FTT describes inadequate growth in children and is diagnosed using growth charts. It affects 5-10% of young children. Causes include inadequate caloric intake, absorption issues, increased needs, or defective utilization. Organic causes stem from medical issues while inorganic are due to caregiver actions. Diagnosis involves history, exam, and tests like bloodwork and growth monitoring. Management focuses on optimal nutrition, supportive environment, education, and follow up to promote catch up growth. Prognosis depends on duration and treatment of the underlying cause.

1. Presented By –NAVJYOT SINGH
M.Sc.(N) 1st YEAR

2. Introduction

FTT describes a condition rather than a
specific disease. Children are considered as
failing to thrive when their rate of growth
does not meet the expected growth rate for a
child their age. 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.

3. Definition

FTT is inadequate physical growth diagnosed
by observation of growth over time using a
standard growth chart, such as the National
Center For health Statistics (NCHS) growth
chart.
Usually it refers to a child whose growth is
below the 3rd or 5th percentiles for their age.

4. Epidemiology

FTT affects 5-10% of young children and
approximately 3-5% of children admitted in
teaching hospitals
Under feeding is the single commonest cause
of FTT that results from parental poverty and
ignorance
95% of cases of FTT inadequate food offered
or take

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

6. Based on pathophysiology FTT is classified as

1
•Inadequate caloric intake
2
•Inadequate absorption
3
•Increased caloric requirement
4
•Defective utilization of calories

7. Organic

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.

8. Inorganic

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

9. Inadequate caloric intake

Incorrect formula preparation
Neglect
Food fads,
Excessive juice consumption
Poverty
Behavioral problem affecting eating

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

11. Increased caloric requirement

Hyperthyroidism
Congenital heart disease
Chronic immunodeficiency

12. Defective utilization of calories

 Genetic anomaly
 Congenital infection
 Metabolic storage disease

13. CAUSES OF FTT

 The most common cause of failure to thrive is malnutrition
 Prenatal
 Prematurity
 Exposure in utero to toxic agents
 Intrauterine growth restriction from any cause
 Postnatal
 Inadequate caloric intake
 Inadequate absorption
 Increased caloric requirement
 Defective utilization of calories

14. SYMPTOMS

 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.
Cont.….

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

16. DIAGNOSTIC EVALUATION

History taking
Examination and Tests

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

18. Examination and Tests

 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

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

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

23. PROGNOSIS

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.

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

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

26. CONCLUSION

 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.

27. BIBLIOGRAPHY

 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
 http://www.healthofchildren.com/E-F/Failure-to-Thrive.html
 http://drugline.org/ail/pathography/743/
 http://www.modernmedicalguide.com/failure-to-thrive/
 http://www.nlm.nih.gov/medlineplus/ency/article/000991.htm
 http://www.slideshare.net/Singaram_Paed/approach-to-a-child-with-
failure-to-thrive