This document discusses failure to thrive (FTT) or weight faltering in children. It defines FTT and outlines its epidemiology, types, clinical manifestations, etiology, approach, treatment, and prognosis. FTT can be organic or nonorganic, with inadequate intake, malabsorption, or increased metabolic demand as potential causes. Evaluation involves history, exam, anthropometry, and laboratory tests. Treatment aims to improve nutrition, address underlying causes, and enhance caregiver ability through education and support, with hospitalization sometimes needed for severe cases or lack of outpatient response.
Chronic Liver Disease in pediatric: a case presentation and discussionDr Abdalla M. Gamal
A presentation from a tutorial about an interesting case that came to the Pediatric Department of Sebha Medical Center and was imaged by the Radiology Department.
The tutorial was a joint effort between Dr Zeinab Salem Ali (from Pediatric Department) and me (from Radiology Department). In her slides, Dr Zeinab presented the case history, examination, investigations, differential diagnosis and discussed the clinical presentation, investigations and management for chronic liver diseases in pediatric patients.In my slides, I discussed the definition, etiology, natural history of this condition and explained the role of imaging in its diagnosis.
These are my slides after some modifications. I added an aknowlegement page to illustrate Dr Zeinab effort and to thank Dr Khaled Aljasem from Pediatric Department for his effort in revising the original presentations and the constructive feedback he provided which improved the quality of the presented material. Then I added a summary for the parts Dr Zeinab has presented to make this powerpoint presentation complete.
This presentation was presented by Dr Zeinab Salem (from Pediatric Department) and me in a joint tutorial between Pediatric Department and Radiology Department of Sebha Medical Center.
Chronic Liver Disease in pediatric: a case presentation and discussionDr Abdalla M. Gamal
A presentation from a tutorial about an interesting case that came to the Pediatric Department of Sebha Medical Center and was imaged by the Radiology Department.
The tutorial was a joint effort between Dr Zeinab Salem Ali (from Pediatric Department) and me (from Radiology Department). In her slides, Dr Zeinab presented the case history, examination, investigations, differential diagnosis and discussed the clinical presentation, investigations and management for chronic liver diseases in pediatric patients.In my slides, I discussed the definition, etiology, natural history of this condition and explained the role of imaging in its diagnosis.
These are my slides after some modifications. I added an aknowlegement page to illustrate Dr Zeinab effort and to thank Dr Khaled Aljasem from Pediatric Department for his effort in revising the original presentations and the constructive feedback he provided which improved the quality of the presented material. Then I added a summary for the parts Dr Zeinab has presented to make this powerpoint presentation complete.
This presentation was presented by Dr Zeinab Salem (from Pediatric Department) and me in a joint tutorial between Pediatric Department and Radiology Department of Sebha Medical Center.
presentation on celiac disease by Dr Muhammad Asad Abbasi.
in this presentation you will learn about approach and clinical presentation of celiac disease and its management
DEFINITION
FTT is defined as attained growth Weight of < 3rd percentile on standard growth chart or Weight for height < 5th percentile on standard growth chart or Weight 20% or more below ideal weight for height. OR
Rate of growth less than 20 g/day from birth to 3 months of age or less than 15 g/day from 3 months to 6 months of age or falloff from previously established growth curve or downward crossing of > 2 major percentiles.
ETIOLOGY
The etiology of FTT has traditionally been divided into organic, inorganic and mixed.
Organic FTT; Is a growth symptom of virtually all serious pediatric physical illnesses, such as gastro esophageal reflux, malabsorption syndrome, cystic fibrosis and congenital heart disease.
Nonorganic FTT; Is a failure of growth without diagnosable organic disease. It is caused by a psychosocial problem between the infant or child and the mother or other primary caregiver.
Mixed FTT; has both organic and nonorganic causes and cannot be described as either alone.
