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Presented By –NAVJYOT           SINGH
            M.Sc.(N) 1st YEAR
Introduction
                
FTT describes a condition rather than a
 specific disease. Children are considered as
 failing to thrive when their rate of growth
 does not meet the expected growth rate for a
 child their age. If the condition progresses,
 the undernourished child may become
 irritable and/or apathetic and may not reach
 typical developmental markers such as
 sitting up, walking, and talking at the usual
 ages.
Definition
                 
FTT is inadequate physical growth diagnosed
 by observation of growth over time using a
 standard growth chart, such as the National
 Center For health Statistics (NCHS) growth
 chart.
Usually it refers to a child whose growth is
 below the 3rd or 5th percentiles for their age.
Epidemiology
              
FTT affects 5-10% of young children and
 approximately 3-5% of children admitted in
 teaching hospitals
Under feeding is the single commonest cause
 of FTT that results from parental poverty and
 ignorance
95% of cases of FTT inadequate food offered
 or take
Classification of FTT
             
Traditionally FTT has been classified as



   1      •Organic

   2      •Inorganic
Based on pathophysiology FTT is classified as

                    
1
    •Inadequate caloric intake

2
    •Inadequate absorption

3
    •Increased caloric requirement

4
    •Defective utilization of calories
Organic
                         
Organic causes include following medical
disorder.
 Premature birth,
 Maternal smoking , alcohol use, or illicit drugs during
  pregnancy
 Mechanical problems present,
 Unexplained poor appetites that are unrelated to
  mechanical problems
 Inadequate intake also can result from metabolic
  abnormalities,
 Poor absorption of food, inability of the body to use
  absorbed nutrients, or increased loss of nutrients.
Inorganic
                       
Inorganic causes: Inorganic causes are those
caused by a caregiver's actions.
 Poor feeding skills on the part of the parent
 Dysfunctional family interactions
 Difficult parent-child interactions
 Lack of social support
 Lack of parenting preparation
 Family dysfunction, such as abuse or divorce
 Child neglect
 Emotional deprivation
Inadequate caloric intake
          
Incorrect formula preparation
Neglect
Food fads,
Excessive juice consumption
Poverty
Behavioral problem affecting eating
Inadequate absorption
          
Cystic fibrosis

Celiac disease

Vitamin deficiencies

Hepatic diseases.
Increased caloric requirement
                    
Hyperthyroidism

Congenital heart disease

Chronic immunodeficiency
Defective utilization of calories
                          
  Genetic anomaly

  Congenital infection

  Metabolic storage disease
CAUSES OF FTT
                              
 The most common cause of failure to thrive is malnutrition

 Prenatal
 Prematurity
 Exposure in utero to toxic agents
 Intrauterine growth restriction from any cause
 Postnatal
   Inadequate caloric intake
   Inadequate absorption
   Increased caloric requirement
   Defective utilization of calories
SYMPTOMS
                
 Height, weight, and head circumference do not
  match standard growth charts
 Weight is lower than 3rd percentile
 Growth may have slowed or stopped after a
  previously established growth curve
 Physical skills such as rolling over, sitting, standing
  and walking decreased
 Mental and social skills decreased
 Secondary sexual characteristics delayed in
  adolescents.

                                                    Cont.….
 Constipation
 Excessive crying
 Excessive sleepiness (lethargy)
 Irritability
 Minimal smiling
 Avoidance of eye contact
 Unresponsive
DIAGNOSTIC EVALUATION
         

History taking

Examination and Tests
History taking
                   
 PRENATAL

 LABOUR, DELIVERY, AND NEONATAL EVENTS

 MEDICAL HISTORY OF CHILD

 SOCIAL HISTORY

 NUTRITIONAL HISTORY
Examination and Tests
          
 Physical examination
 Denver Developmental Screening Test
 A growth chart outlining all types of growth
 Complete blood count (CBC)
 Electrolyte balance
 Hemoglobin electrophoresis
 Hormone studies, including thyroid function tests
 X-rays to determine bone age
 Urinalysis
ASSESSMENT OF DEGREE OF FTT
                        
              Degree of Failure to Thrive
Growth        Mild         Moderate         Severe
parameter

Weight        75-90%       60-74%           <60%
Height        90-95%       85-89%           <60%
Wt/Ht ratio   81-90%       70-80%           <70%
MANAGEMENT
                        
 Children with FTT require 150% of Recommended
  Dietary Allowance (RDA) of calories for catch up
  growth.
 Correction of any underlying disease
 The child’s developmental stimulation
 Improvement in care-giver skills.
 Regular and effective follow up
 Treatment may also involve improving the family
  relationships and living conditions.

