Hello, I’m Dr. Mariam Abayomi, an Intern doctor in Jamaica, passionate about promoting health and wellbeing. I invite you to explore my latest presentation on Failure to Thrive (FTT), a condition that can significantly impact a child’s growth and development. In this presentation, you'll learn about: - Understanding FTT: What is Failure to Thrive? We’ll break down the medical definition, common causes, and symptoms to watch for. - Case Study Insight: Meet [Child’s Name], a [age]-month-old who struggled with FTT. Through their story, we’ll explore the real-life application of diagnosing and managing this condition. - Diagnostic Approaches: From growth charts to lab tests, discover the essential tools and methods used to identify FTT. - Management and Treatment: Learn about the multidisciplinary strategies employed to help children with FTT thrive, including nutritional support, medical treatments, and family education. - Key Takeaways: Highlighting the importance of early detection, comprehensive care, and ongoing monitoring to ensure the best outcomes for children. By following me on social media @HealthInspire, you’ll get updates, tips, and insights into health and wellbeing. Whether you’re a healthcare professional, a student, or a parent, my goal is to provide you with reliable information, support, and a bit of humor to navigate the world of health and wellness. Join me in making a difference – one informed decision at a time. Let's inspire better health together!

1. FAILURE TO THRIVE By: Dr. Mariam Abayomi
(MD)

2. THRIVE- GROWTH, FLOURISH IN SEVERAL
ASPECTS
SURVIVE- BASIC ACT OF STAYING ALIVE, TO
ENDURE DIFFICULT CIRCUMSTANCES

4. HTTPS://SHORTURL.AT/C

5. CASE OF I/0 OF A.W.
• Age: 3 Months
•D.O.B: 27/11/2020 @ 12:10 P.M.
• Sex: Female
•Labour and Delivery
• GA: 38+6/40
• Mode of delivery : LSCS
• APGAR: 7 and 9
•Resusitation: suction, oxygen
• Birth Weight: 3.02kg
• L: 46cm
•HC: 33cm

6. Neonatal Period:
- admitted to NICU for 10 days. Dx- mild respiratory distress syndrome
Adv. Life events: Last Hospitalization 1 month ago for LRTI,FTT.
Immunization- up to date, verbally reported by mother
Developmental history;
 Gross motor; Holds head up steadily
Language: coos
Social: does not recognize parent and doesn’t reach for familiar objects or people
HEENT –No rhinorrhea, otorrhea, congestion, nosebleeds, bleeding gums, sore
throat, throat pain or neck stiffness.

7. Historian : mother
PC: Pt. Was admitted due to FTT and heart failure
HPC:
 Pt known to have complex congental heart disease, facial palsy,
failure to thrive, f/u @ SABH POPD, Infant was in her usual state of
health when she started gasping for air, fast breathing, palpitations,
S.O.B.
 Mother states that appetite remained the same and DCx 5/day but pt.
has lost weight
 patient was rushed to the hospital in taxi and arrived A&E ;Initial vitals
HR: 144bpm RR: 98bpm Spo2 – 92% BP: 99/41mmhg T- 36.9C
Patient received PPV which improved RR and Spo2 and was admitted
for further management.
Nutrition;
Enfamil 20 oz q3 hrly( 1 level scoop of powder per 2 fl oz of water.)

8. On examination: Emanciated infant in obvious respiratory distress, MM pink+
moist, AC, AI, AF capillary refill <2 secs, Obvious facial asymmetry.
Resp: ICR, SCR, Tachypnea, AEEB, RR- 98bpm, crackles nil rales, wheeze.
CVS: Regular pulse, rhythm and volume, apex beat displaced @6th ICS, s1, s2,
s3, pansystolic murmur grade 4/6 heard, thrills, pedal edema, HR: 144bpm
CNS: awake, irritable, facial asymmetry to left side, decreased bulk, normal
tone, moves all limbs equally.
ABD: soft, non tender, BS+ve
Weight : 3.5kg ( 1 month ago) - 2.7kg
Drug hx:
Po lasix 3mg tid
Po captopril 0.9mg tid
Po hemafed 0.8cc

