Growth and developmental assessment — KFP-style written assessment

KFP 1 (10 marks)

A 7-month-old boy is brought in by his mother, worried he is "not gaining weight like his sister did". Records show weight on the 50th centile at birth and the 25th at 4 months; today he plots on the 3rd. Length has tracked the 25th throughout; head circumference the 50th. He is breastfed on demand, takes some solids, is active and smiling. No vomiting, no diarrhoea. ^[4]

1. Name the chart finding and state what it obliges you to do next. (2) ^[4]
2. List the four elements of your structured assessment at this visit. (4) ^[4]
3. Which complication must you actively screen for, and which safeguarding question must you be able to answer? (2) ^[4]
4. His weight at review in two weeks has fallen further. State your next two actions. (2) ^[4]

Model answers

1. He has crossed two or more major weight-for-age centile lines downward (50th to 3rd). This is weight faltering (failure to thrive) until proven otherwise; it obliges structured assessment now, not reassurance. Diagnosis of faltering requires repeated measurements over time on age-appropriate centile charts — his trend qualifies. ^[4]
2. Verify the measurements and plotting; take a full feeding history including an observed breastfeed and solid intake; examine for dysmorphism, organomegaly, thrush and signs of neglect; investigate selectively (urinalysis and iron studies at minimum, coeliac serology and thyroid function where the history points). In affluent settings malnutrition secondary to psychosocial and caregiver factors is the most common cause, so the feeding relationship is the first place to look. ^[4]
3. Iron deficiency is the most common complication of failure to thrive and must be screened with iron studies. Neglect or abuse should always be ruled out explicitly — document that the history and examination were consistent with unintentional underfeeding before treating this as simple dietary insufficiency. ^[4]
4. Further fall despite intervention means escalation: refer to paediatrics (or a multidisciplinary feeding service) for assessment, and broaden the investigation panel for malabsorption and chronic disease. Continue monitoring weekly until catch-up growth is documented. ^[4]