PE2.1-2 | Failure to Thrive — Summary & Reflection

KEY TAKEAWAYS

Key takeaways from this module:

• FTT is a clinical sign — weight-for-age < −2 SD or crossing ≥2 centile lines. Always classify severity using weight-for-height AND MUAC.
• SAM = ANY of: weight-for-height < −3 SD, MUAC <11.5 cm, or bilateral pedal oedema. SAM carries high mortality without treatment.
• Non-organic FTT (>70% of cases) results from inadequate caloric intake due to feeding practices, psychosocial factors, poverty, or maternal depression. Organic FTT results from GI, cardiac, respiratory, renal, endocrine, CNS, infectious, or chromosomal causes.
• Assessment: structured dietary and social history + anthropometry (weight-for-age, weight-for-height, MUAC, head circumference) + targeted investigations. MUAC is the single best field tool for SAM.
• Management: SAM with complications → facility-based (F-75 stabilisation → F-100 rehabilitation); uncomplicated SAM → community RUTF. Address the underlying cause. Micronutrients: add iron only in the rehabilitation phase.
• Counselling: non-blaming, empathetic, practically actionable. Address feeding practices AND psychosocial barriers. Provide red flags for immediate return. Follow up with measurable goals.

REFLECT

Think back to the case in the opening scenario — the 18-month-old boy with an apathetic mother. Now that you have worked through this module:

1. What was the most significant finding you might have missed if you had only plotted weight-for-age and not measured MUAC?
2. How would your conversation with the mother be different from a conversation with a caregiver who is engaged and well-resourced?
3. The module emphasised that maternal depression is often missed. How will you build a routine check for caregiver mental health into your clinical assessments of children with growth problems?
4. Kolb's cycle of learning suggests that true understanding comes from reflecting on experience. After your next clinical encounter with a child who has a growth problem, how will you apply today's learning to your assessment approach?