User:112 CARL/sandbox

My Groups article is: Failure to Thrive

Evaluating the Article : Failure to Thrive

Concerns About the Article:

I. Lack of Citations/Relevant Citations

Critique:

• Only 12 references total. Most of the citations in the article are > 5 years old. One of the links did not work (1).
• Good references: Merck Manual
• Most references are single experiment articles or opinion pieces (on terminology semantics) on FTT. This is not the best reference source as per Wikipedia standards due to potential biases.
• Some references are used for bulk of text without much authority on the subject, especially in the Exogenous Factors section and the Geriatrics section.

Our edit plans:

• Find more up to date references, preferably systematic reviews and general review articles.
• Add complete definitions and references from ICD-10 (more recent). Potentially changing the terminology (some articles had alluded to it).

II. Incomplete Information

Critique:

• Additional information on how FTT is classified or measured clinically (including cutoffs)  is needed (ie. “ evaluated by low weight for the child’s age, or by a low rate of increase in the weight”). The article does present the use of the “5th percentile as a cutoff” but does not make it clear as to the 5th percentile of what. Is this referring to height or weight or body mass index? As a lot of the references are now older there may be updated diagnostic criteria and suggested managements for FTT. What cutoffs or criteria are used in adults?
• The description of adult FTT is very brief and needs to be explored in more detail.
• FTT with respect to preterm babies is not explored. This point was brought up on the Talk page and would be important to include.
• Further explanations into the causes of FTT and insufficient nutrition (definition) would make the article stronger.

Our edit plans:

• Add additional information regarding diagnostic cutoffs and FTT diagnosis across age categories.
• Create additional article sections on FTT treatment/management and long term implications.
• Add information regarding the differences between FTT and normal weight loss at birth.
• Elaborate on “mental issues”, socioeconomic impact (developing countries) and warning signs.

III. Confusing/Awkward Wording

Critique

• A challenge with this article is ambiguous and unjustified phrases that require a  background knowledge of the subject to understand. This goes against Wikipedia’s goal of being accessible and understandable, and is something we hope to improve upon. One example of confusion that would help in clarification is the inclusion of a Failure To Thrive Growth Chart (http://gregorygordonmd.com/failure-to-thrive-growth-chart.html).
• An example of wording that could use improvement includes: “The term (FTT) has been used in different ways, and different objective standards have been defined. Many definitions use the 5th percentile as a cutoff.” Although there are four references provided throughout these two sentences, there is no further elaboration on the points made.

How we’ll fix it

• The page requires more thorough explanations on many of the terms and concepts outlined: what are the different ways in which FTT has been used? What are the different objective standards that are used to characterize FTT? Is there a standard across medicine that is used? If so, what is it? What is the 5th percentile referring to?
• Summary: we will clarify phrasing, add definitions, and provide more well-rounded background in sections relating to the introduction, children, and adults.

IV. Relevance of Information

Critique:

• Overall, the information included in this article is relevant to understanding FTT
• There are several minor inclusions of information that is arguably irrelevant. FOr instance, the mention of how endogenous causes of FTT could emerge in developing countries was unpredicted and not consistent with the context and scope of the discussion, which was primarily about differentiating endogenous from exogenous causes of FTT.

Our edit plans:

• We intend on assessing each piece of information within the article critically and deleting irrelevant or distracting information. Information that belongs better under other subheadings will be moved accordingly and framed in the context of the more relevant discussion.

V. Presence of Biases/Overrepresentation of Views

Critique:

• This article over represents FTT in pediatric patients.
• FTT in adult and geriatric populations are mentioned; however, the description of FTT in these patient populations is extremely sparse in comparison.
• The section outlining exogenous causes of FTT in children uses accusatory language and disproportionately attributes FTT in pediatric patients to inadequate caregiver care.

Our edit plans:

• Group 11 plans to present a more balanced description of FTT in pediatric, adult and geriatric patient populations.
• Accusatory language will be replaced by objective descriptions, and the amount of information provided regarding FTT in each patient population will reflect the knowledge present in the medical literature.

V. Article Organization Critique:

• If causes of FTT are divided into endogenous and exogenous causes why is this section only included under children?

Our edit plans:

• In addition to having categories of FTT based on age it would be nice to have matching subcategories for them.

