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Failure to Thrive Red Flags

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1. Failure to Thrive Red Flags

Failure to Thrive Red Flags Failure to Thrive Red Flags Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Failure to Thrive Red Flags (...) Failure to Thrive Red Flags Aka: Failure to Thrive Red Flags II. Indications III. Red Flags Cardiac findings (suggesting. ) Extremity edema See refractory to adequate caloric replacement or Abnormal Recurrent infections (e.g. recurrent respiratory infections, ) Recurrent or with dehydration IV. Interpretation Positive findings suggest organic cause of and warrant diagnostic evaluation Negative findings (no red flags) are reassuring for non-organic cause and empiric caloric management can be instituted

2018 FP Notebook

2. Failure to Thrive Red Flags

Failure to Thrive Red Flags Failure to Thrive Red Flags Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Failure to Thrive Red Flags (...) Failure to Thrive Red Flags Aka: Failure to Thrive Red Flags II. Indications III. Red Flags Cardiac findings (suggesting. ) Extremity edema See refractory to adequate caloric replacement or Abnormal Recurrent infections (e.g. recurrent respiratory infections, ) Recurrent or with dehydration IV. Interpretation Positive findings suggest organic cause of and warrant diagnostic evaluation Negative findings (no red flags) are reassuring for non-organic cause and empiric caloric management can be instituted

2015 FP Notebook

3. Failure to Thrive Causes

to Thrive Causes Aka: Failure to Thrive Causes II. Precautions First define if growth is truly abnormal (See ) suggest organic cause III. Causes: Normal Physiologic Half of infants under age 2 shift weight, height by 25% (Short Parents) Most common reason for in children IV. Causes: Nonorganic (80% of cases, no Failure to Thrive Red Flags) Accidental error in formula preparation or Improper feeding technique Misconception about nutrition needs fed infants with insufficient (e.g. poor latching (...) Failure to Thrive Causes Failure to Thrive Causes Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Failure to Thrive Causes Failure

2018 FP Notebook

4. Failure to Thrive Causes

to Thrive Causes Aka: Failure to Thrive Causes II. Precautions First define if growth is truly abnormal (See ) suggest organic cause III. Causes: Normal Physiologic Half of infants under age 2 shift weight, height by 25% (Short Parents) Most common reason for in children IV. Causes: Nonorganic (80% of cases, no Failure to Thrive Red Flags) Accidental error in formula preparation or Improper feeding technique Misconception about nutrition needs fed infants with insufficient (e.g. poor latching (...) Failure to Thrive Causes Failure to Thrive Causes Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Failure to Thrive Causes Failure

2015 FP Notebook

5. British guideline on the management of asthma

treatment Severe/life-threatening asthma attack Severe/life-threatening asthma attack ‘Red flags’ and indicators of other diagnoses Prominent systemic features (myalgia, fever, weight loss) Failure to thrive Unexpected clinical findings (eg crackles, clubbing, cyanosis, cardiac disease, monophonic wheeze or stridor) Unexplained clinical findings (eg focal signs, abnormal voice or cry, dysphagia, inspiratory stridor) Persistent non-variable breathlessness Symptoms present from birth or perinatal lung (...) stridor Tracheal or laryngeal disorder Abnormal voice or cry Laryngeal problem Focal signs in chest Developmental anomaly; post-infective syndrome; bronchiectasis; tuberculosis Finger clubbing Cystic fibrosis; bronchiectasis Failure to thrive Cystic fibrosis; host defence disorder; gastro-oesophageal reflux Investigations Focal or persistent radiological changes Developmental lung anomaly; cystic fibrosis; postinfective disorder; recurrent aspiration; inhaled foreign body; bronchiectasis; tuberculosis

