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Transcript of Ftt
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