9. INVESTIGATIONS
Na- 133
K- 5.2
Cl – 98
HCO3- 18
Urea- 5.6
Creat- 2.0 mg/dL
WBC- 11.0
Hb- 10g/dl
CXR: showed
1. increased cardiac silhouette
2. patchy opacity

11. Assessment
Congestive Heart Failure
Complex congenital heart disease
 Failure to thrive
Facial palsy
Plan
Admit to PDW
IVA, CBC, U&E
Feed 60cc of 22kcal q 3 hrly
 Po Captopril 0.9mg tid
Po aldactone 3.5mg bd
Po digoxin 17mcg bd
IV Lasix 4mg stat then 4mg tid
Blood transfusion & consent
For dietician referral

12.  Patient received 30cc PRBC over 4 hours which improved pt’s Hb
Daily weights
Monitor vitals + spo2
ECG: Atrial enlargement, Lt Axis deviation, sinus tachycardia
ECHO:
Mild to moderate aortic valve and mitral valve stenosis
Moderate patent ductus arteriosus
Moderate VSD
Recommendation; Urgent referral to BHC for further management
Cardiologist referral

13. W
R
Mother admits to pt. having Enfamil 2.5 oz every 2 hrs , admits to infant passing
stool, urine, DCx 5 /day
Mother stated that Dr. foster will arrange for her to travel abroad for heart
surgery so she’s currently making passport arrangements for her child, she also
started a Go fund me to cover the cost.
S- nil complaints voiced by mother, denies S.O.B, vomiting, edema.
Mother admits to pt’s compliance to TTH(po Lasix 3mg tid, Po captopril 0.9mg
bd, Po aldactone 3.8mg bd)
WT; 3.15kg  3.30kg (21g/day)
Vitals ; Pulse- 122-124bpm, SPO2- 98%, BP- 88/50
O/E; well looking infant seen in nil distress, mm pink + moist, AC,AF,AI.
Resp: mild SCR, ICR, AEEB, chest is clear
CVS: Apex @ 4th ICS, s1, s2, pansystolic murmur heard
CNS: awake , alert, all limbs move equally
ABD: soft, nontender, BS+ve

14. Assesment
Mild respiratory distress
Not in HF
Stable
Plan
Continue current management
For RPT CBC, U+Es
WR x 3/52

15. WHAT IS FAILURE TO THRIVE
Failure to thrive (FTT) is a descriptive term used to describe inadequate
growth or
Inability to maintain growth in childhood
 Weight for age < 3rd percentile on the growth chart
 Weight for height < 5th percentile on the growth chart
 Weight for age or height < 80% of ideal (ie. 50th percentile)
 Zero growth velocity for 6 months or more

17. EPIDEMIOLOGY
True incidence of FTT is not known!
According to researchgate.net FTT affects
5-10% of young children in developed
countries with a higher incidence in
developing countries!
Prevalence higher in developing countries ,
why?
Poverty
Malnutrition

18.  Organic FTT
Secondary to underlining medical illnesses
 Nonorganic FTT (NOFT)
Accounts for over 70% of cases
Psychosocial causes of FTT
Inadequate food or undernutrition
No known medical condition that causes poor growth
 Mixed FTT
Organic and non organic causes coexist.
Those with organic disorders may also suffer from environmental
deprivation

19. Inadequate caloric intake
Inadequate absorption
Increased energy utilization
Psychosocial factors

20. PSYCHO-SOCIAL FACTORS
Neglect
Maternal depression
Attachment issues

21. INADEQUATE CALORIC INTAKE
Breast feeding difficulties
Non availability of formula or
supplemental feeds
 Incorrect formula preparation
Mechanical problems; cleft palate,
nasal obstruction, sucking or
swallowing dysfuction

22. INADEQUATE ABSORPTION
GI Losses: chronic diarrhea, vomiting
Celiac disease
Cow milk protein intolerance
Intestinal tract obstruction (pyloric stenosis, hernia, malrotation,
intussusception