2019 SIGN

6. Appropriate Use Criteria: Imaging of the Abdomen and Pelvis

a clinical diagnosis. While a commonly performed practice, there is conflicting evidence that abdominal radiography substantially aids the diagnosis of constipation with at best small likelihood ratios (1-1.2) based on well designed studies. 18 Constipation can have both functional and organic causes. When constipation is associated with red flag features such as failure to thrive, unexplained weight loss, or vomiting, referral to a pediatric gastroenterologist should be considered and additional testing (...) Cystic liver disease 33 Failure to thrive 33 Gastroenteritis 33 Hirschsprung’s disease (congenital aganglionosis) 34 Hypospadias 34 Irritable bowel syndrome 34 Jejunal or ileal stenosis 34 Meckel’s diverticulum or diverticulitis 34 Midgut volvulus 34 Neonatal jaundice: biliary atresia and neonatal hepatitis 34 Piriformis syndrome 34 Posterior urethral valve 34 Pyloric stenosis 34 Small left colon syndrome 34 Urinary tract infection 35 Vesicoureteral reflux 35 References 35 Codes 39 History 40 Imaging

2019 AIM Specialty Health

7. Chronic Asthma

respirations and cough; constitutional symptoms; fever unresponsive to normal antibiotics; enlarged lymph nodes; infectious contact; radiographic findings Congenital heart disease Failure to thrive; cyanosis when eating; tachypnea or hepatomegaly; tachycardia; cardiac murmur Cystic fibrosis Nasal polyps, productive cough starting shortly after birth; recurrent chest infections; failure to thrive (malabsorption); loose greasy bulky stools Primary ciliary dyskinesia Recurrent, mild chest infections (...) with cough; recurrent, severe otitis media, purulent nasal discharge; 50% have situs inversus Vascular ring, hilar adenopathy, foreign body Continually noisy respirations or wheeze Bronchopulmonary dysplasia Premature birth; very low birth weight; needed prolonged mechanical ventilation or supplemental oxygen; difficulty with breathing from birth Immune deficiency Recurrent fever and infections (including non-respiratory); failure to thrive Chronic Asthma | April 2018 Clinical Practice Guideline Page 13

2018 Toward Optimized Practice

8. BTS/SIGN British Guideline on the Management of Asthma

treatment Severe/life-threatening asthma attack Severe/life-threatening asthma attack ‘Red flags’ and indicators of other diagnoses Prominent systemic features (myalgia, fever, weight loss) Failure to thrive Unexpected clinical findings (eg crackles, clubbing, cyanosis, cardiac disease, monophonic wheeze or stridor) Unexplained clinical findings (eg focal signs, abnormal voice or cry, dysphagia, inspiratory stridor) Persistent non-variable breathlessness Symptoms present from birth or perinatal lung (...) stridor Tracheal or laryngeal disorder Abnormal voice or cry Laryngeal problem Focal signs in chest Developmental anomaly; post-infective syndrome; bronchiectasis; tuberculosis Finger clubbing Cystic fibrosis; bronchiectasis Failure to thrive Cystic fibrosis; host defence disorder; gastro-oesophageal reflux Investigations Focal or persistent radiological changes Developmental lung anomaly; cystic fibrosis; postinfective disorder; recurrent aspiration; inhaled foreign body; bronchiectasis; tuberculosis

2019 British Thoracic Society

9. Asthma

and symptoms to determine the likelihood of asthma. If the person cannot perform a particular test, attempt to perform at least 2 other objective tests. When a child reaches five years of age, carry out objective tests. Record the basis for a diagnosis of asthma in a single entry in the person's medical records, alongside the coded diagnostic entry. Red-flag signs and symptoms that suggest an and should prompt immediate referral to a respiratory physician for additional investigations include: In adults (...) : Prominent systemic features (such as myalgia, fever, and weight loss). Unexpected clinical findings (such as crackles, finger clubbing, cyanosis, evidence of cardiac disease, monophonic wheeze, or stridor). Persistent, non-variable breathlessness. Chronic sputum production. Unexplained restrictive spirometry. Chest X-ray shadowing. Marked blood eosinophilia. In children: Failure to thrive. Unexplained clinical findings (such as focal signs, abnormal voice or cry, dysphagia, and/or inspiratory stridor

