Depending on the severity of the malnutrition, initiation of catch-up growth may take 2 weeks. Initial weight gain two to three times normal growth can be seen. Weight improvement precedes improvement in stature. For children with chronic, severe malnutrition, many months are needed to reverse all trends in growth. Although many children with FTT eventually reach normal size, they remain at risk for developmental, learning, and behavioral problems.
Malnutrition causes defects in host defenses. Children with FTT may suffer from a malnutrition-infection cycle, in which 5.5 scoops powdered formula 8 27 kcal/oz 13 oz liquid concentrate 6 27 kcal/oz
From Jew R, editor: Department of Pharmacy Services Pharmacy Handbook and Formulary, 2000–2001. Hudson, Ohio, 2000, Department of Pharmacy
Services, p 422. *Final concentrations are reached by adding formula to water. One scoop of powdered formula = one measuring tablespoon. For healthy infants, formulas are prepared to provide 20 kcal/oz.
recurrent infections exacerbate malnutrition, leading to greatersusceptibility to infection. Children with FTT must be evaluated and treated promptly for infection and followed closely.
During starvation, the body slows metabolic processes and growth to minimize the need for nutrients and uses its stores of glycogen, fat, and protein to maintain normal metabolic requirements. The body also generally maintains homeostasis and normal serum concentrations of electrolytes. With the rapid reinstitution of feeding after starvation, fluid and electrolyte homeostasis may be lost. Changes in serum electrolyte concentrations and the associated complications are collectively termed the refeeding syndrome. These changes typically affect phosphorus, potassium, calcium, and magnesium and can result in life-threatening cardiac, pulmonary, or neurologic problems. Infants and children with marasmus, kwashiorkor, and anorexia nervosa and those who have had prolonged fasting are at risk for refeeding syndrome. Refeeding syndrome can be avoided by slow institution of nutrition, close monitoring of serum electrolytes during the initial days of feeding, and prompt replacement of depleted electrolytes.
Occasionally children who live in psychological deprivation develop short stature with or without concomitant FTT or delayed puberty, a syndrome called psychosocial short stature. The signs and symptoms include polyphagia, polydipsia, hoarding and stealing of food, gorging and vomiting, drinking from toilet bowls, and other notable behaviors. Affected children are often shy and passive and are typically depressed and socially withdrawn. Endocrine dysfunction is often identified in affected children, who may have decreased growth hormone secretion and a muted response to exogenous growth hormone. Removal of the child from the adverse environment typically results in rapid improvement in endocrine function and subsequent rapid somatic and pubertal growth of the child. The prognosis for children with psychosocial short stature depends on the age at diagnosis and the degree of psychological trauma. Early identification and removal from the environment portends a healthy prognosis. Those diagnosed in later childhood or adolescence may not reach their genetic potential for growth and have a poorer psychosocial prognosis.