Don't forget that there are two patients during the consultation. (Mum and baby)
Most common cause > 90 %. Normal variant and nutritional deprivation
History and examination is the key. No use ordering a lot investigations
Measure weight, height and head circumference and plot them on growth chart
** Feeding history is the key **
General observation is the key to this examination. Mother baby interaction, signs of abuse and neglect, loss of muscle bulk and subcutaneous fat sores.
Red flags:
- Signs of abuse or neglect
- Poor carer understanding
- Signs of family vulnerability e.g. drug and etoh abuse, domestic violence, social isolation, no family support
- signs of poor attachment
- parental mental health issues
- already/previously case managed by child protection services
- did not attend or cancelled previous appointments
- signs of dehydration
- signs of malnutrition or significant illness
Investigation (if required):
- FBE, ESR
- UEC, LFT
- Iron studies
- Calcium, phosphate
- Thyroid function
- Blood glucose
- Urine MCS
- Coeliac screen
- Stool MCS
- Stool for fat globules and fatty acid crystals
Management depends on the cause. Most of the time can be managed in the community. Admission may be required if the child is dehydrated and unstable social situation.
References:
RCH
John murtagh
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