Talk:Failure to thrive

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Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): 112 CARL.

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Geriatric FTT

At least a sentence or two on the subject would be prudent. See http://www.annals.org/cgi/content/full/124/12/1072 —Preceding unsigned comment added by 98.117.81.227 (talk) 01:07, 18 November 2008 (UTC)

faltering growth

Can you give a citation for faltering growth as a substitute for ftt? I am dubious. It certainly cant be descrbed as "popular". alteripse 11:06, 18 November 2005 (UTC)

new addition

This extensive rewrite contains some useful new info as well as a couple of minor errors, but needs a rewrite in encyclopedic style. It sounds like a superficial "advice to parents" column from a throwaway newspaper. I reinserted a lead paragraph with a concise definition. Please compare with our other articles. I would encourage new editor to make account and examine some other articles for style and structure. If you are not interested I will try to correct some of the major problems over the near future. alteripse 03:19, 21 March 2006 (UTC)

This "extensive rewrite" was copied from KidsHealth. The copyvio has been reverted. Zvika 17:10, 4 April 2006 (UTC)

Deleted Text

As the information on this topic was currently a stub it seemed benefitical to place a link to information (written by medical professionals for parents of affected children). It was not a solicitation, rather an effort by a parent of a child with a growth disorder trying to reach out and help other parents seeking information. I did not intend to offend anyone nor break any "rules". —The preceding unsigned comment was added by Slupie (talk • contribs) 19:59, 27 February 2007 (UTC).

The whole page need to be rewritten

Wider lay use or should be layman term usage of failure to thrive need to be deleted. There are many other terms that have any other meanings in many different aspect but not stated in the same page because it needs to be discussed in another page. also usage of acronyms should not be encourage such as CBC which some would know it as complete blood count but majority will not know it or using other terms such as full blood count. Overall, this topic should be completely rewritten in dictionary style not like advising style with lines of each subtopic and complete with references, that should not only limits on webpages but also recognised world-wide universities teaching of paediatrics textbook. Another very annoying things I've realized written here is when it should be in subtopic of diagnosis, it should not be like a story going to hospital then do this and do that but should be appropriately list down all the relevant clinical features, relevant investigation and findings, not the whole baseline investigation with no real reason explained why it has to be done and the expected results to be seen in failure to thrive. (such as what written here: CBC with differential, an ESR, BUN or serum creatinine level, urinalysis (including ability to concentrate and acidify), urine culture, and examination of the stool for pH, reducing substances, odor, color, consistency, and fat content. Depending on prevalence of specific disorders in the community, blood lead level, HIV, or TB testing may be warranted.) —Preceding unsigned comment added by Shamsul b (talk • contribs) 11:15, 23 January 2008 (UTC)

--210.11.135.5 (talk) 02:43, 12 June 2008 (UTC)

Additional Nonorganic causes

This page needs to be expanded, as there are additional nonorganic causes besides poor caregiving/depravation. I'm looking for sources at the moment, and will update the article shortly, but any help is appreciated.

Specifically FTT can be caused by behavioural aversions (e.g. oral aversion, hand aversion) in children, and is especially prominent in premature babies due to the intubation tubes used during their post-natal care. My daughter (born 26 weeks, 3 days at 428 grams and hospitalised for approx. 5 months) has minor oral aversion and, after gaining 30 grams between her 11th and 14th month, has been diagnosed with FTT, given a nasogastric tube and refered for speech pathology. Nobody has ever questioned our parenting techniques. -- 210.11.135.5 (talk) 02:49, 12 June 2008 (UTC) (aka Calrion)

Merge proposal

It looks like Growth failure is the same thing, so I think these articles should be merged. I'm not sure which term should be the article title, though. WhatamIdoing (talk) 20:35, 16 March 2010 (UTC)

They are not the same thing. In practical terms, growth failure is poor ht growth in a child old enough to stand up. FTT is poor wt gain in an infant too young to stand and measure reliably. As silly as it may sound, that is what the terms refer to in real life. But behind that, the range of causes and the workups are very different. There are whole texts written on FTT and others on growth failure, and the overlap is perahps 10%. The overlap of the two articles should also be less than 10% alteripse (talk) 00:54, 17 March 2010 (UTC)