                                              Cont.….
 Feeding interval should not be greater than 4 hours & a
  maximum time allowed for sucking should be 20
  minutes
 Eliminating distractive events
 Avoiding excessive fruit juices
 For older & young children meals should be last for 30
  minutes, solid foods should be offered before liquid,
  environmental distraction should be minimized.
NURSING MANAGEMENT
                        care of child with FTT
 The nursing management to the
    and their families includes

1
      • Optimum nutrition

2
      • A consistent, warm, caring environment

3
      • Maintenance of daily dietary record

4
      • Parental support and education

5
      • Discharge planning
PROGNOSIS
                
Normal growth and development may be
 affected if a child fails to thrive for a long
 time. Normal growth and development may
 continue if the child has failed to thrive for a
 short time, and the cause is determined and
 treated.
POSSIBLE COMPLICATIONS
             
 Permanent mental

 Emotional

 Physical delays can occur.
PREVENTION
                         by physical
Initial failure to thrive caused
 defects cannot be prevented but can often be
 corrected before they become a danger to the
 child. Maternal education and emotional and
 economic support systems all help to prevent
 failure to thrive in those cases where there is
 no physical deformity.
CONCLUSION
                             
 Failure to thrive is a descriptive term, not a specific
   diagnosis. FTT is result of inadequate usable calories
   necessary for a child’s metabolic and growth demands.
   Simplified approach to FTT is detailed history, thorough
   Physical Examination with primary care giver, initial
   investigation includes CBC, ESR, urinalysis, urine culture,
   stool for ova and cyst of parasites. Trail of nutritional
   therapy with calorie-dense diet.
BIBLIOGRAPHY
                                   
 Dorothy R. Marlow, Textbook of Pediatric nursing, Saunders publisher,
   6th edition, page no. 677-684
 Marilyn J Hockenberry, Essential of pediatric nursing, Mosby publisher,
   8th edition, page no.396-400
 http://www.healthofchildren.com/E-F/Failure-to-Thrive.html
 http://drugline.org/ail/pathography/743/
 http://www.modernmedicalguide.com/failure-to-thrive/
 http://www.nlm.nih.gov/medlineplus/ency/article/000991.htm
 http://www.slideshare.net/Singaram_Paed/approach-to-a-child-with-
   failure-to-thrive
Ftt
Ftt

