Definition ↓Growth in infancy, falling across 2 centile lines and manifest in poor weight gain. May also have proportionally small height and head circumference, though more acute causes tend to affect weight only. If height also low, may suggest constitutionally small child, so check parental heights. Initial loss of up to 10% in first 3-4 days is normal (likely fluid loss), but this should be regained by 3 weeks. Thereafter, there should be an average weekly gain of 150-200 g in normal children, with weight doubling by 4 months and tripling by 12 months. Faltering growth is both an indicator of underlying disease and can itself can cause long-term problems of ↓growth and ↓IQ. Causes Non-organic/environmental (>90%). Inadequate intake due to: Feeding problems (common): unskilled feeding (breast or bottle), insufficient breast milk, infant difficult to feed (e.g. low appetite, weak suck). Maternal problems: neglect, postnatal depression. Organic: GI: IBD, coeliac disease, cow milk p

Background Familial (primary) dyslipidaemia Due to gene mutation(s). Should be suspected in patients with premature IHD (age <55 in men, <60 in women). WHO classifies them type 1-5 (T1-5). Acquired (secondary) dyslipidaemia Most cases of dyslipidaemia are acquired in later life. Obesity, sedentary lifestyle, and diabetes are common risk factors, though many cases are essentially idiopathic. Other causes: Endocrine: hypothyroidism, hypopituitarism. Hepatic: alcohol excess, cholestasis. Renal: nephrotic syndrome, chronic kidney disease. Others: pregnancy, anorexia, gout, antipsychotics. Signs and symptoms Usually detected through CVD risk assessment, or when presenting with complications such as IHD or stroke. The only specific sign is lipid deposits (xanthomas). Their presence and extent are a sign of disease severity. Locations: Eyelids: xanthelasma (also seen in smoking). Eyes: corneal arcus and retinal deposits. Tendon xanthoma: achilles (run finger and thumb along to feel for