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Failure to Thrive
Failure to thrive (FTT) is defined as a lack of appropriate weight gain or a persistent weight loss from a child's normal growth curve. It can be classified as organic, caused by medical issues, or non-organic, caused by psychosocial factors. A thorough history, physical exam, and lab tests are needed to determine the etiology and develop an appropriate treatment plan focused on nutritional rehabilitation and addressing the underlying cause. Prognosis depends on the etiology, with FTT in the first year generally having a poorer outcome. Prevention efforts include exclusive breastfeeding, parental education, and early detection and intervention.
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Failure to Thrive
- 1. FAILURE TO THRIVE CSNVittal
- 2. FTT - DEFINITION “Failureto gain weight or a persistent fall in weight from the child`s normal centile diagnosed by observation of growth over time using a standard growth chart” This excludes 1. Constitutionally light child 2. Transient weight loss associated with acute illness CSN Vittal Descriptive term, not a Specific Diagnosis
- 3. DEFINITION In a childbelow 3yrs age 1 • Wt is below 5th Centile 2 • Weight for height ratio less than 2 SD (or <3rd or 5th percentile) for age and gender 3 • Wt drops down of > 2 major percentiles on growth chart 4 • Triceps skin fold thickness < 5 mm
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- 6. A boy of15 mo age who is 79 cm length as 50th percentile
- 7. A boy of15 mo age who is 79 cm length as 50th percentile , Ideally should weigh 10 kg If he is only 6.7 kg, = 67%
- 8. A boy of15 mo age who is 79 cm length as 50th percentile, Ideally should weigh 10 kg If he is only 6.7 kg, = 67%
- 9. FTT - Classification 1.Organic • G.I. • Renal • Cardio Pulmonary • Endocrine • CNS • Infection • Metabolic 2. Non Organic • Maternal Deprivation • Maternal Depression • Crisis In The Family • Neglect Regarding Nutrition • Ignorance • Child Rearing • Feeding Technique 3. Mixed (25%)
- 10. ETIOLOGY - PRACTICALAPPROACH Inadequate Intake Nutritional ignorance Mechanical problems Child abuse Systemic disease Prenatal insult Caloric Wasting Vomiting Renal disorders Diarrhoea Diabetes mellitus Increased Requirements CHD Hyperthyroi dism Recurrent infections Chronic Resp Dis Altered Growth Potential Prenatal insult Chromosomal abnormality Endocrinopaty
- 11. Approach To AChild With FTT Classification & Etiological Diagnosis Group 1 Normal HC Wt > Ht reduced Malnourished – Def.intake or Malabsorbtion Group 2 Normal or Increased HC, Wt mod. Reduced in proportion to Ht Constitutional dwarfism Endocrinopathies Structural dystrophies Group 3 Subnormal HC, Wt & Ht decreased in proportion Primary CNS defect, IUGR
- 12. HISTORY - FTT •Routine – antenatal, natal, perinatal • Pregnancy – planned or unplanned • Was it a preterm delivery ? • IUGR – worse prognosis • History of TORCH • Dietetic history – detailed • Social & family history CSN Vittal
- 13. PHYSICAL EXAMINATION -ORGANIC FTT CSN Vittal • Thorough general & systemic examination • Assessment of nutrition – Marasmus – Kwashiorkor – Vitamin deficiencies • Nutritional Anthropometry – Weight , – Height , – Head Circumference – Skin fold thickness , – Mid arm Circumference • Neuro developmental assessment
- 14. LABORATORY AIDS TODIAGNOSIS • CBC & ESR • Complete Urine Analysis • Stool Examination & • Mantoux Test • X Rays – to r/o PC, Child Abuse , Bone Age Estim. • Evaluation of Malabsorption – • Stool Fat, Chymotrypsin, Sweat Chloride, Small Bowel Biopsy, Upper G.I. Contrast Studies • Barium Enema, IVP, Sigmoidoscopy • LFT • Electrolytes, pH, Glucose, • BUN, Serum & Urine Amino acids
- 15. MANAGEMENT GOALS • Nutritionalrehabilitation – Eating pattern – Care giver skills – Regular follow-up • Find and treat organic cause if any • Address psycho social and developmental issues
- 16. MANAGEMENT - monitoring Acceptableweight gain per day as per age Age in Months Wt gain (gm/Day) Birth to < 3 mo 20 –30 3 to < 8 mo 15 – 22 6 to < 9 mo 15 – 20 9 to < 12 6 – 11 12 to < 18 5 – 8 18 to 24 3 – 7
- 17. INDICATIONS FOR ADMISSION • Weightfor height less than 70 % of the median • Detailed evaluation for suspected organic disorder • Suspected child abuse or neglect • Non response to out patient management
- 18. PROGNOSIS • FTT infirst year of life regardless of etiology – prognosis is ominous • Maximal brain growth occurs during the first six to twelve months of age . • One third of children with Psycho social FTT have developmental delay, social & emotional problems • Prognosis for organic FTT - variable - depends on the etiology
- 19. PREVENTION • Exclusive breastfeeding for early pregnancy • Community effort • Parental education • Early detection of FTT and intervention • Prevention of low birth weight • Neonatal screening for treatable metabolic disorders
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- 21. 3 Plank Protein Bridge AvailableAnimal Protein Prolonged Breast Feeding Vegetable Protein Mixture Safety Net
- 22. Safety Net 1. SupplementaryFeeding 2. Group eating 3. Akshayapatra
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