2017 Prodigy

10. Child and Adolescent Asthma Guidelines

) C. Red flags suggesting alternate diagnoses* • Daily symptoms from birth • Frequent or daily wet, moist-sounding or productive cough • Digital clubbing • Chest wall deformity • Failure to thrive • Heart murmur • Spilling, vomiting or choking • Asymmetrical chest findings • Stridor as well as wheeze • Persistent ear, nose or sinus infection • Family history of unusual chest disease • Symptoms much worse than objective signs or spirometry *Consider aspiration, bronchiectasis, ciliary dyskinesia

2017 Asthma and Respiratory Foundation NZ

11. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutritio

therapy based on the available health-care facilities in the region of practice of the subspecialist (See under ‘‘Summary of the De?nitions’’ for an overview of other de?nitions used in this guideline). Recommendation: Based on expert opinion, the working group recommends to use the definitions of GER/GERD as described in this section for all infants and children. Voting: 7, 7, 7, 7, 8, 8, 8, 8, 8, 9. (moderate strength) QUESTION 2: WHAT ARE THE ‘‘RED FLAG’’ FINDINGS AND DIAGNOSTIC CLUES (...) manifestations as a consequence of GER is not always clear. As this may lead to both over- and under- diagnoses and –treatment, the working group considered it impor- tant to provide an overview of common symptoms and signs to identify GERD. Clarifying ‘red flags’ (alarm features) red flags should warrant further investigation by health-care professionals to rule out complications of GERD and to uncover underlying dis- orders presenting with signs or symptoms of GER, particularly regurgitation

2018 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

12. British guideline on the management of asthma

(with or without aspiration) Paroxysmal coughing bouts leading to vomiting Pertussis Dysphagia Swallowing problems (with or without aspiration) Breathlessness with light headedness and peripheral tingling Dysfunctional breathing, panic attacks Inspiratory stridor Tracheal or laryngeal disorder Abnormal voice or cry Laryngeal problem Focal signs in chest Developmental anomaly; post-infective syndrome; bronchiectasis; tuberculosis Finger clubbing Cystic fibrosis; bronchiectasis Failure to thrive Cystic fibrosis (...) : Diagnostic indications for specialist referral Adults Children Referral for tests not available in primary care Diagnosis unclear Diagnosis unclear Suspected occupational asthma (symptoms that improve when patient is not at work, adult-onset asthma and workers in high-risk occupations) Poor response to asthma treatment Poor response to monitored initiation of asthma treatment Severe/life-threatening asthma attack Severe/life-threatening asthma attack ‘Red flags’ and indicators of other diagnoses

2016 SIGN

14. Asthma

years of age, carry out objective tests. Record the basis for a diagnosis of asthma in a single entry in the person's medical records, alongside the coded diagnostic entry. Red-flag signs and symptoms that suggest an and should prompt immediate referral to a respiratory physician for additional investigations include: In adults: Prominent systemic features (such as myalgia, fever, and weight loss). Unexpected clinical findings (such as crackles, finger clubbing, cyanosis, evidence of cardiac disease (...) , monophonic wheeze, or stridor). Persistent, non-variable breathlessness. Chronic sputum production. Unexplained restrictive spirometry. Chest X-ray shadowing. Marked blood eosinophilia. In children: Failure to thrive. Unexplained clinical findings (such as focal signs, abnormal voice or cry, dysphagia, and/or inspiratory stridor). Symptoms that are present from birth. Excessive vomiting or posseting. Evidence of severe upper respiratory tract infection. Persistent wet or productive cough. A family

2017 NICE Clinical Knowledge Summaries

15. Irritable Bowel Syndrome (IBS)

and urgency of micturition — Incomplete bladder emptying • Dyspareunia, in women • Insomnia • Low tolerance to medications in general 4.2 Additional tests or investigations In the majority of cases of IBS, no additional tests or investigations are required. An effort to keep investigations to a minimum is recommended in straightforward cases of IBS, and especially in younger individuals. Additional tests or investigations should be considered if warning signs (“red flags”) are present: • Onset of symptoms (...) and differentiating it from IBS-D are assays of fecal bile acid concentration, 23-seleno-25-homo-taurocholic acid (SeHCAT) testing, and high-performance liquid chromatography for serum 7- a- OH-4-cholesten-3-one (C4)—in addition to the use of therapeutic trials (with the bile acid sequestering agents cholestyramine and colesevelam), and heightened awareness of the likelihood of bile acid malabsorption [9]. Celiac disease Main symptoms and/or findings: • Chronic diarrhea • Failure to thrive (in children) • Fatigue