That might be the pattern in some places, but sources like eMedicine and Medline suggest that the terms are interchangeable. Do you have sources that explicitly distinguish between the two terms? WhatamIdoing (talk) 16:46, 17 March 2010 (UTC)

The FTT article from emedicine is written by a gastroenterologist and despite a couple of distracting growth curves of older children with growth failure, focuses on nutrition and poor wt gain in young children, and fits exactly my definition. Contrast it with the emedicine article on growth failure written by an endocrinologist and you will see the focus is on ht growth in older children. These two articles shoul be the models for our articles and correspond precisely to my distinction. The experts in FTT are pediatric gastroenterologists, the patients are infants, and the key anthropometric is the weight. The experts in growth failure are pediatric endocrinologists, the patients are children old enough to stand to be measured, and the key anthropometric is height. Both the emedicine articles were written by experts. The NIH definition is anomalous and clearly written by someone with nothing but superficial knowledge of either. alteripse (talk) 01:16, 18 March 2010 (UTC)

Okay, I've given you two sources that directly declare these terms to be equivalent, using words like "Growth failure, or failure to thrive (FTT), is a descriptive term..." and "Synonym".

You've asserted that specialists in this field or that field prefer one term over the other, and you've asserted that this preference indicates a true distinction, rather than a superficial difference in terminology.

What I need is a source that directly declares that growth failure is not (ever) failure to thrive. It's not enough to say in your experience, gastros seem to choose FTT and endocrinologists seem to choose GF: We need a source that directly makes this assertion.

I haven't been able to find any such source. I have found sources that assert that the opposite. Are you aware of sources that I'm not able to find? WhatamIdoing (talk) 23:37, 21 March 2010 (UTC)

Dont be obtuse. The two emedicine articles you and I linked above are about 90% noncongruent and show that the closest thing there is to an online medical encyclopedia written by medical authorities also considers them different enough to be worth 2 articles by two different types of specialists. Asking for a source that says they are not the same is like asking me for a source that says bronchitis and pneumonia are not the same (i.e., a superficial chapter on resp infections might include them together but a larger or more detailed treatment would not). Go to a medical library or to Amazon and look at the contents list of a major pediatric text and you will find the two topics dealt with in two different parts of the book. Of course you could merge the articles, but when someone decides to do the topic right it will get big enough to be be separated again. You are smarter than this. alteripse (talk) 10:47, 22 March 2010 (UTC)

Your analogy would only be relevant if there were any realistic chance of reliable sources asserting that bronchitis and pneumonia are the same.

As for Emedicine having more than one article, this doesn't prove anything. I find four major articles there exclusively about myocardial infarction (Cardio, PedsEmergency, and Radiology), but I think we can agree that MI in front of an emergency room physician is not actually a different disease compared to MI in front of a cardiologist. That source seems to enjoy having the maximum number of articles, all written from the perspective of different specialties (and sometimes multiple ones from the same discipline).

But if you want to declare that peds textbooks are the best determinants, then here's a sample:

• ISBN 9780763783563 p 391 begins "Growth failure (also known as failure to thrive)..." and the index (p. 692) says, "Growth failure. See failure to thrive"
• ISBN 9780781770323 p 97 uses the terms interchangeably
• ISBN 9780838584507 p 7-11 uses the terms interchangeably, describing, e.g., "children with severe psychosocial failure to thrive" in one paragraph and "children with grown failure" in the next.
• ISBN 9780323011990 p 677 (gastro text) uses both terms in adjacent sentences to describe toddlers with celiac disease

So that's what my survey of peds texts say. Can you name even one medical textbook that treats these two terms as completely different things (e.g., separate chapters on FTT and GF, or gives separate/different definitions for them, or tells students when to use each term)? WhatamIdoing (talk) 22:12, 22 March 2010 (UTC)

But you didnt actually read the sources, did you? Or you would have discovered that FTT is a subset of growth failure and the pages indexed referring to infant nutritional growth failure (FTT) are dealt with in different parts of the book than the pages dealing with height growth failure in older children. But you know what. I dont care. Do what you want, Randy from Boise. Put the skeletons in the article. alteripse (talk) 02:32, 23 March 2010 (UTC)

I haven't read every page of these textbooks, but I've read enough to see that these sources (and others) use the two terms interchangeably.

