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Publication
Abordagem da má evolução ponderal
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Advisor(s)
Abstract(s)
RESUMO
Introdução: A má evolução ponderal encontra-se entre um
dos motivos mais frequentes de referenciação à consulta de Pediatria.
As dificuldades encontradas na definição desta entidade
e as diferentes abordagens desta situação tornam difícil uma homogeneização
de critérios e atitudes.
Objetivo: Orientar a abordagem e seguimento das crianças
com má evolução ponderal.
Métodos: Revisão de artigos pertinentes publicados sobre a
designação de “má evolução ponderal”, “fallo de medro” ou “failure
to thrive” usando as bases de dados Cochrane e Pubmed.
Desenvolvimento: A maioria das causas de má evolução
ponderal envolve uma ingestão calórica inadequada condicionada
por problemas psicossociais e comportamentais. De facto
apenas 5% das causas de má evolução ponderal podem ser
atribuídas a patologia orgânica o que dificulta uma abordagem
sistematizada destas crianças. Os exames complementares
de diagnóstico na avaliação destas crianças contribuem muito
pouco para o diagnóstico e não estão recomendados por rotina.
O seguimento multidisciplinar destas crianças e suas famílias,
idealmente com acompanhamento domiciliário, associado
a uma otimização da ingestão alimentar mostrou-se eficaz no
ganho ponderal e na melhoria da interação da criança com os
cuidadores.
Conclusões: Uma identificação precoce desta situação
associada a uma intervenção multidisciplinar que vise uma otimização
da ingestão calórica minimiza as sequelas a longo prazo.
ABSTRACT Introduction: Failure to thrive is one of the most frequent consultation referrals in Pediatrics. Both the difficulties in its definition and the different approaches lead to a lack of consensual management. The fact that, in about 70% of the cases, the causes of failure to thrive are non organic, complicates this issue. Objective: With this review the authors aim to propose a diagnostic and management strategy to evaluate and monitor these patients. Methods: Review of relevant articles published on the designation of “failure to thrive” or “fallo of medro” using the databases PubMed and Cochrane. Development: The most frequent cause of failure to thrive is related to an inadequate energy intake conditioned by psychosocial or behavioral problems. In fact only 5% of the causes of poor weight gain can be attributed to organic disease, which makes a systematic approach of these children even more diffi cult. The random use of laboratory tests contributes very little to the underlying diagnosis and is not recommended. A multidisciplinary approach of these children and their families, ideally with home monitoring, associated with an optimization of food intake is effective in weight gain and in a better interaction between the children and the caregivers. Conclusions: Early recognition of this situation, associated with a multidisciplinary approach, optimized the energy intake, minimizes the long-term consequences.
ABSTRACT Introduction: Failure to thrive is one of the most frequent consultation referrals in Pediatrics. Both the difficulties in its definition and the different approaches lead to a lack of consensual management. The fact that, in about 70% of the cases, the causes of failure to thrive are non organic, complicates this issue. Objective: With this review the authors aim to propose a diagnostic and management strategy to evaluate and monitor these patients. Methods: Review of relevant articles published on the designation of “failure to thrive” or “fallo of medro” using the databases PubMed and Cochrane. Development: The most frequent cause of failure to thrive is related to an inadequate energy intake conditioned by psychosocial or behavioral problems. In fact only 5% of the causes of poor weight gain can be attributed to organic disease, which makes a systematic approach of these children even more diffi cult. The random use of laboratory tests contributes very little to the underlying diagnosis and is not recommended. A multidisciplinary approach of these children and their families, ideally with home monitoring, associated with an optimization of food intake is effective in weight gain and in a better interaction between the children and the caregivers. Conclusions: Early recognition of this situation, associated with a multidisciplinary approach, optimized the energy intake, minimizes the long-term consequences.
Description
Keywords
Má evolução ponderal avaliação nutricional diagnóstico tratamento Failure to thrive nutritional assessment diagnosis treatment
Citation
Nascer e Crescer 2013; 22(3): 162-166