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![Etiology based on pathophysiology
Inadequate nutrient absorption or increased losses
• Malabsorption
• Biliary atresia, cirrhosis
• Vomiting or "spitting up" (related
to infectious gastroenteritis,
increased intracranial pressure,
adrenal insufficiency, or drugs [eg,
purposeful administration of syrup
of ipecac])
• Intestinal tract obstruction (pyloric
stenosis, hernia, malrotation,
intussusception)
• Infectious diarrhea
• Necrotizing enterocolitis or short
bowel syndrome](https://image.slidesharecdn.com/failuretothrive-230308082301-1f512848/85/FAILURE-TO-THRIVE-pptx-14-320.jpg)
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FAILURE TO THRIVE.pptx
- 1. FAILURE TO THRIVE DR. HabeebRehman KM
- 2. INTRODUCTION • Descriptive termrather than a diagnosis • Used for infants and children upto 3years of age whose physical growth is significantly less than their peers of same age and sex.
- 3. DEFINITIONS • Weight forage below 3rd centile for age on the growth chart or more than two standard deviations below the mean for children of same age and sex. • Weight for height less than -2 Z score. • Weight downcrossed two major centiles in growth chart in a short time
- 4.
- 5. FTT - Classification •NONORGANIC • Prenatal • Malnourished mother • Lack of prenatal bonding • Postnatal • Poor feeding skills • Dysfunctional family • Difficult parent-child interactions • DifficultChild • Abuse/Neglect 3/8/2023 5
- 6. • Non organiccauses • Poverty • Misperceptions or lack of knowledge about diet and feeding • Lack of breast feeding • Feeding diluted formula • Dysfunctional parent-child relationship.
- 7. FTT - Classification •ORGANIC FTT • Prenatal Causes • Prematurity and complications • Toxic exposure • Postnatal • Inadequate intake • Lack of appetite • Inability to suck/swallow 3/8/2023 7 • postnatal • Poor absorption and/or use of nutrients • GI disorder (celiac, CF) • Inborn errors of metabolism • Increased metabolic demand • Hyperthyroidism • Chronic Disease
- 8. ETIOLOGY • ORGANIC FTT •Gastrointestinal-GER, malabsorption, inflammatory bowel disease, pyloric stenosis. • Neurological- mental retardation, cerebral palsy. • Renal- renal tubular acidosis, chronic renal failure. • Cardiopulmonary-CHD, cystic fibrosis, asthma
- 9. • ORGANIC FTT •Endocrine- hypothyroidism, diabetes mellitus. • Infections- chronic parasitic infections of GIT, tuberculosis, HIV • Genetic- IEM, chromosomal anomalies. • Miscellaneous – malignancy, lead poisoning
- 11. Etiology based onpathophysiology 1. Inadequate nutrient intake 2. Inadequate appetite or inability to eat large amounts 3. Inadequate nutrient absorption or Increased losses 4. Increased nutrient requirements or ineffective utilization
- 12. Etiology based onpathophysiology Inadequate nutrient intake • Inappropriate feeding technique • Disturbed caregiver/child relationship • Economic deprivation • Inappropriate nutrient intake (eg, excess fruit juice consumption, factitious food allergy, inappropriate preparation of formula, inadequate quantity of food, inappropriate food for age, neglect, food fads) • Inappropriate parental knowledge of appropriate diet for infants and toddlers • Insufficient lactation in mother • Gastroesophageal reflux • Psychosocial problems • Mechanical problems (cleft palate, nasal obstruction, adenoidal hypertrophy, dental lesions) • Sucking or swallowing dysfunction (CNS, neuromuscular, esophageal motility problems)
- 13. Etiology based onpathophysiology Inadequate appetite or inability to eat large amounts • Psychosocial problems • Cardiopulmonary disease • Hypotonia, muscle weakness, or hypertonia • Anorexia of chronic infection or immune deficiency • Cerebral palsy • CNS pathology (eg, tumor, hydrocephalus) • Genetic syndrome • Anemia (eg, iron deficiency) • Chronic constipation • Gastrointestinal disorder (eg, pain from gastroesophageal reflux, intestinal tract obstruction) • Craniofacial anomalies (eg, cleft lip and palate, micrognathia)
- 14. Etiology based onpathophysiology Inadequate nutrient absorption or increased losses • Malabsorption • Biliary atresia, cirrhosis • Vomiting or "spitting up" (related to infectious gastroenteritis, increased intracranial pressure, adrenal insufficiency, or drugs [eg, purposeful administration of syrup of ipecac]) • Intestinal tract obstruction (pyloric stenosis, hernia, malrotation, intussusception) • Infectious diarrhea • Necrotizing enterocolitis or short bowel syndrome
- 15. Etiology based onpathophysiology Increased nutrient requirements or ineffective utilization • Hyperthyroidism • Malignancy • Chronic inflammatory bowel disease • Chronic systemic disease (juvenile idiopathic arthritis) • Chronic or recurrent systemic infection (urinary tract infection, tuberculosis, toxoplasmosis) • Chronic metabolic problems (storage diseases, and inborn errors of metabolism, such as galactosemia, methylmalonic acidemia, diabetes mellitus, adrenal insufficiency) • Chronic respiratory insufficiency (bronchopulmonary dysplasia, cystic fibrosis) • Congenital or acquired heart disease
- 20. Etiology by ageof onset • Prenatal • Intrauterine growth restriction • Prematurity • prenatal infection • congenital syndromes • teratogenic exposures (eg, anticonvulsants, alcohol).