NOTE:-
The standard classification of dividing the causes of FTT as organic and non-organic is probably not very appropriate. Whether the condition is primarily organic or non-organic in origin, all children who fail to thrive suffer the physical and psychological consequences of malnutrition and are at a significant risk for long-term physical and psycho developmental sequelae. Organic diseases are responsible for less than 20% of cases with FTT. The causes of FTT are as;-
1. INADEQUATE CALORIC INTAKE
• Incorrect formula preparation
• Neglect
• Excessive juice consumption
• Poverty
• Behavioral problem affecting eating
• Non-availability of food
• Misperceptions about diet and feeding practices
• Errors in formula reconstitution
• Dysfunctional parent-child interaction, child abuse and neglect
• Behavioral feeding problem
• Mechanical problems with sucking, swallowing and feeding
• Primary neurological diseases
• Chronic systemic disease resulting in anorexia, food refusal and neurological problems
2. INADEQUATE ABSORPTION
• Cystic fibrosis
• Celiac disease
• Vitamin deficiencies
• Hepatic diseases.
3. INCREASED CALORIC REQUIREMENT
• Hyperthyroidism
• Congenital heart disease
• Chronic immunodeficiency
• Chronic respiratory disease
• Neoplasm
• Chronic or recurrent infection
4. EXCESSIVE LOSS OF CALORIES
• Persistent vomiting
• Gastro esophageal reflux disease
• Gastrointestinal obstruction
• Increased intracranial pressure
• Renal losses - renal tubular acidosis
• Diabetes mellitus
• Inborn errors of metabolism
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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In the DSM-5, all types of substance abuse and dependence have been
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The four main behavioral effects of AUD are impaired control over
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
3. Definition
Weight for age less than 5th percentile
Length for age less than 5th percentile
Weight velocity less than 5th percentile
Body mass index less than 5th percentile for age
and gender
Weight less than 75% of median weight for age
Weight less than 75% of median weight for length
Weight less than 5th percentile for age on two
occasions or weight deceleration crosses two
major percentile lines over time (centile lines used:
5, 10, 25, 50, 75, 90, 95)
4. When should suspect FTT ?
Height/length for age <-2 Z score on standard
growth chart
Rate of growth < 5 cm/yr
Crossing of two major percentile line e.g.,
declining from above 75th percentile to below
50th percentile on height over a period of time
Child is growing much below the mid parental
height range
5.
6. Average rate of height gain at different
ages
Age Height/Length
1st yr 25 cm
2nd yr 12.5 cm
3rd yr 7.5-10 cm
3-12yrs 5-7 cm
Adolescent girls-12-16
yrs
Adolescent boys 14-18
8 cm/yr
10 cm/yr
7. Average rate of wt gain at different
ages
Age Expected daily wt gain
(gm/day)
0-3 months 30
3-6 months 25
6- 9 months 15
9-12 month 10
1-9 yrs 2-2.5 kg/yr
10-18 yrs 4-6 kg/yr
8. Weight get affected earlier and to a greater
extent as compared to linear growth or growth of
head circumference which get affected in severe
and prolonged nutritional deprivation
As weight is accepted as simplest and most
reasonable marker of FTT, the condition has
been now renamed as weight faltering
Which is most reasonable marker of
FTT ?
9. Epidemiology
Nearly 80% of children with FTT present in the first
18 month of life
In India as per national family health survey-3
(NFHS-3, 2005-2006) using WHO growth
standard, 22.9% children under 3 yrs are wasted
with higher prevalence in rural 24.1% as
compared to urban areas
10. Types
Organic FTT (30%) –Caused by a known medical
condition (Biological FTT )
Nonorganic( 70%)-Caused by psychosocial
neglect, poverty and accidental errors in feeding
(Environmental FTT)
Mixed type- organic + non organic
FTT and malnutrition are closely related.
FTT is medical problem or a label of investigation,
whereas PEM is a diagnosis.
11. Severity classification of FTT
Method Mild
FTT
Moderate
FTT
Severe
FTT
Gomez classification
(Present wt/median wt for age)
75-
90%
61-75% <60%
Wellcome classification
Height/median height for age
Weight/median weight for age
90-
94%
80-
89%
85-89%
70-80%
<85%
<70%
McLaren classification
(Present weight
:height)/(median wt: height for
age)
81-
90%
70-80% <70%
Classification based on 90- 85-89% <85%
13. Inadequate weight for corrected age, weight for
height and BMI, as well as failure to gain adequate
weight over a period of time
Growth parameters should be measured serially
and plotted on growth charts appropriate for the
child’s sex, age.
