Failure to thrive (FTT) refers to inadequate growth, defined as weight or weight for height below the 3rd percentile for age on growth charts. FTT can be due to organic causes like medical issues or non-organic causes such as psychosocial problems. Evaluation of FTT involves collecting growth data, medical history, nutritional history, developmental assessment, physical exam, and laboratory tests to identify potential causes. Common causes include inadequate calorie intake, inability to utilize calories, increased calorie needs, and calorie loss through vomiting or malabsorption.
DEFINITION
FTT is defined as attained growth Weight of < 3rd percentile on standard growth chart or Weight for height < 5th percentile on standard growth chart or Weight 20% or more below ideal weight for height. OR
Rate of growth less than 20 g/day from birth to 3 months of age or less than 15 g/day from 3 months to 6 months of age or falloff from previously established growth curve or downward crossing of > 2 major percentiles.
ETIOLOGY
The etiology of FTT has traditionally been divided into organic, inorganic and mixed.
Organic FTT; Is a growth symptom of virtually all serious pediatric physical illnesses, such as gastro esophageal reflux, malabsorption syndrome, cystic fibrosis and congenital heart disease.
Nonorganic FTT; Is a failure of growth without diagnosable organic disease. It is caused by a psychosocial problem between the infant or child and the mother or other primary caregiver.
Mixed FTT; has both organic and nonorganic causes and cannot be described as either alone.
NOTE:-
The standard classification of dividing the causes of FTT as organic and non-organic is probably not very appropriate. Whether the condition is primarily organic or non-organic in origin, all children who fail to thrive suffer the physical and psychological consequences of malnutrition and are at a significant risk for long-term physical and psycho developmental sequelae. Organic diseases are responsible for less than 20% of cases with FTT. The causes of FTT are as;-
1. INADEQUATE CALORIC INTAKE
• Incorrect formula preparation
• Neglect
• Excessive juice consumption
• Poverty
• Behavioral problem affecting eating
• Non-availability of food
• Misperceptions about diet and feeding practices
• Errors in formula reconstitution
• Dysfunctional parent-child interaction, child abuse and neglect
• Behavioral feeding problem
• Mechanical problems with sucking, swallowing and feeding
• Primary neurological diseases
• Chronic systemic disease resulting in anorexia, food refusal and neurological problems
2. INADEQUATE ABSORPTION
• Cystic fibrosis
• Celiac disease
• Vitamin deficiencies
• Hepatic diseases.
3. INCREASED CALORIC REQUIREMENT
• Hyperthyroidism
• Congenital heart disease
• Chronic immunodeficiency
• Chronic respiratory disease
• Neoplasm
• Chronic or recurrent infection
4. EXCESSIVE LOSS OF CALORIES
• Persistent vomiting
• Gastro esophageal reflux disease
• Gastrointestinal obstruction
• Increased intracranial pressure
• Renal losses - renal tubular acidosis
• Diabetes mellitus
• Inborn errors of metabolism
Determinants of Eating Behavior and its Impact on Chronic Diseases.pptxWajid Rather
S-1 Prevalence of Chronic disease in India
S-2 Percentage of Hypertension in Indians
S-3 Percentage of Hypertension in Indians
S-4 Percentage of overweight Indians
S-6 Chronic diseases share
common risk factors and conditions
S-7 Major Factors Influence Our Eating Behavior
S-8 Portion sizes
S-9 Informational Eating Norms
S-10 Family and Social Determinants
S-11 Environmental Influences on eating Behaviour
S-12 Parental Influences on on children's Eating pattern and Food Choices
S-13 Eating Disorders
S-14 Types of Eating Disorders
S-15 Health Effects of Different Types of Eating Disorders
S-16-18 Diagnostic Consideration for Different types of Eating Disorders
S-23 Different Treatment Options for eating Disorders
S-24-27 Nutritional Assessment, Intervention and Nutrition Monitoring and Evaluation
Determinants of Eating Behavior and its impact on chronic Diseases.pdfWajid Rather
Slide no 1: Determinants of Eating Behavior and its Impact on Chronic Diseases
Slide -2 Prevalence of Chronic Diseases in India
Slide-3 Percentage of Hypertension in Indians
Slide-4 Percentage of Overweight Indians
Slide-5 Chronic Disease share common Risk factors and Conditions
Slide-6 Major Factors influence our Eating Behaviour and Food Choices
Slide-7 Portion Sizes
Slide-8 Information Eating Norms
Slide-9 Social Determinants
Slide-10 Environmental Influence on Children's Eating and Food Choices
Slide-11 Parental Influences on Children Eating and Food Choices
Slide-12 Eating Disorders
slide-13 Types of Eating Disorders
Slide-14 Health Effects of Different types of Eating Disorders
Slide -15 Diagnostic Consideration for different Eating Disorders
Slide-16 Treatment options for Eating Disorders
Slide -17 Nutrition Assessment
slide-18 Nutrition Intervention
Slide -19 Nutrition Monitoring and Evolution
This is an undergraduate presentation on failure to thrive in Pediatrics. In this presentation I mentioned about Diagnosis, Etiology, Etiology, Diagnostic Evaluation and Management.
