Edit Suggestions

Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

1. Under Etiology/Causes, we propose to add: Causes of FTT can be largely grouped into three categories: inadequate caloric intake, inadequate nutrient absorption, and increased metabolism ^[1]. Inadequate caloric intake causes may include, among other things, gastroesophageal reflux, insufficient breast milk supply or ineffective latching, and incorrect formula preparation ^[1]. Inadequate nutrient absorption includes anemia or iron deficiency, celiac disease, and cystic fibrosis ^[1]. Increased metabolic causes includes chronic infection, congenital heart disease, and hyperthyroidism ^[1].

2. We noticed that link 1, the Dorland Medical Dictionary, was no longer active. We propose to change the link to the MedlinePlus definition. https://medlineplus.gov/ency/article/000991.htm

3. We propose to insert a History section to discuss the origin and evolution of the term ‘Failure to Thrive’. FTT was first introduced in the early 20th century to describe poor growth in orphan children but became associated with negative implications (such as maternal deprivation) that often incorrectly explained the underlying issues ^[2]. Throughout the 20th century, the term ‘FTT’ was expanded to include many different issues related to poor growth, which made it broadly applicable but non-specific ^[2]. The current conceptualization of FTT acknowledges the complexity of stunted growth in children and has shed many of the negative stereotypes that plagued previous definitions ^[2]. We plan to describe the major changes to the definition of FTT with a descriptive timeline. This section will allow readers to gain a better understanding of the evolution of the term FTT and help readers identify outdated definitions of the term that are no longer included in the current conceptualization of FTT. We will reference the following literature review: Estrem HH, Pados BF, Park J, Knafl KA, Thoyre SM. Feeding problems in infancy and early childhood: evolutionary concept analysis. Journal of advanced nursing. 2017 Jan 1;73(1):56-70 ^[2].

4. We propose to insert a new heading under the Children section to include more specific information on the diagnosis evaluation of FTT, namely, Investigations and Basic Work Up. After taking a patient’s history and performing a physical exam to evaluate whether or not a child is meeting their growth potential (using appropriate growth charts and calculations), a full work up may be obtained. This work up is conducted in a stepwise fashion. This section will read similarly to the following, with greater detail: Failure to thrive may be evaluated through a multifaceted process, beginning with a patient history that notably includes diet history, which is a key element for identifying the reasons behind failure to thrive ^[3]. Next, a complete physical examination should be done, with special attention being paid to identifying possible organic sources of failure to thrive ^[3]. This could include looking for dysmorphic features, abnormal breathing sounds, and signs of specific vitamin and mineral deficiencies ^[3]. The physical exam could also reveal signs of possible child neglect or abuse ^[3]. Based on the information gained from the history and physical examination, a workup can then be conducted, in which possible sources of failure to thrive can be further probed, through blood work, X-rays, or other tests ^[3]. The details will be discussed further and reference will be made to an article published by The Canadian Pediatric Society [Internet]. The toddler who is falling off the growth chart. 2012. [cited 2017 Oct 9]. Available from: http://www.cps.ca/en/documents/position/toddler-falling-off-the-growth-chart ^[4].

5. We propose to add a section on appropriate intervention, particularly highlighting psychosocial interventions, for treating pediatric patients who present with FTT. We will also be referencing The Canadian Pediatrics Society in this respect ^[4].

6. We propose to insert the following in the Children section: Weight loss after birth is normal and most babies return to their birth weight by 3 weeks of age ^[5]. Clinical assessment for faltering weight is recommended for babies who lose more than 10% of their birth weight or do not return to their birth weight after 3 weeks ^[5]. Will will reference the following: National Institute for Health and Care Excellence (2017). Faltering growth- recognition and management. NICE Clinical Guideline (NG75) ^[5].

7.We propose to replace the following in the Children section: “many definitions use the 5th percentile as a cutoff” to FTT is suggested by a fall in one or more weight centile spaces on a WHO growth chart depending on birth weight or when weight is below the 2nd percentile of weight for a certain age irrespective of birth weight ^[5]. In children whose birthweight was between the 9th and 91st percentile FTT is indicated by a drop across 2 or more centile spaces ^[5]. We will reference the following: National Institute for Health and Care Excellence (2017). Faltering growth- recognition and management. NICE Clinical Guideline (NG75) ^[5].

8. We propose to add a reference to the WHO growth charts. World Health Organization. The WHO child growth standards. Available at http://www.who.int/childgrowth/standards/en/

9.We propose to add references to the currently uncited causes of endogenous failure to thrive such as cystic fibrosis and coeliac disease ^[5]. We will reference the following: National Institute for Health and Care Excellence (2017). Faltering growth- recognition and management. NICE Clinical Guideline (NG75) ^[5].

10. We propose to explicitly distinguish between three sub-diagnoses that fall within the category of failure to thrive (failure to grow, failure to gain weight, and failure to grow and gain weight) in the Introduction section. This introduction will read as follows: The term ‘failure to thrive’ has been used vaguely and in different contexts to refer to different issues in pediatric growth. It is most commonly used to describe a failure to gain weight, but some providers have also used it to describe a failure to grow, or a failure to grow and to gain weight ^[3].

Thank you for your time and your review. We would appreciate and welcome any feedback or suggestions that you many have. 112 CARL ( talk) 17:05, 6 November 2017 (UTC)