In preterm LBW babies corrected age can be used
to compare physical growth and development till 2
yrs of age
CLINICAL MANIFESTATIONS
14. Nutritional deficiency –Poor wt velocity
slow deceleration of height velocity poor
head growth as compared to children with normal
variant
Systemic illness- FTT manifests as early as 8 wks
of age depending on age of onset of illness and
have more severe wt deficit as compared to the
children with behavioral difficulties leading to poor
feeding
CLINICAL MANIFESTATIONS
16. Rumination, anorexia nervosa, bulimia may be
noted in few
Neglect of hygiene diaper rash, dirty
fingers and nails, intertrigo, dirty skin and dress
etc.
Alopecia on occiput baby was lying
unattended for prolonged period
Tear in the frenulum and angle of mouth
force feeding by a rejecting mother
The child may lack eye contact and fails to interact
with mother and environment
Physical abuse psychosocial FTT
CLINICAL MANIFESTATIONS
17. INADEQUATE INTAKE
MALABSORPTION
INCREASED METABOLIC DEMAND
Diagnostic Classification of Causes
and Selected Examples of FTT
18.
19. INADEQUATE INTAKE
Inadequate food offered
-Food insecurity
-Poor knowledge of child’s needs
-Formula dilution or excessive juice
-Breastfeeding difficulties
-Medical child abuse/caregiver fabricated illness
-Medical neglect
-Food fads including “rice” milk as substitute for
formula or cow milk
Diagnostic classification of causes
and selected examples of FTT
20. Child not taking enough food
-Oromotor dysfunction, neurologic disease
-Developmental delay
-Behavioral feeding problem (altered oromotor
sensitivity, pain and conditioned aversion)
-Anorexia from systemic causes
Diagnostic Classification of
Causes and Selected Examples of
Failure to Thrive
21. Emesis
-Pyloric stenosis
-Gastroesophageal reflux
-Eosinophilic esophagitis
-Vascular rings
-Malrotation with intermittent volvulus
-Increased intracranial pressure and other
neurologic disorders
-Inborn errors of metabolism
-Rumination
-Cyclic vomiting
Diagnostic Classification of
Causes and Selected Examples of
Failure to Thrive
22. MALABSORPTION
-Cystic fibrosis
-Celiac disease
-Hepatobiliary disease
-Food protein allergy, insensitivity, or intolerance
-Infection (giardiasis)
-Short gut syndrome
Diagnostic Classification of
Causes and Selected Examples of
Failure to Thrive
32. HISTORY INTERPRETATION
DIET
Diet assessment Quantification of total calorie
intake
Technique of milk/formulae
preparation
Over diluted milk- low
calorie content
Over concentrated milk-
unpalatable
Type of food-Fruit juice,
soda, aerated drinks, water,
inadequate or inappropriate
complementary foods
Poor calorie intake
Clinical evaluation of FTT-
HISTORY
33. HISTORY INTERPRETATION
Feeding behavior
Observed feeding session Helps to understand
behaviors like easy
distractibility, feeding battles,
swallowing dysfunction.
Proper supervision and
parent child interaction
required
Technique of feeding Improper feeding
Intermittent snacks Poor meal time, early satiety
Clinical evaluation of FTT-
HISTORY
34. Clinical evaluation of FTT-
HISTORY
MEDICAL HISTORY INTERPRETATION
Birth history- prematurity,
IUGR, complications at birth
Catch up growth may be
incomplete in many babies
History of recurrent illness-
otitis media, diarrhea,
pneumonia
Inadequate catch- up growth
opportunity in between illness
Contact with tuberculosis,
HIV, recurrent infections
TB, HIV, other
immunodeficiencies
Stool pattern, worms in stool Malabsorption syndrome
35. Clinical evaluation of FTT-
HISTORY
MEDICAL HISTORY INTERPRETATION
Polyuria, polydypsia, FTT despite
increased appetite
RTA, Diabetes mellitus,
diabetes insipidus,
hyperthyroidism
Vomiting and reflux GERD
Past medical history- chronic
anemia, asthma, renal disease,
cardiac disease, liver disease
Pointers towards the
organic cause for FTT
Injury marks, frequent accidents Neglect, abuse
36. Clinical evaluation of FTT-
HISTORY
MEDICAL HISTORY INTERPRETATION
Family history- parental
height , parity, sibling
height
Shorter parental height and high
parity has been shown to have
slow weight gain in infancy
Any illness in family Developmental delay,
constitutional delay
Discord/ stressors in
family
Child neglect
37. CLINICAL EXAMINATION INTERPRETATION
Anthropometry- accurate measure wt
, ht/length, head circumference and
plot on reference growth chart
Severity of FTT
Recurrent, diarrhea, anemia, poor
growth, poor appetite
Celiac disease