https://orcid.org/0000-0001-9306-2267
https://1drv.ms/p/s!Am9GQ5GMX-WyjmOfgcNpov4RewVL
Pamudith Karunaratne
DEFINITION
FTT is defined as attained growth Weight of < 3rd percentile on standard growth chart or Weight for height < 5th percentile on standard growth chart or Weight 20% or more below ideal weight for height. OR
Rate of growth less than 20 g/day from birth to 3 months of age or less than 15 g/day from 3 months to 6 months of age or falloff from previously established growth curve or downward crossing of > 2 major percentiles.
ETIOLOGY
The etiology of FTT has traditionally been divided into organic, inorganic and mixed.
Organic FTT; Is a growth symptom of virtually all serious pediatric physical illnesses, such as gastro esophageal reflux, malabsorption syndrome, cystic fibrosis and congenital heart disease.
Nonorganic FTT; Is a failure of growth without diagnosable organic disease. It is caused by a psychosocial problem between the infant or child and the mother or other primary caregiver.
Mixed FTT; has both organic and nonorganic causes and cannot be described as either alone.
NOTE:-
The standard classification of dividing the causes of FTT as organic and non-organic is probably not very appropriate. Whether the condition is primarily organic or non-organic in origin, all children who fail to thrive suffer the physical and psychological consequences of malnutrition and are at a significant risk for long-term physical and psycho developmental sequelae. Organic diseases are responsible for less than 20% of cases with FTT. The causes of FTT are as;-
1. INADEQUATE CALORIC INTAKE
• Incorrect formula preparation
• Neglect
• Excessive juice consumption
• Poverty
• Behavioral problem affecting eating
• Non-availability of food
• Misperceptions about diet and feeding practices
• Errors in formula reconstitution
• Dysfunctional parent-child interaction, child abuse and neglect
• Behavioral feeding problem
• Mechanical problems with sucking, swallowing and feeding
• Primary neurological diseases
• Chronic systemic disease resulting in anorexia, food refusal and neurological problems
2. INADEQUATE ABSORPTION
• Cystic fibrosis
• Celiac disease
• Vitamin deficiencies
• Hepatic diseases.
