2.
Failure to thrive (FTT) is a chronic, potentially life threatening disorder of
infants and children who fail to gain and may even lose weight. Children
are considered as failing to thrive when their rate of growth does not meet
the expected growth rate for a child of their age. More specifically, the
term characterized those whose weight is below the 3rd percentile on an
appropriate growth chart.
Introduction
4.
The deviation from a normal growth channel is actually more descriptive
of what is happening to an individual than a decrease in the actual
amount of weight. Any infant or child at the fifth percentile should alert
the caregiver that a problem exists. 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.
5.
FTT is a term used to describe inadequate growth or the
inability to maintain growth in childhood.
Attained growth
• Weight<3rd percentile on standard growth chart.
• Weight for height<5th percentile on standard growth chart.
• Weight 20% or more below ideal weight for height.
Rate of growth
• Less than 20g/day from birth to 3 months of age.
• Less than 15g/day from 3 months to 6 months of age.
• Fall off from previously established growth curve.
• Downward crossing of >2 major percentiles.
Definition
6.
Traditionally FTT has been classified as
Classification of FTT
1 •Organic
2 •Inorganic
2 •Mixed
7.
Occurs when there is underlying medical cause
like:
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.
Organic
8.
Due to causes other than medical cause.
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
Inorganic
10.
1 •Inadequate caloric intake
2 •Inadequate absorption
3 •Increased caloric requirement
4 •Excessive loss of calories
5
•Altered growth potential or regulation.
CAUSES OF FTT
11. Incorrect formula preparation
Neglect
Excessive juice consumption
Poverty
Behavioral problem affecting eating
Non-availability of food
Misperceptions about diet and feeding practices
Errors in formula reconstitution
1.Inadequate caloric intake
12.
Dysfunctional parent-child interaction, child abuse
and neglect
Behavioral feeding problem
Mechanical problems with sucking, swallowing
and feeding
Primary neurological diseases
Chronic systemic disease resulting in anorexia, food
refusal and neurological problems
Continue…
17.
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.
CLINICAL FEATURES
Cont.….
20.
PRENATAL
(INTRANATAL) LABOUR, DELIVERY, AND
NEONATAL EVENTS
MEDICAL HISTORY OF CHILD
SOCIAL HISTORY
NUTRITIONAL HISTORY
History taking
21.
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
Examination and Tests
22.
Degree of Failure to Thrive
Growth
parameter
Mild Moderate Severe
Weight 75-90% 60-74% <60%
Height 90-95% 85-89% <60%
Wt/Ht ratio 81-90% 70-80% <70%
ASSESSMENT OF DEGREE OF FTT
23.
Children with FTT require 50% of Recommended Dietary
Allowance (RDA) of calories for catch up growth.
Correction of any underlying disease
Improvement in care-giver skills.
Regular and effective follow up
Treatment may also involve improving the family relationships
and living conditions.
MANAGEMENT
Cont.….
24. 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.
25.
NURSING MANAGEMENT
The nursing management to the care of child with FTT
and their families includes
1
•Optimum nutrition
2
•A consistent, warm, caring environment
3
•Organized program of Appropriate Stimulation
4
•Parental support and education
5
•Discharge planning
26.
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.
PROGNOSIS
28. Initial failure to thrive caused by physical defects
cannot be prevented but can often be corrected
before they become a danger to the child.
Maternal education, emotional and economic
support systems all help to prevent FTT in those
cases where there is no physical deformity.
PREVENTION
29.
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 by 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.
CONCLUSION
30. 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
IAP Textbook of pediatrics, 5th addition, page no.113
http://www.healthofchildren.com/E-F/Failure-to-Thrive.html
http://www.modernmedicalguide.com/failure-to-thrive/
http://www.slideshare.net/Singaram_Paed/approach-to-a-child-
with-failure-to-thrive
BIBLIOGRAPHY