23. INCREASED CALORIC
REQUIREMENT/ORGANIC
CAUSES
 Hyperthyroidism
 Congenital heart disease
 Cerebral palsy
 Chronic immunodeficiency
 Chronic respiratory disease
 Neoplasm

24. APPROACH TO A CHILD
WITH FAILURE TO
THRIVE

25. HISTORY TAKING
•Prenatal:
• Gestational age
• Exposure to (TORCH) infection
• Maternal cigarette or drug use
• Use of medication
Pregnancy health history, including a
detailed history of weight gain,
prenatal care, nutrition and unusual
nutritional practices, general
complications, bleeding.
Labor and delivery and
complications, if any

26. PERINATAL HISTORY
Neonatal asphyxia/Apgar scores
Small for gestational age
 Birth weight and length
 Congenital malformations or infections
 Maternal bonding at birth
 Length of hospitalization
 Feeding difficulties during neonatal period

27. •Medical:
• Immunizations, developmental milestones
• history of infections
• GIT system- GI losses and malabsorption
•Social:
• Economic, financial, and social support
• Caregiver perception of child care
•Nutritional history:
• Food allergies
• Vitamin supplementation
Family history
• Stature and growth patterns
• Medical problems
• Developmental delays

28. FEEDING HISTORY
 Breast and formula feeding
 Typical feeding schedule, plus food preparation (formula prep, portion size)
 Methods of feeding, length of time spent feeding, and diet supplementation/medication
 Description of type of solid foods taken (quantitative composition and frequency of meals
and snacks)
 Prospective 3-day food diary
Picky eater

29. HISTORY

30. HISTORY

32. Goals of physical
examination include
1. Detection of an underlying
disease that may impair
growth
2. Assessment for signs of
possible child abuse
3. Assessment of the severity
and possible effects of
malnutrition

33. ON EXAMINATION- ENERGY
CONSERVATION MOOD
Not interested in the surroundings
Poor socialization
Apathetic
Irritable on handling

34. HAIR CHANGES
Thin silky hair
Easily pluckable
Colour changes
Aloplecia – scalp, eye brows

35. Most common clinical presentation is poor growth
Reduced subcutaneous fat or muscles
Dermatitis

36. CONT’D…
Neglect of hygiene
Diaper rash
Unwashed skin
Uncut and dirty finger nails or
unwashed clothing
Delays in social and speech development
Expressionless face
Lack of energy

37. MOUTH
Sores within the mouth
Candida infx
Smooth pale tongue
 Red beefy tongue

38.  Vital signs
 Temperature  hypothermia
 PR  tachycardia
 RR  tachypenic
 BP  hypotension
 Anthropometry derangements

39. •INVESTIGATIONS
•Blood work:
• CBC: leukopenia, thrombocytopenia
• → immunodeficiency, infection, Iron
studies→ anemia
• RBG-------Hypoglcemia
• U/A-------- UTI
• Inflammatory markers: erythrocyte sedimentation
rate
• (ESR) and CRP → underlying inflammation
• Biochemistry:
• Electrolyte imbalance: hyponatremia,
hypokalemia, hypomagnesemia
• → malnutrition/dehydration
• ↓ Prealbumin → malnutrition
• Metabolic acidosis
• Urea and creatinine → kidney function
• Liver function tests
• Allergy testing for milk protein
• Hormonal studies:
• TSH, T3/T4
• Growth hormone
•Specific tests to confirm underlying cause:
• Chloride sweat test → cystic fibrosis
• Tissue transglutaminase deficiency → celiac disease
•Imaging:
• Chest X-ray
• cardiac silhouette abnormality → congenital
cardiomyopathy
• Bone series: multiple fractures at different stages → rickets
or abuse
•GI series → rule out an anatomic defect

40. GROWTH CHARTS
Standard growth charts are commonly
used to define how the growth of a child
compares to normal.
Growth charts are constructed using a
group of normal children living:
In a given area at a given time.
05/01/2008 E.C 40

41. INDICATIONS FOR ADMISSION
Outpatient treatment failure
Severe malnutrition or dehydration
 Electrolyte imbalance
 serious underlying medical illness
 Extremely poor parent-child interaction or suspect
Abuse; for safety or full work up

42. MANAGEMENT
A multidisciplinary approach is taken to manage FTT, especially in
nonorganic causes.
•Nonorganic FTT: the goal is to Improve psychosocial well-being
and nutrition.
• Lactation consultant to educate mother or caregiver on proper latch and
feeding routine
• Dietitian to assess the quality of food intake
• Child psychologist and social service worker involvement in cases of abuse
and trauma
• Nutritional rehabilitation
•Organic FTT: Treat the underlying cause.