3. INCREASED CALORIC REQUIREMENT
• Hyperthyroidism
• Congenital heart disease
• Chronic immunodeficiency
• Chronic respiratory disease
• Neoplasm
• Chronic or recurrent infection
4. EXCESSIVE LOSS OF CALORIES
• Persistent vomiting
• Gastro esophageal reflux disease
• Gastrointestinal obstruction
• Increased intracranial pressure
• Renal losses - renal tubular acidosis
• Diabetes mellitus
• Inborn errors of metabolism
Determinants of Eating Behavior and its Impact on Chronic Diseases.pptxWajid Rather
S-1 Prevalence of Chronic disease in India
S-2 Percentage of Hypertension in Indians
S-3 Percentage of Hypertension in Indians
S-4 Percentage of overweight Indians
S-6 Chronic diseases share
common risk factors and conditions
S-7 Major Factors Influence Our Eating Behavior
S-8 Portion sizes
S-9 Informational Eating Norms
S-10 Family and Social Determinants
S-11 Environmental Influences on eating Behaviour
S-12 Parental Influences on on children's Eating pattern and Food Choices
S-13 Eating Disorders
S-14 Types of Eating Disorders
S-15 Health Effects of Different Types of Eating Disorders
S-16-18 Diagnostic Consideration for Different types of Eating Disorders
S-23 Different Treatment Options for eating Disorders
S-24-27 Nutritional Assessment, Intervention and Nutrition Monitoring and Evaluation
Determinants of Eating Behavior and its impact on chronic Diseases.pdfWajid Rather
Slide no 1: Determinants of Eating Behavior and its Impact on Chronic Diseases
Slide -2 Prevalence of Chronic Diseases in India
Slide-3 Percentage of Hypertension in Indians
Slide-4 Percentage of Overweight Indians
Slide-5 Chronic Disease share common Risk factors and Conditions
Slide-6 Major Factors influence our Eating Behaviour and Food Choices
Slide-7 Portion Sizes
Slide-8 Information Eating Norms
Slide-9 Social Determinants
Slide-10 Environmental Influence on Children's Eating and Food Choices
Slide-11 Parental Influences on Children Eating and Food Choices
Slide-12 Eating Disorders
slide-13 Types of Eating Disorders
Slide-14 Health Effects of Different types of Eating Disorders
Slide -15 Diagnostic Consideration for different Eating Disorders
Slide-16 Treatment options for Eating Disorders
Slide -17 Nutrition Assessment
slide-18 Nutrition Intervention
Slide -19 Nutrition Monitoring and Evolution
This is an undergraduate presentation on failure to thrive in Pediatrics. In this presentation I mentioned about Diagnosis, Etiology, Etiology, Diagnostic Evaluation and Management.
https://orcid.org/0000-0001-9306-2267
https://1drv.ms/p/s!Am9GQ5GMX-WyjmOfgcNpov4RewVL
Pamudith Karunaratne
Feeding and Eating disorders are one of the devastating disorders , Anorexia is a killer disease , very common in childhood and adolescent, mainly in girls more than boys. Bulimia is charecterize by binge eating followed by compulsive purging . Binge eating disorders and night eating syndrome are becoming very prevalent
Feeding disorders as avoidant restrictive food intake disorder , rumination disorders and pica are the types of feeding disorders in infant and childhood period
psychological rehabilitation, nutritional plan and medical therapy are the most effective lines of treatment foe eating Disorders
Aim of nutritional assessment
To identify nutritional problems of the community
To find the underlying cause for malnutrition
To plan and implement control of malnutrition
Maintain good nutrition of community
Service providers who receive high nutrition risk referrals, particularly Registered Dietitians, need to be knowledgeable about general and clinical pediatric nutrition as well as counselling skills for working with families and children.
This is the second of five self-directed training modules available in PowerPoint presentations that have been developed and evaluated to respond to this need
Presentation covers the different types of nutritional status in individuals; undernutrition, malnutrition, and over nutrition. Also discusses different causes of those types.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Feeding and Eating disorders are one of the devastating disorders , Anorexia is a killer disease , very common in childhood and adolescent, mainly in girls more than boys. Bulimia is charecterize by binge eating followed by compulsive purging . Binge eating disorders and night eating syndrome are becoming very prevalent
Feeding disorders as avoidant restrictive food intake disorder , rumination disorders and pica are the types of feeding disorders in infant and childhood period
psychological rehabilitation, nutritional plan and medical therapy are the most effective lines of treatment foe eating Disorders
Aim of nutritional assessment
To identify nutritional problems of the community
To find the underlying cause for malnutrition
To plan and implement control of malnutrition
Maintain good nutrition of community
Service providers who receive high nutrition risk referrals, particularly Registered Dietitians, need to be knowledgeable about general and clinical pediatric nutrition as well as counselling skills for working with families and children.
