Clinical Case Study

The final project for my 5-week clinical rotation was a case study on a patient of my choosing. I probably saw close to or over 100 patients during this rotation, and the patient I chose was a 5-month old diagnosed with failure to thrive (FTT). The reason I chose this patient because it was in an area I was not so familiar with (pediatric nutrition), and I found the social/environmental cause of it interesting to learn about.  Roanna and I presented our case studies today in front of an audience of 10 Registered Dietitians. I learned a lot from her case study, which was focused on a 25-year old anorexic patient with multiple health issues.  Here is my powerpoint presentation for my case study below.

Possible Causes for Failure to Thrive (FTT)

Failure to Thrive is defined in infants and children as a “physical sign of undernutrition, characterized by growth rates that do not meet expected standards for infants and toddlers under 3 years of age.”

Insufficient growth and undernutrition could be caused by either “organic” or “nonorganic” causes.

Nonorganic failure to thrive can be looked at as environmental in nature. This is primarily thought to be caused by the caregiver’s actions– not feeding the child appropriate amounts (unintentionally or intentionally), not recognizing the child’s hunger cues, not feeding enough during the day, insufficient breast milk production, parental neglect, and family relationship problems.

Organic failure to thrive has been associated with a chronic disease process or disability.  These can be diseases that cause inadequate energy intake (Prader-Willi syndrome, GERD); inadequate nutrient absorption (celiac disease, cystic fibrosis, Bartter syndrome); increased metabolic demands (cerebral palsy, fetal alcohol syndrome, hyperthyroidism), or defective nutrient utilization (Cornelia de Lange syndrome, Inborn errors of metabolism, Down syndrome).

Failure to thrive could also be caused by a combination of organic and nonorganic factors– perhaps the child has GERD and gets upset during feeding times due to the pain of acid reflux. The parents may interpret that as a cue to stop the feeding, and thus the child could become underweight due to its diagnosis of GERD as well as the parents’ failure to provide enough energy and nutrition to the child.

Here’s an example of a growth chart:

Here you can see a baby girl who has stayed within the 50-75th percentile for length at birth as well as at 5 months of age. The child was also born at an appropriate weight – also in the 50-75th percentile. However, at 5 months of age, the child’s weight-for-age has dropped to below the 5th percentile. These growth charts show that the child’s weight gain has not followed the growth curve appropriately and is now underweight. A child whose weight plateaus and drops below the 5th percentile for weight could be malnourished and defined as failure to thrive.