Steatorrhea, chronic respiratory sign,
bronchiectasis, salt wasting crisis,
increased sweat chloride
Cystic fibrosis
Clinical evaluation of FTT-clinical
Exam
38. CLINICAL EXAMINATION INTERPRETATION
Icterus, hepatosplenomegaly,
bleeding, pallor, ascites
Chronic liver disease
Breathlessness with or without
cyanosis, murmur
Congenital heart disease
Recurrent abdominal pain,
bloody diarrhea
Milk protein allergy,
inflammatory bowel disease
Organ specific sign-
neurological, immunological,
renal
Organ specific illnesses
Clinical evaluation of FTT-clinical
Exam
39. Tests Interpretation
Complete blood count Anemia, infection
Urine analysis Urinary tract infection
Stool for ova ,cysts, fat
globules,
Parasitic infestation, fat
malabsorption
Total protein and albumin Hypoproteinemia
LFT-AST, ALT, PT, PTT, aPTT Chronic liver disease
Tests for tuberculosis and
congenital infections
TB, TORCH infections
Retro test HIV
RFT- serum creatinine CKD
Serum electrolytes, VBG RTA
Celiac screen Celiac disease
Laboratory studies
40. Tests Interpretation
Sweat chloride test Cystic fibrosis
Skeletal survey Look for evidence of physical
abuse, dysmorphic
syndromes
Bone age To differentiate genetic cause
from nutritional causes
BA=CA (genetic)
BA<CA (nutritional)
Thyroid function tests Hypothyroidism/Hyperthyroidi
sm
Tests for tuberculosis and
congenital infections
TB, TORCH infections
Metabolic screen IEM
Allergy testing Specific food allergy
Laboratory studies
41. TREATMENT
Goal of treatment -
Improving nutritional status through provision of
adequate nutrition
Treating the underlying cause of FTT if present
Improving the caregiver’s ability to provide
adequate diet to the child through education,
capability enhancement and psychological
support
Preventing a relapse of FTT through close follow
up and monitoring
42. TREATMENT
Mild FTT
Increase in nutrient intake can be achieved by
making appropriate changes in diet content,
feeding schedule and feeding environment.
Continuing to provide home-based food with
correction of faulty feeding practices and suitable
modifications to improve calorie content
Feeding environment with minimal distractions
helps in achieving better intake of food and less
of food battles
No need of special diet or drug in mild FTT
Regular monitoring for catch-up growth is
43. TREATMENT
Moderate FTT
Multidisciplinary team comprising of pediatrician,
dietician, child psychologist, developmental
specialist, social worker and a nurse
Outpatient management needs- frequent follow
up and home visits
Diet modified to produce calorie dense food
Treatment of any underlying medical illness
Improving psychosocial problem
Changing feeding environment
Changing feeding routine
44. Indications for hospitalization-
Severe FTT
Failure of outpatient management(no response
after 23 months of outpatient management) a
specialized, multidisciplinary inpatient assessment
should be considered.
Underlying medical problem requiring in-hospital
care
Psychosocial circumstances that put the child at
risk for harm
TREATMENT
45. Feeding pattern
Constant feeding schedule as per the age
Need to feed 8-12 times/day in the first 4 months
as compared to 6-8 feeds/day in later infancy
Allow the infant to feed for 20-30 min
Offer solids before liquid
Avoid distraction during feeding
>1 yr age children follow rule of 3----3 meal,3
snack,3 choices
Avoid grazing diet pattern and snacks should be
timed at least one hour before meal time
TREATMENT
46. Feeding environment- comfortable, relaxed with
minimum distraction
Eating with other family members should be
encouraged
Avoid force feeding, strict parenting approach,
autonomy struggle as it leads to food battle and
creates unpleasantness
Regular interaction between physician, dietician,
nurse practitioner and psychologist is essential
TREATMENT
47. Calorie requirement-
Calorie and vitamin rich food required for catch-
up growth
Calorie intake should be 150 % of
recommended daily calorie intake based on the
expected wt not the actual wt
Can be achieved by gradually increasing food
intake or by enrichment of food to increase
calorie content
TREATMENT
48. High calorie formulas that offers more than 20
Cal/ounce (1 ounce=28.3 gm) and high calorie
supplements like oil are useful
High energy milk like F100- 100 Cal/100 ml (milk
100 ml, sugar 1 tsf, oil ½ tsf), cereal milk and
thickened feeds (milk 100 ml+2 tsf cereal flour or
SAT mix) are beneficial.
