FTT

1. F.T.T(Failure to thrive)
Definition
 Refers to infants whose weight is less than the normals for their gestation corrected age, sex, genetic potential, and medical condition.
 Does not include infants and kids with genetic short stature, constitutional growth delay, prematurity, or IUGR who have appropriate weight
for length and normal growth velocity.
 There is no consensus regarding the specific definition
 Weight below the 3rd or 5th % for gestation corrected age and sex
 Weight less than 80% of ideal weight for age
 Depressed weight for length
 A rate of daily weight gain less than that expected for age
Background
Normal growth in infants
 Average birth weight = 3.3kg
 Weight drops as much as 10% in first few days of life (likely due to loss of excess fluid)
 Birth weight should be gained back by 10 days of age. Birthweight should be doubled by age 4 months
 tripled by age 12 months.

2.  On average, infants gain:
 26-31grams per day from 0-3 months
 16-18 grams per day from 3-6 months
 12-13 grams from 6-9 months
 9-12 grams per day from 9-12 months
 7-9 grams per day from 1- 3 years
 Length increases by:
 25cm during the 1st year
 12.5 cm in the 2nd year
 5-6cm/year between 4 years old and puberty
 Up to 12cm/year around puberty
 Head circumference average at birth = 35cm
 47 cm by age 1 year
 55 cm by age 6 years

3. Potential implications
 Persistent short stature
 Secondary immune deficiency
 Increased susceptibility to infection, since illness decreases appetite and nutrient intake,
which leaves the child vulnerable to severe or prolonged infections
 Permanent CNS damage
Classification and causes
Based upon Pathophysiology
 Inadequate intake
 Inadequate absorption or increased losses
 Increased requirements (excess metabolic demand)
 Defective utilization

4. Increased requirements and defective utilization
CCCCCC HM
Inadequate absorption or increased losses
I I I I I MMM ABC PVS
Inadequate intake
I I I I I GG PMC S
CHD
Chronic IBD
Chronic systemic disease ( SLE,IJA)
Chronic or recurrent systemic infections ( TB, UTI)
Chronic respiratory insufficiency (BPD,CF)
Chronic metabolic disorder (inborn error of
metabolisms, storage diseases, diabetes mellitus,
adrenal insufficiency)
Hyperthyroidism
Malignancy
Intussusception
Infectious diarrhea
IBD
IO
Increase ICP
Malabsorption (CF,CHD)
Milk allergy
Malrotation
Adrenal insufficiency
Biliary atresia/cirrhosis
Celiac disease
Pyloric stenosis
Vomiting ,G/E
Short gut syndrome
Inappropriate feeding technique
Inappropriate nutrient intake (excessive juice intake
Insufficient lactation
Inability to eat large amounts (cardiopulmonary disease)
Inadequate appetite (anorexia of chronic disease,
chemotherapy, chronic constipation)
GERD
Genetic syndromes
Psychosocial problems
Mechanical obstruction (ie. cleft palate, dental lesions)
CNS dysfunction (CP hypotonia)
Sucking/swallowing dysfunction

5. Mental retardation, cerebral hemorrhage, cp, hydrocephalus, degenerative disorder
CNS
Hypothyroidism, hyperthyroidism, parathyroid disorder, pituitary disorder , adrenal insufficiency or excess ,DM, GH
deficiency
Endocrine
CHD, CHF, BPD, CF, OSA, Asthma, anatomical abnormalities of upper airway
Cardiopulmonary
GERD, NEC, IBD, celiac disease, pyloric stenosis, cleft palate, lactose intolerance, milk protein intolerance, Hirschsprung
disease, short gut syndrome, biliary disease, liver disease, cirrhosis, pancreatic insufficiency, malabsorption
GI
UTI, RTA, Diabetes insipidus, chronic renal disease
Renal
Chromosomal abnormalities, congenital syndrome, perinatal infection
Congenital
Inborn error metabolic
Metabolic
TB, HIV, parasitic infection
Infectious
Lead poising, malignancy, adenoid, tonsils, rickets, Anemia
Miscellaneous

6. Psychosocial Causes
Poor or inappropriate diet for age
.
Excessive use of fruit juice
Improper formula preparation
Diluted or over-concentrated
Food fads and special diets, including applying
diets for adults to kids
Parental neglect
Poverty or financial stressors leading to food
shortage
Food phobia
Parental mental health problems
Parental eating disorders
Child abuse
Other cause
Parental depression
Divorce
Lack of knowledge
Poverty
Early introduction of solid food

7. Evaluation of proportionality
Decreased weight in proportion to length
Reflects inadequate nutritional intake
Decreased length in proportion of weight
Suggestive of an endocrinologic abnormality
Decreased length with a proportionate weight
May be nutritional, genetic, or endocrine in origin
Head circumference impaired as much as, or more than, weight or
length Suggestive of an intrauterine infection, teratogenic exposures,
congenital syndromes, or other causes of microcephaly

8. Physical findings
General
> Loss of subcutaneous fat > Reduced muscle
mass
> Marasmus > Kwashiorkor
HEENT
>Dysmorphic features >Shape of head
>fontanelles > Sutures
>Oral abnormalities >Enlarge tonsils
Cardiac and pulmonary
>Cyanosis >Clubbing
>Resp distress >Dusky skin
>Murmurs
Abdomen
>Abdo distention >Organomegaly
Neuro
Detailed exam looking for any deficits
>Dermatitis
>Jaundice
Skin/hair

9. Investigations
GROWTH CHARTS
This is a vital tool for picking up failure to thrive à look at
the pattern of growth over time History
CBC ,U/A , Lytes, renal function, albumin
Lead level
Bone age
Thyroid function studies
Tests for GERD, malabsorption, celiac, or CF
Stool analysis
Sweat test
TTG-IGA
Liver enzymes
Infectious work-up: urine, stool, respiratory and/or blood
cultures
HIV, TB investigations
GH def
GF-1