Contrary to your assertion, the sources don't restrict FTT solely to "infant nutritional growth failure". Multiple sources use it to describe lack of growth in non-infants/toddlers/children. All sources name non-nutritional problems, like Down syndrome and cardiac defects as a cause of organic FTT (only non-organic FTT is a nutritional problem). Several sources directly equate the two terms.

I agree with the lead's assertion that "Common usage refers to infancy", but that doesn't mean that 'losing weight due to neglect, and the kid is old enough to stand up' is different from 'losing weight due to neglect, and the kid is not old enough to stand up.' WhatamIdoing (talk) 02:49, 23 March 2010 (UTC)

FTT - Newborn

Should we add 779.34, for babies under 28 days? --SarekOfVulcan (talk) 13:43, 27 April 2012 (UTC)

Hi SarekOfVulcan (talk)! Good idea, please do so. Lova Falk talk 15:38, 21 May 2013 (UTC)

Edit Suggestions

Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

1. Under Failure to thrive#Children, we propose to add: "Causes of FTT can be largely grouped into three categories: inadequate caloric intake, inadequate nutrient absorption, and increased metabolism. Inadequate caloric intake causes may include, among other things, gastroesophageal reflux, insufficient breast milk supply or ineffective latching, and incorrect formula preparation. Inadequate nutrient absorption includes anemia or iron deficiency, celiac disease, and cystic fibrosis. Increased metabolic causes includes chronic infection, congenital heart disease, and hyperthyroidism."

2. We noticed that link 1, the Dorland Medical Dictionary, was no longer active. We will update the link with a medline plus definition.

3. We propose to insert a "History" section to discuss the origin and evolution of the term ‘Failure to Thrive’. "FTT was first introduced in the early 20th century to describe poor growth in orphan children but became associated with negative implications (such as maternal deprivation) that often incorrectly explained the underlying issues. Throughout the 20th century, the term ‘FTT’ was expanded to include many different issues related to poor growth, which made it broadly applicable but non-specific. The current conceptualization of FTT acknowledges the complexity of stunted growth in children and has shed many of the negative stereotypes that plagued previous definitions."

4. We propose to insert a new heading “Signs and Symptoms” under the Children section to include more specific information on the diagnostic evaluation. Evidence we propose to add: "Failure to thrive may be evaluated through a multifaceted process, beginning with a patient history that notably includes diet history, which is a key element for identifying the reasons behind failure to thrive. Next, a complete physical examination should be done, with special attention being paid to identifying possible organic sources of failure to thrive. This could include looking for dysmorphic features, abnormal breathing sounds, and signs of specific vitamin and mineral deficiencies. The physical exam could also reveal signs of possible child neglect or abuse. Based on the information gained from the history and physical examination, a workup can then be conducted, in which possible sources of failure to thrive can be further probed, through blood work, X-rays, or other tests."

5. We propose to insert a new heading “Treatment” under  Failure to thrive#Children section. We propose to add: “Infants and children who have had unpleasant eating experiences (e.g. acid reflux or food intolerance) may be reluctant to eat their meals. Additionally, force feeding an infant or child can discourage proper self-feeding practices and in-turn cause undue stress on both the child and their parents. Psychosocial interventions can be targeted at encouraging the child to feed themselves during meals. Also, making mealtimes a positive, enjoyable experience through the use of positive reinforcement can improve eating habits in children who present with FTT. If behavioral issues persist and are affecting nutritional habits in children with FTT it is recommended that the child see a psychologist."

6. We propose to insert the following in the Failure to thrive#Children: "Weight loss after birth is normal and most babies return to their birth weight by 3 weeks of age.^[8] Clinical assessment for faltering weight is recommended for babies who lose more than 10% of their birth weight or do not return to their birth weight after 3 weeks.^[8]"

7. We propose to replace the following to Failure to thrive#Children: Remove: “many definitions use the 5th percentile as a cutoff”. Replace with: "FTT is suggested by a fall in one or more weight centile spaces on a WHO growth chart depending on birth weight or when weight is below the 2nd percentile of weight for age irrespective of birth weight. In children whose birth weight was between the 9th and 91st percentile FTT is indicated by a drop across 2 or more centile spaces.

8. We propose to add a reference to the WHO growth charts.

9. We propose to add a new citation to the currently non-cited causes of endogenous failure to thrive such as cystic fibrosis and coeliac disease.