2015 World Gastroenterology Organisation

16. March 2014 supplement to the 2013 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection

Health Access Initiative), Praphan Phanupak (Thai Red Cross AIDS Research Centre, Thailand), Anton Pozniac (Chelsea and Westminster Hospital, United Kingdom), George Siberry (National Institutes of Health, United States of America), Wendy Stevens (National Health Laboratory Service, South Africa). WHO: Meg Doherty, Nathan Ford, Guy-Michel Gershy- Damet, Gottfried Hirnschall, Maria Mercedes Perez Gonzales, Anita Sands, Nathan Shaffer, Willy Urassa, Marco Vitoria. The consultation was supported (...) , regardless of the type of rapid diagnostic tests used, and their failure to follow standard operating procedures. For instance, a study of false-positive test results found that trained staff in the Democratic Republic of the Congo did not follow standard operating procedures (29). In addition, a United States–based study of HIV rapid diagnostic tests using oral fluid used by trained health workers reported that user error was the most common cause of poor specificity, attributable to such factors

2014 World Health Organisation HIV Guidelines

17. "Crying without tears" as an early diagnostic sign-post of triple A (Allgrove) syndrome: two case reports. (PubMed)

of the AAAS gene. The second patient, an 8 months old boy was presented because of anisocoria and unilateral optic atrophy. MRI revealed cerebellar vermis hypotrophy. Psychomotor retardation, failure to thrive, and frequent vomiting lead to further diagnostic work-up. Achalasia was diagnosed radiologically. In addition, the mother mentioned absence of tears since birth leading to the clinical diagnosis of triple A syndrome. In contrast to the first cases genetic testing was negative.These two patients (...) illustrate the heterogeneity of triple A syndrome in both terms, clinical expression and genetic testing. We particularly aim to stress the importance of alacrima, which should be considered as a red flag symptom. Further differential diagnosis is required in every child affected by alacrima.

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2018 BMC Pediatrics

18. When will the stigma of mental health end in medicine?

health in our everyday practice and our hiring of physicians before we can hope to optimally address the mental health needs of our patients. Depression and anxiety are not a sign of weakness, a sign of incompetence in being able to work as a physician or a red flag that needs to be further investigated. There are risks, but we have an entire field of medical professionals that are specialized in managing those risks. If we don’t change, the number of competent, compassionate and hard-working (...) When will the stigma of mental health end in medicine? When will the stigma of mental health end in medicine? When will the stigma of mental health end in medicine? | | November 15, 2018 48 Shares Imagine being a cancer patient afraid of seeing an oncologist because they would likely need to discuss chemotherapy and all the lifestyle changes that it entails. Imagine being a patient with heart failure afraid of seeing the cardiologist because they may be prescribed a diuretic to remove excess

2018 KevinMD blog

20. Managing undernutrition in the elderly. Prevention is better than a cure

, such as cancer or cardiac, hepatic or renal failure. Manage chronic or reversible medical conditions once ‘red flags’ have been eliminated, many other medical conditions or their treatments that may contribute to undernutrition can be addressed within general practice (Table 3). It is also important to review patient attitudes toward weight; elderly patients may be confused by Figure 1. Contributing factors and health outcomes associated with undernutrition 1,3,5,7,22 Contributing factors • Medical – eg (...) . It is important to address all of these factors concurrently: addressing social factors without managing contributing medical factors and vice versa may not be fully effective. A multidisciplinary approach may assist in managing these patients. Identify ‘red flag’ conditions If a patient presents with undernutrition, the first objective in general practice is to assess for any potentially life- threatening or serious medical conditions (‘red flags’) that may have led to unintentional weight loss

2012 Clinical Practice Guidelines Portal

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