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

1. Presented By – ULFAT AMIN
M.Sc.(N) 1st YEAR

2.  Failure to thrive (FTT) is a chronic, potentially life threatening disorder of
infants and children who fail to gain and may even lose weight. Children
are considered as failing to thrive when their rate of growth does not meet
the expected growth rate for a child of their age. More specifically, the term
characterized those whose weight is below the 3rd percentile on an
appropriate growth chart. The deviation from a normal growth channel is
actually more descriptive of what is happening to an individual than a
decrease in the actual amount of weight. Any infant or child at the fifth
percentile should alert the caregiver that a problem exists. 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.
Introduction

3. 
 Attained growth
• Weight < 3rd percentile on standard growth chart.
• Weight for height < 5th percentile on standard growth
chart.
• Weight 20% or more below ideal weight for height.
 Rate of growth
• Less than 20 g/day from birth to 3 months of age
• Less than 15 g/day from 3 months to 6 months of age
• Falloff from previously established growth curve
• Downward crossing of > 2 major percentiles
Definition

4. 
 Traditionally FTT has been classified as
Classification of FTT
1 •Organic
2 •Inorganic
2 •Mixed

5. 
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.
Organic

6. 
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
Inorganic

7. 
 Has both organic and inorganic causes and cnt be
described alone.
Mixed

8. 
1 •Inadequate caloric intake
2 •Inadequate absorption
3 •Increased caloric requirement
4 •Excessive loss of calories
5
•Altered growth potential or regulation.
Causes of FTT

9.  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
Inadequate caloric intake

10. 
Cystic fibrosis
Celiac disease
Vitamin deficiencies
Hepatic diseases.
Inadequate absorption

11. 
 Hyperthyroidism
 Congenital heart disease
 Chronic immunodeficiency
 Chronic respiratory disease
 Neoplasm
 Chronic or recurrent infection
Increased caloric requirement

12. 
 Persistent vomiting
 Gastro esophageal reflux disease
 Gastrointestinal obstruction
 Increased intracranial pressure
 Renal losses—renal tubular acidosis
 Diabetes mellitus
 Inborn errors of metabolism
Excessive loss of calories

13. 
 Chromosomal abnormalities
 Endocrinopathies
Altered growth potential or
regulation

14. 
 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.
CLINICAL FEATURES
Cont.….

15.  Constipation
 Excessive crying
 Excessive sleepiness (lethargy)
 Irritability
 Minimal smiling
 Avoidance of eye contact
 Unresponsive

16. 
History taking
Examination and Tests
DIAGNOSTIC EVALUATION

17. 
 PRENATAL
 LABOUR, DELIVERY, AND NEONATAL EVENTS
 MEDICAL HISTORY OF CHILD
 SOCIAL HISTORY
 NUTRITIONAL HISTORY
History taking

18. 
 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
Examination and Tests

19. 
Degree of Failure to Thrive
Growth
parameter
Mild Moderate Severe
Weight 75-90% 60-74% <60%
Height 90-95% 85-89% <60%
Wt/Ht ratio 81-90% 70-80% <70%
ASSESSMENT OF DEGREE OF FTT

20. 
 Children with FTT require 150% of Recommended Dietary
Allowance (RDA) of calories for catch up growth.
 Correction of any underlying disease
 Improvement in care-giver skills.
 Regular and effective follow up
 Treatment may also involve improving the family
relationships and living conditions.
MANAGEMENT
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
 The nursing management to the care of child with FTT
and their families includes
1
•Optimum nutrition
2
•A consistent, warm, caring environment
3
•Organized program of Appropriate Stimulation
4
•Parental support and education
5
•Discharge planning

23. 
 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.
PROGNOSIS

24. 
Permanent mental
Emotional
Physical delays can occur.
POSSIBLE COMPLICATIONS

25.  Initial failure to thrive caused by physical defects
cannot be prevented but can often be corrected
before they become a danger to the child.
Maternal education, emotional and economic
support systems all help to prevent FTT in those
cases where there is no physical deformity.
PREVENTION

26. 
 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.
CONCLUSION

27.  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
 IAP Textbook of pediatrics, 5th addition, page no.113
 http://www.healthofchildren.com/E-F/Failure-to-Thrive.html
 http://www.modernmedicalguide.com/failure-to-thrive/
 http://www.slideshare.net/Singaram_Paed/approach-to-a-child-
with-failure-to-thrive
BIBLIOGRAPHY