- 21. • Neonatal (<1month) • Poor quality of suck (whether breast- or bottle-fed) • incorrect formula preparation • breast-feeding problems • inadequate number of feedings • poor feeding interactions (eg, infant gags or vomits during feedings, mother misreads signals of hunger or satiety) • Neglect • parental mental illness • metabolic, chromosomal, or anatomic abnormalities.
- 22. • 3 to6 months • Underfeeding (possibly associated with poverty) • improper formula preparation • milk protein intolerance • oral motor dysfunction • cystic fibrosis • congenital heart disease • gastroesophageal reflux.
- 23. • 7 to12 months • Feeding problems (inadequate quantity/ frequency, delayed introduction of solids, intolerance of new foods) • intestinal parasites.
- 24. • >12 months •highly distractible child • distracting environment • acquired illness • new psychosocial stressor (divorce, job loss, new sibling, death in the family, etc) • sensory-based feeding disorders in children with developmental disorders (eg, autism) • swallowing dysfunction.
- 25. Evaluation of achildwith FTT • HISTORY • PHYSICAL EXAMINATION • ANTHROPOMETRY • INVESTIGATIONS
- 26. History Prenatal • General obstetrichistory • Recurrent miscarriages • Use of drugs, smoking Natal, post-natal • Prematurity • Birth weight • Neonatal asphyxia • Congenital malformations or infections. • Maternal bonding at birth
- 27. Evaluation of achild with FTT History Medical history • Past medical / surgical illness • Development • Immunization Psychosocial history • Age and occupation of parents • Who feeds the child • Life stressors • Availability of social and economic support. • History of violence or abuse of care-giver
- 28. Nutritional history • Detailsof breast feeding. • Formula feeds. • Solid foods • Vitamin and mineral supplements • Food likes and dislikes, allergy
- 31. Physical examination • Signsof PEM • Signs of vitamin deficiency • Dysmorphic features • Serial growth parameters • Development assessment • Focussed examination for identifying chronic illnesses • Signs of possible child abuse
- 33. LAB INVESTIGATIONS • Notusually required if cause is psychosocial • Donr to rule out Organic cause • 1st line:- CBC+ESR, URE+CULTURE, Stool r/e LFT,RFT,RBS, Electrolytes, ca, P, HIV &TB to be ruled out 2nd line:-TFT, ABG, Celiac disese serology Urine for metabolic disease Echo, CXR, USG abdomen
- 34. Management • Child’s dietand eating pattern • Child’s development stimulation • Improvement in care-giver skills • Treatment of underlying disease if any • Regular and effective follow up.
- 35. Diet and eatingpattern • Mothers should be counselled about feeding problems • Avoid fruit juices • Feeding interval should not be > 4hours. • For older infants and young children meals should last for about 30 minutes.
- 36. • solid foodsshould be offered before liquids. • environment distractions should be minimised • not to be force-fed. • Catch up growth • High calorie diet with 1.5 – 2 times the expected calorie. • Gaining weight at a rate greater than 50th percentile for the age.
- 37. Monitoring nutritional therapy •1st priority to achieve an ideal weight for age • 2nd goal is catch up length for age • Effectiveness of therapy is monitored by gain in weight
- 38. Developmental stimulation • Intensiveenvironmental stimulation • Foster homes
- 39. Other aspects • Improvementin care-giver skills • Treatment of underlying disease if any • Regular and effective follow up.
- 40.