This is the second of five self-directed training modules available in PowerPoint presentations that have been developed and evaluated to respond to this need
Presentation covers the different types of nutritional status in individuals; undernutrition, malnutrition, and over nutrition. Also discusses different causes of those types.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
12. Other definition
Change of growth that has crossed two
major growth percentiles (i.e. from above the
75th percentile to below the 25th).
13. Attained growth
Weight <3rd percentile on NCHS growth
chart
Weight for height <5th percentile on NCHS
growth chart
Weight 20% or more below ideal weight for
height
Triceps skinfold thickness < 5 mm
14. Rate of growth
Depressed rate of weight gain
<20 g/d from 0 to 3 months of age
<15 g/d from 3 to 6 months of age
Falloff from previously established growth curve
Downward crossing of >2 major percentiles on
NCHS growth chart
Documented weight loss
22. c)Unavailability of food
Inappropriate feeding technique
Insufficient/inadequate volume of food
Inappropriate food for age
Withholding of food (abuse, neglect)
41. Medical history
Prenatal care and complications (infection,
maternal nutrition, drug exposure)
Gestational age and growth parameters at birth
(SGA, prematurity)
Perinatal complications (infections, CNS
insults, anomalies)
42. Previous hospitalizations, illnesses, and surgery
Current medications
Review of systems (vomiting, stooling patterns,
mechanics of feeding/swallowing, anorexia,
distress/tiring with feeds)
43. Nutritional history
Caloric intake
Breast-fed: schedule and length of feeds; maternal
cues to prefeeding engorgement, milk let-down, and
drainage postfeeding; maternal diet, rest, stress, and
medications
Formula fed: type, method of preparation; feeding
schedule; amount offered and consumed
Mixed diet: 3-day diet history (food/beverage type,
method of preparation, quantity consumed)
44. Schedule and length of feedings
Daily feeding/mealtime environment
Location/positioning during feedings
Perceptions of suck, swallow, and grasp of nipple
Caregivers involved with feedings
45. Amount and type of mealtime
supervision
Behavior during feeding
History of progression to solid/table foods
Favorite/disliked foods
Parental knowledge/beliefs regarding
child/infant feeding
Family eating practices and beliefs
Financial constraints affecting food
availability
50. Observation of a feeding
Feeding environment (home observation)
Type and amount of food offered
Duration of feeding
Child's oromotor and fine motor skills
51. Laboratory studies
Diagnostic tests directed by positive findings
on history, physical, and review of growth
date
@complete blood count,
@serum electrolytes,
@serum creatinine, urinalysis (± culture),
total protein/albumin, bone age (if height
growth also poor)
52. Hospitalize if:
Evidence of physical abuse and/or severe
neglect
High risk for abuse and neglect, very disturbed
parent & child interaction, poor parent functioning,
and/or an extremely stressful environment
Severe malnutrition and/or medically unstable
Outpatient management failure
Editor's Notes
What do you notice about this curve?The child is decreasing in weight and height percentiles over time. However, for the last 1 year (3 points) the child remains stable on the 10%ile for weight. Sometimes children between 12 mos to 2 years have a period of growth decline where they trend downward to find “their curve”. Sometimes children are born on the 75%ile but don’t really belong there based on genetics and other factors, they may trend downward to find their own curve. The reassuring thing is the child is not losing weight nor staying the same weight. Also, she is stable now on the 10% and height is stable at 25%ile.
What do you notice in this growth chart?
The points are all very close to or below the 5%ile. However, the child has been following a predictable pattern of growth since birth. He never loses weight or stays the same weight. He is just a smaller child and has been this way since birth.
Making sense of the growth chart is easier when you take into account the weight for height. If the weight for height is low, this means that the child’s weight is not appropriate for their height. This is more concerning than simply if their weight for age is low.
This is the weight for height for the child Thomas whose growth chart we looked at before. Remember both his weight and height were low but his weight for height is NORMAL (10%ile). This shows Thomas weighs an appropriate amount for how tall he is.