Paediatric Physiotherapy - Infant - Failure to Thrive (Nectarine)

Context of assessment: The student has been requested to perform a ward based, developmental assessment for a patient admitted to the ward for investigation of poor feeding and weight loss. It is expected that the patient will undergo a further developmental assessment at a later date, therefore, the student has been instructed to adequately assess the patient to acknowledge and reassure mother on possible developmental delay. Background information for infant clinical scenario: Setting: Acute inpatient paediatric ward Gender: Female Patient age: 6 months Main Presentation: Failure to thrive, developmental delay Student Name: Sally Educator Name: Jenny Patient/ Parent Name: Taylor and Cassie (mother) Clinical History: Reason for referral to physiotherapy: Paediatricians have identified developmental delay History of presenting condition: Patient admitted to hospital via ED 4 days ago for investigation of failure to thrive (poor feeding, weight loss, dehydration and general irritability) and coffee ground vomiting. She is currently an inpatient on the paediatric ward of a hospital, receiving nasogastric feeds and awaiting endoscopy tomorrow for confirmation of suspected cow’s milk protein allergy and related oesinophilic oesophagitis. Investigations: Blood tests – elevated platelets Stool sample – faecal leukocytes and positive for blood Urine sample – (shows dehydration) Growth chart – CW 4995g (less than 3rd centile) Consulting teams Paediatricians Gastroenterology Dietician Social Worker Past medical history: Mum reports losing breast milk at 3 months and starting infant formula. Baby took formula initially and then started to become irritable, cry, looked in pain, periods of diarrhoea, intermittent cough and runny nose. Trialled different formulas with similar results. Took up to an hour for baby to take a bottle. Sometimes baby would refuse bottle. Had 2 GP visits. Sleeps poorly during day and wakes regularly through night. Recent onset of eczema on legs and arms. Has trialled Omeprazole (prescribed by GP) with no benefit. Birth history K39+0, BW 2954g (25th centile), SVD, APGARS 7,9,9 Normal pregnancy and scans Passed healthy hearing newborn screen Past surgical history: Nil Developmental history: Smiling and cooing Just starting to reach for toys Never liked tummy time Always has to be carried Not rolling Started on solids at 4 months Medications: Ranitidine (Zantac) – started in ED Neocate infant formula – day 1 today Social & Family History: Mum (23yo) and Dad (24yo – Jack), married First baby (G=1, P=1) No local family support Dad is a mechanic, Mum is on maternity leave from an office admin job. Parents share a car and have good access to public transport Parental concerns/goals: Anxiety around baby’s health and the cause of this, current hospital admission and Doctor’s suggestion of developmental delay.