10. We propose to change the lead paragraph in Failure to thrive#Children to: "The term ‘failure to thrive’ has been used vaguely and in different contexts to refer to different issues in pediatric growth. It is most commonly used to describe a failure to gain weight, but some providers have also used it to describe a failure to grow, or a failure to grow and to gain weight."

Thank you for your time and your review. We would appreciate and welcome any feedback or suggestions that you many have.112 CARL (talk) 03:30, 7 November 2017 (UTC)

References

COMMENTS: This article will benefit if you get rid of the existing sections and create the sections commonly used for medical topics: Signs and symptoms, Causes, Diagnosis, Prevention, Treatment, Prognosis, Epidmeiology and History. In that order. Some of your proposed content will slot into those sections. Examples: Your #9 will go into Causes; #8 and #7 into Diagnosis; JenOttawa's proposed revision to #6 could go into Diagnosis; #5 establishes Treatment; #4 reads more like Diagnosis than Signs and Symptoms, also it is written as a how-to-treat ("should", "could") so needs to be rephrases as simple sentences; #3 establishes History; and #1 establishes Causes. Some of the sections recommended have no content. See if you can get at least one sentence and citation into each. Or if that is going beyond the scope of the assignment, delete rather than leave blank. Subsequent editors will fill in. Finally, as a separate conducted edit, I suggest that you BE BOLD and delete the Adults section entirely. If another editor disagrees, that person can revert it, and, one hopes, add more content and citations. Because right now it is weak. David notMD (talk) 12:42, 7 November 2017 (UTC)

Thank you for your comments, David. We agree with the suggestions you have made and are aware that such suggestions would require a significant reworking of the article. We will use your advice in that we will reformat some sections in which we have proposed specific changes within the medical topics format headings. We will use these headings to shift some of the current material around so that it flows better and adheres more closely to the Wikipedian medical topics format. 112 CARL (talk) 17:54, 10 November 2017 (UTC)

Anyone else want to comment on David's suggestion about deleting the Adult section? This would also include modifying the first paragraph. Does "Failure to Thrive" also apply to adults?JenOttawa (talk) 13:07, 7 November 2017 (UTC)

In my opinion, adult failure to thrive is because of an underlying disease. Or else already addressed in the articles on cachexia (includes redirect from Wasting syndrome), sarcopenia and anorexia nervosa. David notMD (talk) 12:39, 10 November 2017 (UTC)

Thank you for your comments. Physician specialists and other topic experts we have consulted have also mentioned that failure to thrive does not accurately describe conditions in adult/geriatric patients. We will continue to monitor the talk page to see if this action garners additional support. 112 CARL (talk) 17:54, 10 November 2017 (UTC)

@112 CARL: Every time you make an edit you should add a brief description in the Edit summary space at the bottom of the screen. Other editors can figure it out anyway via View history and clicking on "prev" but it helps if you describe what was done. David notMD (talk) 01:33, 16 November 2017 (UTC)

Thank you! I will be more mindful of this. I was previewing my edits before saving which did not re-prompt me to add the edit summary. I think I have figured things out now. Thanks for the heads up.112 CARL (talk) 06:26, 21 November 2017 (UTC)

Wikiproject Medicine Update

As part of the Wikiproject course offered at my medical school, I will be working to improve the quality of the failure to thrive article. Failure to thrive is a common diagnosis in pediatrics; furthermore, it is currently a listed as a “Start” article of “High-importance” on Wikipedia’s quality assessment scale. My proposed workplan is as follows:

Epidemiology:I will create a new section, attempting to provide epidemiological data on prevalence, regional differences, socioeconomic statistics, admission rates, and any additional data I can find.

Differential diagnosis by etiology: I've added a new section for grouping various causes of failure to thrive. Currently, there is redundancy with the etiologies section, however, I think it presents the concepts in a more organized fashion than the original format. I plan to edit the etiologies section, leaving most of the details because they are excellent, but eliminating some of the redundant concepts.

Diagnostic approach: I'm planning to work on this section to discuss indications for laboratory workup and will also provide statistics for diagnostic yield of studies, wherever available.

