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Additional resources for CURRENT Diagnosis & Treatment in Family Medicine
General Considerations Failure to thrive (FTT) is an old problem that continues to be an important entity for all practitioners who provide care to children. Growth is one of the essential tasks of childhood and is an indication of the child’s general health. Growth failure may be the first symptom of serious organ dysfunction. Most frequently, however, growth failure represents inadequate caloric intake. Malnutrition during the critical period of brain growth in early childhood has been linked to delayed motor, cognitive, and social development.
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297. 24 / CHAPTER 3 neurotoxic effects of bilirubin. Bilirubin can enter the brain when not bound to albumin, so infants with low albumin are at increased risk of developing kernicterus. Conditions that alter the blood–brain barrier such as infection, acidosis, hypoxia, sepsis, prematurity, and hyperosmolarity may affect the entry of bilirubin into the brain. In infants without hemolysis, serum bilirubin levels and encephalopathy do not correlate well.
The parents, afraid to overtax the “fragile” child, may not give the child the time needed to eat. They may become frustrated that they are not easily able to accomplish this most basic and essential component of care for the child. Parents of an ill child may perceive that other aspects of care are more important than feeding, such as strict adherence to a medication or therapy regimen. Children with organic disease underlying FTT often gain weight in the hospital when fed by emotionally uninvolved parties such as nurses, volunteers, or physicians: these people do not feel that the child’s difficulties represent personal failure and may be more patient.