SAT mix is precooked ready to mix powdered
cereal pulse mixture prepared from rice: wheat:
black gram: sugar in the ratio of 1:
TREATMENT
49. Family counseling is important
Weight gain in response to feeding establishes
psychological FTT
A wt gain of ½ kg/wk or 70 gm/kg/wk is expected
Children with severe malnutrition- incremental
increase in calories to avoid refeeding syndrome
Refeeding syndrome-A syndrome consisting of
metabolic disturbances that occur as a result of
reinstitution of nutrition to patients who
are starved or severely malnourished.
TREATMENT
50. The type of caloric supplementation is based on
the severity of FTT and the underlying medical
condition.
The response to feeding depends on the specific
diagnosis, medical treatment, and severity of FTT.
Minimal catchup growth should generally be 23
times the average weight gain for corrected age.
TREATMENT
51. Multivitamin supplementation should be given to
all children with FTT to meet the RDA, because
these children commonly have iron, zinc, and
vitamin D deficiencies, as well as increased
micronutrient demands with catchup growth
Underlying medical condition-organic causes of
FTT should be treated appropriately
TREATMENT
52. Fat malabsorption, cystic fibrosis and other
condition with pancreatic insufficiency –
pancreatic enzyme replacement therapy
Celiac disease- gluten free diet
Food allergy- Avoid specific food allergen
CHD, CLD, CKD, RTA, endocrine disorder-
specific treatment should be provided
Immunization to be as per schedule.
Intercurrent illness to be treated promptly
TREATMENT
53. Therapy for the psychosocial factors should be
specific for the
underlying issue (maternal depression, insufficient
funds for food)
Parent education should focus on what is normal
infant development and correcting any parental
misconceptions about feeding and temperament,
as well as learning the infant cues for hunger,
satiety, and sleep.
TREATMENT
54. Some children who develop feeding aversion
behaviors will require treatment by a specialized
feeding team.
If abuse or purposeful neglect is a concern, the
family should be referred to the child protective
service team.
TREATMENT
55. PROGNOSIS
FTT early in life, regardless of cause, is concerning
because maximal postnatal brain growth occurs in
the first 6 mo of life.
Studies investigating the longterm sequelae of FTT
in young infants and children have been conflicting,
and there is no clear consensus regarding the long-
term emotional, cognitive and metabolic effects.
Despite inconclusive longterm outcomes in children
who have FTT, investigators support early
nutritional interventions for children who have poor
56. Early FTT may be associated with increased risk
factors
(including dyslipidemia, hypertension, and glucose
intolerance) for cardiovascular disease as an adult
perhaps relating to epigenetic responses to
impaired nutrition and/or inflammation.
The growing importance of cardiovascular disease
among adults in lower and middle income nations
where many children still have inadequate nutrition
offers yet another reason why early FTT should be
cause for concern globally.
PROGNOSIS
57. References
NELSON’S TEXTBOOK OF PEDIATRICS ,20th EDITION
KE Elizabeth –Nutrition and child development , 5 th edition
Failure to Thrive: An Update SARAH Z. COLE, DO, Mercy
Family Medicine Residency, St. John’s Mercy Medical
Center, St. Louis, Missouri, American Academy of Family
Physicians. April 1, 2011 , Volume 83, Number 7:829-834
Effect of community based management in failure-to-
thrive: randomised controlled trial. Wright CM, Callum J,
Birks E, Jarvis S ,BMJ. 1998;317:571-574
PG textbook of pediatrics- Piyush Gupta, 1st edition
OP Ghai- textbook of pediatrics- 8th edition
Failure To Thrive: An Old Nemesis in the New Millennium
Textbook of pediatric gastroenterology by Riaz 2011