Prognosis: I will create a new section, outlining the long-term outcomes of failure to thrive, as well as long-term complications associated with untreated cases. — Preceding unsigned comment added by Tylerhall87 (talk • contribs) 21:08, 8 March 2018 (UTC)

Our edits are on this google doc below: https://docs.google.com/document/d/1kLvsx4S_vCbErBaXmO5dlS3YHS2Ct-GdPjwnFuAfdb8/edit?usp=sharing

UCF COM WikiProject Medicine Peer Review

Overall, you did a great job. Your edits have substantially improved the article. You have addressed all the goals you listed initially. All references are appropriate, reputable, and up to date. I spot checked several reference links and all were functional. The article flows well and is easy to comprehend. There are several edits that I have listed below that you may consider making. Most are subtle.

- Consider spelling out WHO to World Health Organization (WHO) in the lead section.

- A reference is needed for the following sentence in the lead section: “As used by pediatricians, it covers poor physical growth of any cause and does not itself imply abnormal intellectual, social, or emotional development, although it can subsequently be a cause of such pathologies.” There are multiple sentences (i.e. “Milk allergies can cause endogenous FTT”) in the etiologies section that do not have references as well.

- Consider adding the word “excessive” prior to the word “gas” as clarification in the etiologies section.

- Gas and acid reflux are hyperlinked to an article on GERD in the etiologies section. The word “gas” can be removed from the hyperlink.

- Maybe consider adding a sentence or something along the lines of this to the treatment section: “if a specific condition such as inflammatory bowel disease is identified as a cause for a child’s FTT then treatment is directed towards that underlying condition.”

- There are a couple of typos I came across:

1) Remove the word “is” that precedes “occurs” in the following sentence in the presentation section: “Failure to thrive is occurs in children whose nutritional intake is insufficient for supporting normal growth and weight gain.”

2) In the following sentence in the prognosis section either “achieving” or “reaching" can be used but using both may be redundant: “Failure to thrive may also result in children not achieving reaching their growth potential, as estimated by mid-parental height.”Abotwin (talk) 22:33, 25 March 2018 (UTC)Abotwin

Thank you for the review and your helpful editing suggestions! I've reviewed your suggestions and made the appropriate updates. Tylerhall87 (talk) 16:46, 27 March 2018 (UTC)

MUSC COM Wikiproject Medicine

Work plan: In the next 4 weeks I will be working on this article as part of my curriculum at my medical school. Failure to thrive is a common problem with the pediatric population, and one that has many potential causes. Understanding the intricacies of the disorder and the multifaceted nature of its origins can better help us understand how to treat it. I hope to improve this article by:

-In the "Presentation" portion, I will add likely physical exam findings that physicians use to assess the need for more extensive workup

-Under the "Diagnosis" heading, list normal blood work and labs that are performed, as well as what these tests are intended to rule out or rule in

-Addressing re-feeding syndrome and the pathophysiology behind it, most likely under the "Treatment" heading

-I would also like to add some images, particularly one of a normal growth chart and one of a FTT child

-List the "congenital heart defects" most often associated with FTT, as well as TORCH infections

-Add some of the "nonorganic causes" that are missing (ARFID, speech pathology, esophageal dysmotility)

-Address pre- and perinatal conditions that can predispose a child to FTT (poor breast milk production, Low birth weight, intrauterine growth restriction, perinatal stress, and prematurity)

-Address maternal substance use and the relation to FTT

-Discuss "wasting" as a decrease weight in proportion to length vs. "stunting", where height decreases after weight decreases; both are indicative of FTT

-Add a sentence or two about head circumference, and the difference in etiologies in children with decreased weight, length and head circumference vs. children with only decreased weight

-In "Epidemiology", provide some worldwide statistics on FTT to compare and contrast the US vs. Europe vs. World

-In "Treatment" I would like to add the goal growth parameters that define adequate response to treatment. I would also like to address the temporary (usually) measures used to circumvent feeding difficulties in the setting of adequate or near-adequate absorption (G-tubes, NG tubes)

Bts200 (talk) 20:28, 19 November 2018 (UTC)

Hey there! I've completed my peer review of your article, and after reviewing your work plan, here are my thoughts in response to your plan:

1) I think the information you've included in the "Presentation" section is solid. For example, you talk about the decrease in head growth, decelerated weight gain, and deceleration in stature. One suggestion I might have is to maybe categorize the Fetal Alcohol Syndrome and malabsorption etiologies (Crohn's, cystic fibrosis) into the following "Etiologies" section. I see that one of your goals was to include physical exam findings, and you did a good job doing that.

