failure to thrive

1. Presented By – ULFAT AMIN
M.Sc.(N) 1st YEAR

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

3. 

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

9. 
Has both organic and inorganic causes
and can’t be described alone.
Mixed

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…

13. 
Cystic fibrosis
Celiac disease
Vitamin deficiencies
Hepatic diseases.
2. Inadequate absorption

14. 
 Hyperthyroidism
 Congenital heart disease
 Chronic immunodeficiency
 Chronic respiratory disease
 Neoplasm
 Chronic or recurrent infection
3.Increased caloric requirement

15. 
 Persistent vomiting
 Gastro esophageal reflux disease
 Gastrointestinal obstruction
 Increased intracranial pressure
 Renal losses—renal tubular acidosis
 Diabetes mellitus
 Inborn errors of metabolism
4. Excessive loss of calories

16. 
 Chromosomal abnormalities
 Endocrinopathies
5.Altered growth potential or
regulation

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.….

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

19. 
History taking
Examination and Tests
DIAGNOSTIC EVALUATION

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

27. 
Permanent mental
Emotional
Physical delays can occur.
POSSIBLE COMPLICATIONS

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