The oral health professional has a responsibility to screen for diet-related disorders and to treat or refer as appropriate.
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Affiliation(s)
- Teresa A Marshall
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, N335 Dental Science Building, Iowa City, IA 52242, USA.
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Abstract
OBJECTIVE This study was conducted to explore the experience of families of children who were failing to thrive. The aim of the study was not to generalize the findings but to generate a rich description of the phenomenon of living with children who were not growing as expected. BACKGROUND Although failure to thrive has been found to have long-term negative implications for children there is little information available on how families experience this phenomenon. METHODS A purposive sample of 12 families with children who were failing to thrive from multiple known and unknown reasons were interviewed (21 participants: mothers, fathers, and grandmothers). FINDINGS Twenty-seven subthemes emerged from the descriptions provided by the participants and these were then grouped into seven themes. Families spoke of an all-encompassing fear with which they lived. They were affected by the comparisons of the children made by others and themselves. In the process of seeking care for the children, the families described how their concerns often were not heard by the professionals. They felt blamed for their children's growth failure and this added to a sense of isolation and helplessness. Nurses and doctors who listened and acknowledged that they trusted the family were respected and valued. Families felt they were then valuable members of the care team. Regardless of the difficulties, families described how they adapted and persevered in their attempt to provide as normal a life as possible for the children. They considered themselves the experts who best knew the children and continued to provide the complex care that was needed. CONCLUSIONS The research suggests that health care professionals need to be more aware of the impact of their words and actions on families.
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Hoare K, Wright CM, Wilson P, Weaver LT. Disseminating weaning messages: an intervention trial. Br J Community Nurs 2002; 7:196-200. [PMID: 11979198 DOI: 10.12968/bjcn.2002.7.4.10225] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports a non-randomized intervention study conducted in two market towns to find out whether participant-centred health education discussions improve parents' knowledge and actions concerning infant feeding. Following an initial quiz, parents of 8-week-old infants attended a discussion on weaning (intervention) or home safety (control). They were then asked to complete a questionnaire about their knowledge and actions concerning weaning when their infants were 7-9 months old. A total of 61 parents took part in the intervention and 49 in the control. In the post-intervention questionnaire, the intervention group reported using more home-cooked foods and less commercially-prepared foods and knew the optimum time to register their infants with the dentist. These results suggest that participant-centred discussions are an effective way of disseminating public health messages concerning infant feeding.
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Affiliation(s)
- K Hoare
- Sure Start Bedlington and Scotland Gate, Northumberland
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Keller E, Gausche R, Meigen C, Keller A, Burmeister J, Kiess W. Auxological computer based network for early detection of disorders of growth and weight attainment. J Pediatr Endocrinol Metab 2002; 15:149-56. [PMID: 11874179 DOI: 10.1515/jpem.2002.15.2.149] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION For several years practising pediatricians and pediatric endocrinologists in Leipzig have been collaborating closely to achieve early detection of growth disorders. As a result of this collaboration a data-bank was established in September 1998 into which height and weight measurements were entered and related to age and gender. This well established network of pediatricians in practice, pediatric endocrinologists and the auxological data-bank functions well. METHODS All data are anonymized and continually monitored. By September 2000, the data for 60,984 children had been assessed. The data were evaluated using the German Synthethic Norm Curve for body height and German normal data for BMI. Pathology of growth dynamics was assumed when change in height SDS was greater than 0.5 height SDS/year. RESULTS Analysis showed that 2,216 children (3.6%) had a height greater than the 97th percentile and 2,775 children (4.5%) had a height less than the 3rd percentile of the normative reference. BMI above the 97th percentile was found in 7,687 children (12.6%) and below the 3rd percentile in 2,678 children (4.4%). When assessing growth development (n = 5,665), 194 (3.4%) showed acceleration and 155 (2.7%) showed deceleration of growth. CONCLUSION The computer-based monitoring system is useful to document short-term and long-term changes of growth and weight attainment in the general population. The presence of growth disorders and/or disturbed weight gain can be detected early in the individual child.
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Abstract
The development of failure to thrive (FTT) is hypothesized to be caused by the interaction between biological and environmental factors. Birthweight is one biological variable thought to play a role in the infant's growth failure. In studies that enrolled infants with FTT who were full-term at birth, the reported birthweights of these infants were significantly less than healthy control infants (M = 2959 g vs. M = 3364 g), t(14) = -4.597, P < 0.000. There is growing evidence that there is a subgroup of full-term newborn infants who actually may have experienced some degree of intrauterine growth retardation but their birthweights remain above the traditional cut-off of 2500 g so that they go unrecognized. The question to consider is whether these infants are as behaviourally vulnerable as full-term infants with classic intrauterine growth retardation. It may be that this unrecognized group is at a higher risk of developing FTT. The purpose of this manuscript is to discuss birthweight as a possible precursor to the development of FTT.
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Affiliation(s)
- D K Steward
- RN and College of Nursing, The Ohio State University, Columbus, Ohio 43210, USA.
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Abstract
For decades, the overwhelming majority of infants requiring mechanical ventilation for respiratory failure were treated with standard time-cycled, pressure-limited intermittent mandatory ventilation. Technologic advances in the 1990s brought forth sophisticated transducers and microprocessor-based mechanical ventilators that enabled implementation of many newer modes of mechanical ventilation. Some of these are volume-targeted rather than pressure-targeted, and many allow an element of patient control of the ventilator, including initiation and termination of inspiration and control of flow. Some modes are even hybrids, combining the best features of both pressure-targeted and volume-targeted modes. This article reviews the principles and salient clinical features of the newer ventilatory modes for newborns with respiratory failure.
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Affiliation(s)
- S M Donn
- Division of Neonatal-Perinatal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.
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