2) "Diagnosis" information is well done. You included the pertinent blood work, labs, and images that are commonly used in making an accurate diagnosis. One thought I have is to maybe include a minor point about the utility (or not) of genetic panels for endogenous causes that run in families. But overall, I think this section could stand on its own without any changes.

3) I like the refeeding syndrome bit that you added, and I think it is clear to the non-medical person (it's a difficult concept to convey to the casual reader). Good job with this.

4) I see you linked the TORCH infections along with congenital heart defects in your article-- good job with this to make cross-referencing easier on the casual reader.

5) You wanted to address pre- and perinatal conditions that can predispose to FTT, and I think you did well with this by grouping into endogenous vs exogenous etiologies. Great job distinguishing "wasting" vs "stunting"-- I did know these differences!

6) I might suggest rearranging the "Epidemiology" section and putting it more towards the top, perhaps before the "Etiology" section.

Your sources are relevant, reliable, and up to date. You included appropriate in-line citations. This is a complex topic that had a lot of "talking" going on among a number of writers, and I think you did a nice job updating it and adding useful information. I see that you wanted to add a FTT growth curve, but I understand that may not have been possible given the licensing restrictions.

I felt that the writing of the article was neutral and well-referenced. It includes a lot of information. Nice work!

-GJS200 — Preceding unsigned comment added by Gjs200 (talk • contribs) 17:50, 9 December 2018 (UTC)

Is "faltering growth" now the accepted term instead of "failure to thrive"?

I came across this text that says that faltering growth is the new term to be used instead of 'failure to thrive'. How much of this is true as of early 2019? --CopperKettle 07:11, 29 April 2019 (UTC)

Comments for Recent Edits 9.13.21

"In 2014 approximately 462 millions adults were estimated to be underweight" - could add a comma after 2014

Both moderate and severe acute malnutrition are problems primarily localized to resource-limited regions and are uncommon in resource rich countries like North America, Australia[38]. - can change end of the sentence to "like the United States or Australia" since you are referring to countries (Meseigbe)

Low Resourced regions and Management in low resourced regions could be its own section and you could move Epidemiology either to the beginning part of the article or as its own section before Signs and Symptoms

"Other features include reduced physical activity, mental apathy, and retarded psychomotor and mental development" - Instead of retarded, maybe use a word like "delayed" (Kamwiki123)

UCSF Wikipedia Elective December 2021

Hello! I am a fourth year medical student at UCSF. I am planning to work on this article during my month-long WikiProjects Medicine course in November/December 2021. Here are my plans for edits. Any feedback/suggestions are welcome!

Lead

• Edit language to be clearer, reduce jargon, and eliminate redundancies

Signs and symptoms

• Edit language to be clearer, reduce jargon
• Organize this section to more clearly delineate what signs/symptoms correspond with which categories of causes
• Move any information that belongs in other sections of this article to the appropriate sections

Cause

• Move any information that belongs in other sections of this article to the appropriate sections
• Standardize information following each bullet point "Inadequate caloric intake," "Malabsorption/caloric retention defect," and "Increased metabolic demand"

Epidemiology

• Add more information on epidemiology in developed/high income countries, consider adding sub-section on this to match the sub-section "Low resourced regions"
• Move "Management in low resourced regions" to the Treatment/Management section of the article

Diagnosis

• Clean up and improve organization of this section
• Reduce jargon (E.g., use more commonly understandable language for the sentence: "Common bloodwork should include a CBC with differential, a complete metabolic panel to look for electrolyte derangements, a thyroid function test, and a urinalysis.")

Treatment

• Consider re-organizing this section and adding sub-sections/headers for each etiological category for failure to thrive
• Add information on treatment of any etiologies of failure to thrive that are not currently covered in this section
• Move information from "Management in low resourced regions" above to this section; organize so that this added information flows smoothly

Prognosis

• Look into more recent research for prognosis of failure to thrive, update section if there are new findings and more updated information

MountainMarigold (talk) 04:17, 29 November 2021 (UTC)

UCSF Wiki Medicine Peer Review

Hello! I want to thank you for the improvements you've made to the page, offer some peer review and suggestions for further editing among Wikipedians! Below I offer thoughts that relate to the plan you laid out for the UCSF course.

