Return to Scenario ListShow Learning Points most relevant to Phase 1:

Failure to thrive

Clinical Discipline(s)/Organ System(s)
Paediatrics, Immunology
Progress Test Topic(s)
Child health
A 10 month old NZ European infant girl attends the paediatric outpatient department because the Plunket nurse and her mother are concerned that she is not gaining enough weight. Her weight at the age of 6 months was on the 25th percentile and now is on the 2nd percentile.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy and physiology of the gastrointestinal tract
   - Physiology of growth
   - Infant nutrition and nutrient absorption
   - Pathophysiology of nutritional deficiencies and malabsorption
   - Pathogenesis of autoimmunity (coeliac disease) and allergy
   - Histopathology of coeliac disease and cystic fibrosis
   - Psychosocial development during infancy and childhood
Clinical and Communication Skills 
   - Assessment of child with poor growth including plotting growth parameters (height, weight and head circumference)
   - Obtain a thorough feeding history for a child including when foods introduced (cereals, cows' milk)
   - Recognise symptoms and signs relevant to normal development, that may concern caregivers
   - Recognise important features of history and clinical examination such as cardiac murmurs, dysmorphism, history of recurrent infections or steatorrhoea
   - Differentiate nutritional from other rarer causes of poor weight gain in infancy and early childhood
   - Differentiate short stature due to familial factors from rarer causes, familial short stature, constitutional delay in growth
Personal and Professional Skills 
   - Empathise with the parent/caregiver and show willingness to listen to their concerns recognising failure to grow and feeding can be a source of stress
   - Explore social history, screening for domestic violence/safety and postnatal depression
Hauora Māori 
   - Awareness of disproportionate impact of socioeconomic deprivation on Māori, and appropriate response
Population Health 
   - Epidemiologic differences in growth (WHO growth charts vs NZ)
   - Health promotion of breast feeding
Conditions to be considered relating to this scenario
inadequate caloric intake (feeding problems), familial patterns of growth, food allergy (cows milk protein intolerance/allergy)
Less common but 'important not to miss'
coeliac disease, pyschosocial deprivation (maternal depression, disturbed maternal-infant interaction, neglect), cystic fibrosis
congenital or acquired immunodeficiency, chronic illness (malabsorption, chronic infection), disease of major organ system (e.g. chronic renal failure), congenital heart disease, hypothyroidism, genetic syndrome (Turner's syndrome)