The Talk Page of this Article:

Last Contributed to:

• According to the Wikipedia talk page for the topic of Failure to Thrive, the last suggestion for editing was made in April 2012. However, it is important to note that this suggestion was not responded to until May 2013 (over 1 year later) and it is unclear whether or not the suggested change was actually implemented.

Main Suggestions/Discussion:

• Failure to thrive in elderly patients is not mentioned in the Failure to Thrive Wikipedia article. In the talk page discussion, editors suggest that Failure to Thrive in all populations (premature infants, term infants, children, adults, and the elderly) be described in terms of epidemiology and disease origin (inorganic and organic causes).
• Faltering growth is mentioned as being interchangeable with Failure to Thrive but is never referenced in the Wikipedia article. Additionally, acronyms such as CBC are used and never defined. Editors suggest that all terms and acronyms be defined and referenced.
• Editors suggest that investigations for the condition and their findings as well as differential diagnoses be explained and referenced.

References To Consider

Al Nofal, A., & Schwenk, W. F. (2013). Growth Failure in Children. Nutrition in Clinical Practice, 28(6), 651–658.

Anderson K, Baraldi C, and Supiano M. (2012). Identifying failure to thrive in the long term care setting. Journal of the American Medical Directors Association.13, 665-e15.

Black, R.E., Victora, C.G., Walker, S.P., Bhutta, Z.A., Christian, P., de Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., et al. (2013). Maternal and child undernutrition and overweight in low-income and middle income countries. Lancet 382, 427-451.

Butler M.G., Manzardo A.M. and Forster J.L. (2015). Current topics in the diagnosis and management of the pediatric non organic feeding disorders (NOFEDs). Clinical Nutrition. 34, 195-200.

Butler M.G., Manzardo A.M. and Forster J.L. (2016). Prader-Willi syndrome: Clinical genetics and diagnostic aspects with treatment approaches. Paediatric Reviews. 12, 136-166.

de Onis and Branca F. (2016). Childhood stunting: a global perspective. Matern Child Nutr 12, 12-26.

de Onis, M., Dewey, K.G., Borghi, E., Onyango, A.W., Blossner, M., Daelmans, B., Piwoz, E., and Branca, F. (2013). The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions. Matern Child Nutr 9 Suppl, 6-26.

Estrem, H.H., Pados, B.F., Park, J., Knafl, K.A. & Thoyre, S.M. (2017). Feeding problems in infancy and early childhood: evolutionary concept analysis. J Adv Nurs 73, 56-70.

Homan, G.J. Failure to Thrive: A Practical Guide. (2016). Am Fam Physician. 94, 295-299.

Joshi S. (2015). Vitamin Supplementation in the elderly. Clinics in geriatric medicine. 31, 355-66.

Li M, and Belmonte JC. (2016) Mending a faltering heart. Circulation research. 118, 344-51.

Morcaldi G, Bellini T, Rossi C, Maghnie M, Boccardo F, Bonioli E and Bellini C. (2015). Lymphodysplasia and Kras Mutation: A Case Report and Literature Review. Lymphology. 48, 121-7.

National Institute for Health and Care Excellence (2017). Faltering growth- recognition and management. NICE Clinical Guideline (NG75).

The Canadian Pediatric Society [Internet]. The toddler who is falling off the growth chart. 2012. [cited 2017 Oct 9]. Available from: http://www.cps.ca/en/documents/position/toddler-falling-off-the-growth-chart

Weightman, A. L., Morgan, H. E., Shepherd, M. A., Kitcher, H., Roberts, C., & Dunstan, F. D. (2012). Social inequality and infant health in the UK: systematic review and meta-analyses. BMJ Open, 2(3), e000964.

World Health Organization (WHO) [Internet]. Guideline: updates on the management of severe acute malnutrition in infants and children. Geneva (Switzerland): World Health Organization (WHO); 2013. p. 115. [cited 2017, Oct 9]. Available from: https://guideline.gov/summaries/summary/49017

World Health Organization (WHO) [Internet]. Promoting optimal monitoring of child growth in Canada: Using the new World Health Organization growth charts. World Health Organization (WHO); 2010. [cited 2017, Oct 9]. Available from: http://www.cps.ca/en/documents/position/child-growth-charts

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.