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Ftt

  • 1. Presented By –NAVJYOT SINGH M.Sc.(N) 1st YEAR
  • 2. Introduction  FTT describes a condition rather than a specific disease. Children are considered as failing to thrive when their rate of growth does not meet the expected growth rate for a child their age. If the condition progresses, the undernourished child may become irritable and/or apathetic and may not reach typical developmental markers such as sitting up, walking, and talking at the usual ages.
  • 3. Definition  FTT is inadequate physical growth diagnosed by observation of growth over time using a standard growth chart, such as the National Center For health Statistics (NCHS) growth chart. Usually it refers to a child whose growth is below the 3rd or 5th percentiles for their age.
  • 4. Epidemiology  FTT affects 5-10% of young children and approximately 3-5% of children admitted in teaching hospitals Under feeding is the single commonest cause of FTT that results from parental poverty and ignorance 95% of cases of FTT inadequate food offered or take
  • 5. Classification of FTT  Traditionally FTT has been classified as 1 •Organic 2 •Inorganic
  • 6. Based on pathophysiology FTT is classified as  1 •Inadequate caloric intake 2 •Inadequate absorption 3 •Increased caloric requirement 4 •Defective utilization of calories
  • 7. Organic  Organic causes include following medical disorder.  Premature birth,  Maternal smoking , alcohol use, or illicit drugs during pregnancy  Mechanical problems present,  Unexplained poor appetites that are unrelated to mechanical problems  Inadequate intake also can result from metabolic abnormalities,  Poor absorption of food, inability of the body to use absorbed nutrients, or increased loss of nutrients.
  • 8. Inorganic  Inorganic causes: Inorganic causes are those caused by a caregiver's actions.  Poor feeding skills on the part of the parent  Dysfunctional family interactions  Difficult parent-child interactions  Lack of social support  Lack of parenting preparation  Family dysfunction, such as abuse or divorce  Child neglect  Emotional deprivation
  • 9. Inadequate caloric intake  Incorrect formula preparation Neglect Food fads, Excessive juice consumption Poverty Behavioral problem affecting eating
  • 10. Inadequate absorption  Cystic fibrosis Celiac disease Vitamin deficiencies Hepatic diseases.
  • 11. Increased caloric requirement  Hyperthyroidism Congenital heart disease Chronic immunodeficiency
  • 12. Defective utilization of calories   Genetic anomaly  Congenital infection  Metabolic storage disease
  • 13. CAUSES OF FTT   The most common cause of failure to thrive is malnutrition  Prenatal  Prematurity  Exposure in utero to toxic agents  Intrauterine growth restriction from any cause  Postnatal  Inadequate caloric intake  Inadequate absorption  Increased caloric requirement  Defective utilization of calories
  • 14. SYMPTOMS   Height, weight, and head circumference do not match standard growth charts  Weight is lower than 3rd percentile  Growth may have slowed or stopped after a previously established growth curve  Physical skills such as rolling over, sitting, standing and walking decreased  Mental and social skills decreased  Secondary sexual characteristics delayed in adolescents. Cont.….
  • 15.  Constipation  Excessive crying  Excessive sleepiness (lethargy)  Irritability  Minimal smiling  Avoidance of eye contact  Unresponsive
  • 16. DIAGNOSTIC EVALUATION  History taking Examination and Tests
  • 17. History taking   PRENATAL  LABOUR, DELIVERY, AND NEONATAL EVENTS  MEDICAL HISTORY OF CHILD  SOCIAL HISTORY  NUTRITIONAL HISTORY
  • 18. Examination and Tests   Physical examination  Denver Developmental Screening Test  A growth chart outlining all types of growth  Complete blood count (CBC)  Electrolyte balance  Hemoglobin electrophoresis  Hormone studies, including thyroid function tests  X-rays to determine bone age  Urinalysis
  • 19. ASSESSMENT OF DEGREE OF FTT  Degree of Failure to Thrive Growth Mild Moderate Severe parameter Weight 75-90% 60-74% <60% Height 90-95% 85-89% <60% Wt/Ht ratio 81-90% 70-80% <70%
  • 20. MANAGEMENT   Children with FTT require 150% of Recommended Dietary Allowance (RDA) of calories for catch up growth.  Correction of any underlying disease  The child’s developmental stimulation  Improvement in care-giver skills.  Regular and effective follow up  Treatment may also involve improving the family relationships and living conditions. Cont.….
  • 21.  Feeding interval should not be greater than 4 hours & a maximum time allowed for sucking should be 20 minutes  Eliminating distractive events  Avoiding excessive fruit juices  For older & young children meals should be last for 30 minutes, solid foods should be offered before liquid, environmental distraction should be minimized.
  • 22. NURSING MANAGEMENT  care of child with FTT  The nursing management to the and their families includes 1 • Optimum nutrition 2 • A consistent, warm, caring environment 3 • Maintenance of daily dietary record 4 • Parental support and education 5 • Discharge planning
  • 23. PROGNOSIS  Normal growth and development may be affected if a child fails to thrive for a long time. Normal growth and development may continue if the child has failed to thrive for a short time, and the cause is determined and treated.
  • 24. POSSIBLE COMPLICATIONS  Permanent mental Emotional Physical delays can occur.
  • 25. PREVENTION  by physical Initial failure to thrive caused defects cannot be prevented but can often be corrected before they become a danger to the child. Maternal education and emotional and economic support systems all help to prevent failure to thrive in those cases where there is no physical deformity.
  • 26. CONCLUSION   Failure to thrive is a descriptive term, not a specific diagnosis. FTT is result of inadequate usable calories necessary for a child’s metabolic and growth demands. Simplified approach to FTT is detailed history, thorough Physical Examination with primary care giver, initial investigation includes CBC, ESR, urinalysis, urine culture, stool for ova and cyst of parasites. Trail of nutritional therapy with calorie-dense diet.
  • 27. BIBLIOGRAPHY   Dorothy R. Marlow, Textbook of Pediatric nursing, Saunders publisher, 6th edition, page no. 677-684  Marilyn J Hockenberry, Essential of pediatric nursing, Mosby publisher, 8th edition, page no.396-400  http://www.healthofchildren.com/E-F/Failure-to-Thrive.html  http://drugline.org/ail/pathography/743/  http://www.modernmedicalguide.com/failure-to-thrive/  http://www.nlm.nih.gov/medlineplus/ency/article/000991.htm  http://www.slideshare.net/Singaram_Paed/approach-to-a-child-with- failure-to-thrive