Failure to Thrive

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

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.

Introduction

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.

Definition

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

Epidemiology

Traditionally FTT has been

classified as

Classification of FTT

1•Organic

2•Inorganic

1

• Inadequate caloric intake

2• Inadequate absorption

3

• Increased caloric requirement

4

• Defective utilization of calories

Based on pathophysiology FTT is classified as

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.

Organic

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

Inorganic

Incorrect formula preparation Neglect Food fads, Excessive juice consumption Poverty Behavioral problem affecting eating

Inadequate caloric intake

Cystic fibrosis

Celiac disease

Vitamin deficiencies

Hepatic diseases.

Inadequate absorption

Hyperthyroidism

Congenital heart disease

Chronic immunodeficiency

Increased caloric requirement

Genetic anomaly

Congenital infection

Metabolic storage disease

Defective utilization of calories

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

CAUSES OF FTT

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.

SYMPTOMS

Cont.….

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

History taking

Examination and Tests

DIAGNOSTIC EVALUATION

PRENATAL LABOUR, DELIVERY, AND NEONATAL EVENTS

MEDICAL HISTORY OF CHILD

SOCIAL HISTORY

NUTRITIONAL HISTORY

History taking

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

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

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.

MANAGEMENT

Cont.….

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.

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• Maintenance of daily dietary record

4• Parental support and education

5• Discharge planning

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

Permanent mental

Emotional

Physical delays can occur.

POSSIBLE COMPLICATIONS

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 and emotional and economic

support systems all help to prevent

failure to thrive in those cases where

there is no physical deformity.

PREVENTION

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.

CONCLUSION

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

BIBLIOGRAPHY