Lead
I think this is clear and jargon free - great! However, I would suggest a few minor edits:

• "FTT, also known as weight faltering or faltering growth, is a term used in medicine to refer to insufficient...."
• I would delete: "The term "failure to thrive" has been used in different ways,[5]" and start with "There is no objective..."
• This seems out of place in the lead: "While weight loss after birth is normal and most babies return to their birth weight by three weeks of age, clinical assessment for FTT is recommended for babies who lose more than 10% of their birth weight or do not return to their birth weight after three weeks.[8]"

Signs and symptoms

• Again, clear and jargon free!
• My query here is that "Signs and symptoms" itself seems like an inappropriate header given this is not a disease, as you explain in the lead, but in effect a clinical sign itself.
• Instead, I would focus on the distinction between stunting and wasting, and perhaps add growth curves that show the difference in these two patterns of growth.
• I might also add a sentence to disambiguate syndromes of short stature, which typically present in early adolescence.
• "Inadequate caloric intake could be caused by lack of access to food, or caretakers may notice picky eating habits, low appetite, or food refusal." -- I would move this sentence down to the start of the next paragraph -- or even section -- on considering etiologies. It would be very interesting to have a sense of the prevalence and influence, globally, of each factor.
• "Symptoms can include abdominal pain, abdominal distention, hyperactive bowel sounds, bloody stools, or diarrhea.[14][15]" This sentence at the end gets at 'signs and symptoms' but really it's nonspecific and these are symptoms of the diseases named, not FTT, so I would still argue against this framing.

Cause

• Such a well-organized and informative section. I like the paragraph format, rather than bullets, and the distinction between endogenous and exogenous causes. Much of the second paragraph of the 'Signs and Symptoms' sectino could be usefully moved here, as again these symptoms relate to the underlying cause.
• Since you've set it up nicely, I'd include a sentence noting that "Inadequate caloric intake" can be from endogenous, exoganous, or mixed factors, many of which are in the table below. Same for the next two sections.

Epidemiology

• This section is clear, concise and straight forward!
• I wonder if the studies mentioned [ref 57] explain why males are more likely admitted for FTT in the US?
• Also I wonder why the subheadings are not symmetrical, eg: "High-resourced regions" and "Low-resourced regions"
  

Diagnosis

• I think that because diagnosis encompasses the definition, this section might usefully be placed first. It also captures some of the ancillary signs/symptoms that might point to underlying causes, leading the reader into the sections on etiology and epidemiology.
• "Laboratory workup should be done in response to specific history and physical examination findings. Medical providers should take care not to order unnecessary tests, especially given estimates that the usefulness of laboratory investigations for children with failure to thrive is 1.4%.[19]" -- Just noting that this is very interesting! Makes sense given the epi if this estimate is global.
  

Treatment

• I can't easily comment on the organizational changes and improvements you have made, though I think this section could use some further organizational work.
• The first paragraph should start with its own 'lead' that says clearly, 'treatment depends on the underlying cause, as well as the resources available.'
• Consider separating refeeding syndrome into its own paragraph clearly marked as a potential complication of treatment.
• Consider separating behavioral interventions into their own clearly delineated paragraph.
• I don't know that "Management in low-resourced regions" needs its own subheading. It could be separated as CMAM or RUTF as particular interventions, and is very well written and interesting!
• Prevention may warrant a sub-heading; if so would also consider Complications and move refeeding information below.
  

This article is so absolutely important, and chock full of information. Thank you for your diligent work and to the community at large for your efforts! Massmedicine (talk) 00:02, 15 December 2021 (UTC)

Hi! Thank you so much for your peer review. I really appreciate your suggestions, particularly your advice on framing the "Treatment section," as I have yet to begin revising this section. I will also continue to think about how to delineate between the presentation of FTT in general versus the signs and symptoms that are indicative of an underlying disease, given that FTT is a sign in itself. I am hopeful that though I may not have time to act on each one of your suggestions before the course ends this week, future editors may find your peer review helpful when framing how they will continue to improve on this page. MountainMarigold (talk) 03:16, 15 December 2021 (UTC)