TALK TO DR AMINU MAGASHI

TALK TO DR AMINU MAGASHI

Talk to Dr Aminu Magashi

My child suffers from ‘failure to thrive’

Our family pediatrician diagnosed by nine month old baby girl as suffering from failure to thrive. Please I need more information about this problem?

Susan L.

Children are considered as failing to thrive when their rate of growth does not meet the expected growth rate for a child their age. The average full-term baby doubles its birth weight by six months and triples by one year.

Children with failure to thrive are often not meeting those milestones. If a baby continues to lose weight or does not gain weight as expected, he or she is probably not thriving. Children who fail to thrive are either not receiving or have an inability to take in or retain adequate nutrition in order to gain weight and grow.

Causes and symptoms

The cause of failure to thrive is typically differentiated into organic and non-organic. Organic causes are those caused by an underlying medical disorder. Inorganic causes are those caused by a caregiver’s actions.

Organic causes of failure to thrive may include:

1. Premature birth, especially if the fetus had intrauterine growth retardation.

2. Maternal smoking, alcohol use, or illicit drugs during pregnancy.

3. Mechanical problems present, resulting from a poor ability to suck or swallow, for example, presence of cleft lip and cleft palate.

4. Unexplained poor appetites that are unrelated to mechanical problems or structural abnormalities, for example, breathing difficulties that can result from congestive heart failure. (Any difficulty in breathing makes eating more difficult and can result in it. Inadequate intake also can result from metabolic abnormalities, excessive vomiting caused by obstruction of the gastrointestinal tract, or kidney dysfunction. In addition, gastroesophageal reflux causing regurgitation of formula or refusal of feeding.)

5. Poor absorption of food, inability of the body to use absorbed nutrients, or increased loss of nutrients.

Some examples of non-organic causes of failure to thrive are:

1. Poor feeding skills on the part of the parent.

2. Dysfunctional family interactions.

3. Difficult parent-child interactions.

4. Lack of social support.

5. Lack of parenting preparation.

6. Family dysfunction, such as abuse or divorce .

7. Child neglect .

8. Emotional deprivation.

The following symptoms are possible indications of failure to thrive:

1. Delayed social and mental skills.

2. Delayed development of secondary sexual traits in adolescents.

3. Height, weight, and head circumference in an infant or young child not progressing as expected on growth charts.

4. Edema (swelling).

5. Wasting.

6. Enlarged liver

7. Rashes or changes in the skin.

8. Changes in hair texture .

When to call the doctor

Parents should notify their physician if their child does not seem to be developing at a normal pace. If parents notice a drop in weight or if the baby does not want to eat, the doctor should be notified.

Diagnosis

If a child fails to gain weight for three months in a row during the first year of life, physicians normally become concerned. The most important part of a physician’s evaluation is taking a detailed history.

Prenatal history is important, and the doctor will want to know if the pregnant mother smoked, consumed alcohol, used any medications, or had any illness during the pregnancy. The doctor will also want a dietary history, to determine if there have been any feeding problems.

Treatment

Because there are numerous factors that may contribute to a failure to thrive diagnosis, children diagnosed with the disorder sometimes have an entire medical team working on the case. If there is an underlying physical cause, correcting that problem may reverse the condition. The doctor will recommend high-calorie foods and place the child on a high-density formula.

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National Assembly: Return our 2016 health budget

I reached out for a brief chat with Nigeria’s Health Minister, Professor Isaac Adewole and the Executive Director of National Primary Health Care Development Agency, Dr Ado J Muhammad on matters related to the 2016 Health Budget recently. It was a chance to meet after the 1st plenary session during the Universal Health Coverage Financing Forum in Washington DC on Thursday 14th April 2016.

The event took place as a sideline to the 2016 World Bank/IMF Spring Meeting. I brought up the issue of what we already know with regards to the 2016 Budget by the National Assembly. In the passed budget about four billion naira was slashed from funds allocated for routine immunization and polio eradication.

The reader may remember that President Buhari has requested for details from the national assembly to help him understand some of reviews they did before they passed the budget.

In the 2016 budget presented by President Buhari in December 2015, about eight billion naira was allocated for routine immunization and polio eradication respectively and in what was returned to him 50% each of the allocation were removed and moved elsewhere. This was the issue I raised with our health leaders emphasizing the need to put heads together to ensure the funds are returned in the final 2016 budget that will be accented to by President Buhari. I want to believe that the National Assembly slashed these funds not intentionally to starve the health sector but because they might not be fully aware of significance of these allocation and consequences of their actions.

Our national legislatures should be aware that Nigeria is at crossroads. This is because it has now joined the club of ‘Lower Middle Income Countries (LMICs) ’. With a GDP of about $510 billion in 2014, it has now become the biggest economy in Africa ahead of South Africa which has occupied the 1st position for a long time.

Nigeria that has over the years being enjoying support from GAVI (Global Alliance for Vaccine ) to finance its Routine Immunization Programme which was reported to contribute significantly to reduction of under-five mortality rate. From 2015 by virtue of its ‘LMIC’ status, the country has commenced transition process from GAVI support.

GAVI transition is calculated at 15% increase in Nigeria co-financing in 2015, and linear increase in co-financing obligation between 2015 and 2020. In 2020, the full market price occurs, and Nigeria will pay the full cost of device and average freight for new vaccines. Having said that last year (2015) Nigeria was expected to start marching GAVI funds, we couldn’t do it, World Bank had to bail us out with a loan of $200 million.

Last year with the World Bank facility of $200m, Nigerian government had purchased enough vaccines that would last up to 3rd quarter of 2016, hence National Primary Health Care Development Agency (NPHCDA) only allocated about N4 billions of its 2016 requirement that would be sufficient to cover the last and 4th quarter of 2016. So technically if we didn’t have the surplus of the vaccines purchased with World Bank loan, this year our requirement to purchase vaccines would have being 14.4 billion naira not four billion naira.

I am sure now the national legislatures will see clearly that returning that money slashed is about credibility both in the eyes of local and international communities. And also it is about saving the lives of children, the leaders of tomorrow. If we can’t provide for our children, what message are we sending to the rest of the world?

The ministerial conference on immunization in Africa that took place February this year is still fresh in our memory. Nigerian delegation were all out signing up to the declaration for immunization in Africa.

The conference had recognized the remarkable achievement of the African continent for interrupting wild poliovirus transmission for more than one year; achieving near elimination of meningococcal meningitis A epidemics, and the significant reduction in disease burden and mortality due to measles.

The conference also recalled with nostalgia the Heads of State Declaration on Polio Eradication in Africa: “Our Historic Legacy to Future Generations” (Johannesburg, June 2015); the World Health Assembly resolution (WHA68.6) on the Global Vaccine Action Plan (Geneva, May 2015), the commitment made by African Ministers of Health on Universal Health Coverage in Africa (Luanda, April 2014); and the Immunize Africa 2020 Declaration (Abuja, May 2014) endorsed by African Heads of State.

All these that we have signed up to as the giant of Africa will mean nothing if we fail to commit and allocate financial resources to routine immunization and polio eradication.

All comments to Dr Aminu Magashi, Publisher Health Reporters ([email protected])