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Failure To Thrive - Growth Disorder.pptx
- 1. Failure To Thrive(FTT) DR ARUNA KUMARI SANGWAN PG 3RD YEAR SCHOLAR
- 2. DEFINITIONS OF FTT •FTT is not a syndrome, rather it is a physical sign that a child is receiving inadequate nutrition for optimal growth and development • Older dichotomous view emphasized organic (underlying medical condition, rare) vs. non-organic causes (environmental, more common) • Now appreciated to be most commonly mixed/multi- factorial in cause
- 3. ORGANIC & INORGANICCAUSES Organic - caused by an underlying medical disorder Inorganic - caused by caregivers' or parents' actions Doctors are less likely to make a distinction today because medical and behavioral causes often appear together. ◦ For instance, if a baby has severe reflux and is reluctant to eat, feeding times can be stressful. The baby may become upset and frustrated, and the caregiver might be unable to feed the child adequate amounts of food.
- 4. ORGANIC CAUSES OFFTT • Systemic disease such as cardiac, pulmonary, GI • Sensory or motor delays • Malabsorption • Prolonged mechanical ventilation and/or prolonged tube feedings leading to sucking and swallowing problems or food refusal • An intolerance of milk protein • Infections-Parasites, urinary tract infections, tuberculosis
- 5. INORGANIC CAUSES OFFTT • Inadequate knowledge of infant nutrition needs • Family chaos, child neglect, financial hardship • Neglect and/or abuse • Parental mental illness/MR • Poor bonding and interaction • Lack of maternal response to infant needs; inability to recognize cues • Family stress • Parental drug abuse • Poor parental role models • Infant temperament • Poverty
- 6. PHYSICAL EXAM • Neurodevelopmentalstatus • Neurocutaneous markings • Dysmorphic features • Nutritional status • Dehyrdration • Feeding observation ▫ Bottle feeding ▫ Spoon/self-feeding ▫ Creating proper social environment
- 7. DIAGNOSIS • Goal isto determine cause • Anthropometric measurements • Health history • Dietary history and dietary rituals • Behaviors and interactions • Observe feeding if possible • Developmental assessment • Social history • Labs to rule out organic causes
- 8. LABORATORY TESTS • Ashotgun approach is not cost-effective • Tests must be performed based on positive findings from history and physical • Additional lab and imaging tests are completed for children who do not respond to dietary intervnetion • Important to review newborn metabolic screening tests for inborn errors of metabolism and hypothyroidism • Routine tests in children 6-18 months are for iron deficiency, TB, chronic UTI
- 9. MANAGEMENT • Need interdisciplinarymanagement • Reverse malnutrition—may require oral or tube feedings • Relieve stressors (family may just need to find food source) • Behavior modification at meal time • Continue to monitor growth response • If organic, treat disease process in addition to correcting nutritional deficits • More serious problems such as electrolyte disturbances and dehydration often require hospitalization
- 10. FACTORS AFFECTING RECOVERY •Early onset of FTT • Young or uncooperative parent • Low income • Low parental educational level • Severe feeding resistance from child • Quality of follow-up—child needs home visits with observations and measurements
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- 12. PROGNOSIS • Almost allchildren show adequate improvement with intervention • Many improve even without intervention as they become more independent in feeding themselves when hungry • A small percent of “picky eaters” have anxiety disorders and a few have autism spectrum disorders • Children who require gastrostomy feeding tubes and who have neurologic dysfunction interfering with swallowing usually require enteral feeding for life
- 13. PROGNOSIS (CONT.) • Someevidence of poorer cognitive and school outcomes of FTT children • Early iron deficiency anemia leads may lead to irreversible developmental deficits • Children experiencing calorie malnutrition may have also experienced environmental deficits (parental attention, emotionally/cognitively stimulating home) • Should be monitored for developmental and behavioral problems
- 14. CHART-BASED DEFINITIONS OFFTT • Children younger than 3 years of age, • Below 3rd or 5th percentile for age on more than one consecutive occasion • Weight drops down two major percentile lines • Whose weight is less than 80% of the ideal weight for age • Below the 3rd or 5th percentile on the weight-for- length curve
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- 16. DIFFERENTIAL DIAGNOSIS • 1)FTT with microcephaly ▫ TORCH infections ▫ Teratologic & genetic conditions ▫ Brain injury • 2) FTT with short stature ▫ Genetic syndromes (Russell-Silver, Turner, Down) ▫ Endocrine (hypothyroid, hypophosphatemic rickets, growth hormone deficiency) ▫ Teratologic conditions (fetal alcohol syndrome)
- 17. DIFFERENTIAL DIAGNOSIS 3) FTTcharacterized by adequate height for age and normal head circumference ▫ Inadequate calories offered (inadvertent/intentional) ▫ Child unwilling to accept food that is offered (poor appetite, oral aversion, food aversion, oromotor dysfunction) ▫ Caloric loss through vomiting or malabsorption or hypermetabolic state
- 18. NUTRITIONALAND FLUID NEEDS •120 kcal/kg/day needed for proper weight gain • Formula or other liquid nutritional supplement • Rice cereal • Vegetable oil • Vitamins and minerals • Daily weights • Strict I & O