Paediatric Physiotherapy - Infant - Failure to Thrive (Apple)

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.