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
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.….
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.
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.