43. TREATMENT
Resuscitation
Maintenance
Stimulation
Education

44. RESUSCITATION
Deal with acute life threatening events
Volume depletion/dehydration
Cardiopulmonary distress or failure
Hypothermia
Hypoglycaemia
Severe metabolic derangement

45. MAINTENANCE
Changes occur in the body's metabolic and
homeostatic mechanisms in adaptation to
malnutrition.
During maintenance the aim is to provide
sufficient calories to prevent further
breakdown of protein for energy and
Avoiding overwhelming the down regulated
processing mechanisms causing worsening
metabolic derangement

46. Calories
 100 Kcal/kg/day of feed, aim for appox 0.7g/kg/day of protein
 Given in divided feeds throughout a 24hour period (eg.q3hourly)
Supplements
mineral mix 2mls/kg divided in feeds
folic acid 2.5 – 5 mg/day
multivitamins (tropovite)

47. MINERAL MIX
Potassium chloride 37.28g
Magnesium chloride 50.84g
Tri-Potassium citrate 54.08g
Zinc acetate 3.36g
Dissolve in deionized water and make up to a litre
2ml/kg/day divided equally among the feeds

48. MAINTENANCE CONT’D
Daily Weights
Do not increase the calories during maintenance
Use of Intravenous Fluids?
Keep warm

49. STIMULATION
Stimulation results in faster recovery from
nutritional insult and promotes psychomotor
development
Care givers should be sensitized to this fact and
take the opportunity to stimulate and show
affection at each interaction
Organized play therapy
Allow interaction with other children once clinically
able to do so – play mats
Staff should have bright clothing ( and smiles)
Mobiles and crib decorations
Do not cover child's face or restrain them

50. EDUCATION
Encourage parents to be present as
often as possible
How to prepare nutritionally appropriate
and cost effective meals
How to manage acute infection and
diarrhea
Immunization schedule and importance

51. WHEN TO DISCHARGE
• Weight gain: The infant should be consistently gaining weight,
ideally at an appropriate rate for their age.
• Resolution of problem
• Adequate nutrition: The infant should be tolerating feeds well
and receiving appropriate nutrition, whether through
breastfeeding, formula feeding, or other means.
• Medical stability: Any underlying medical conditions
contributing to failure to thrive should be adequately managed
and stable.
•Family support: The family should have access to resources and
support to continue caring for the infant's needs at home,
including feeding support if necessary.
• Follow-up care: There should be a plan in place for ongoing
monitoring and follow-up with healthcare providers to ensure
continued progress and address any concerns that may arise.

52.  Congenital heart disease is an organic
cause of FTT
Parental education plays a crucial role in the
management of failure to thrive.
Failure to thrive due to neglect or abuse
requires a multidisciplinary approach to
management, involving healthcare
professionals, social workers, and legal
authorities to ensure the safety and well-being
of the child.

53. FOLLOW UP
Ward review in a week
POPD monthly for years(
depends
On the severity and if there’s
improvement)
Monitor growth
Monitor development

54. REFERENCES
1.https://www.hopkinsmedicine.org/health/conditions-and-diseases/failure-to-thrive
2.https://www.ncbi.nlm.nih.gov/books/NBK459287/
3.https://www.msdmanuals.com/professional/pediatrics/miscellaneous-disorders-in-
infants-and-children/failure-to-thrive-ftt-in-children

55. “DON’T JUST SURVIVE, THRIVE!”-
MARIAM.

56. HTTPS://SHORTURL.AT/C