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FAILURE TO THRIVE

Atan Baas SinuhajiDepartment of ChildHealth

School of Medicine,University Of Sumatera Utara

Medan

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FAILURE TO THRIVE

( FTT )

=1=

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ABS-BIKA FKUSU 3

GROWTH

Increase in the

mass of body tissues

Anthropometric measurement

Head

Circumference

Body

Lenght

Body

Weight

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ABS-BIKA FKUSU 4

Development

Skill

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5

Anthropometric asessment

At the spesific time

Poor  Poor 

Malnutrition F T T

Repeated visit

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6

WATERLOW

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Table 1. WATER LOW’S CLASSIFICATION

NORMAL WASTED STUNTED

WEIGHT/ AGE %WEIGHT/ HEIGHT %

HEIGHT/ AGE %

100 70 70100

100

70

100

100

87

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F.T.T

SUBOPTIMAL OF GROWTH

REPEATED VISIT

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MALNUTRITION

GENETIC

PSYCHOSOCIAL

FTT

Malnutrition : inadequate nutrients

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ABS-BIKA FKUSU 10

 Malnutrition is

the sine qua non of the failure to thrive

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CALORI / NUTRIENTS

Intake

Stools Absorption

Utilization

Basal

Metabolism

Peripheral Utilization

Growth

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IMPAIRED OFPERIPHERAL

UTILIZATION

BASAL UTILIZATION

NUTRIENTS

MALABSORPTION

INTAKE

NUTRITIONINADEQUATE

MALNUTRITION

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Etiology of growth disorders

1. Inadequate intake of calories/nutrients

2. Excessive calories/nutrientslosses

 – Vomiting

 – Malabsorption

3. Basal metabolism

 – Fever 

 – Hyperthyroidea

 – Hyperkinesia

 – Infection

4. Impaired of peripheralutilization

 – Chronic infection

 – Malignancy – Congenital heart

diseases

 – Anemia

 – Inborn errors – Hormonal

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ABS-BIKA FKUSU 14

CALORIES /

NUTRIENTS

IMMUNITY

GROWTHDISEASES

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ABS-BIKA FKUSU 15

Lean body

mass %

loss of total

Complication (related to lost lean

body mass)

Associated

mortality (%)

10 Impaired immunity, increasedinfection 10

20Decreased healing, weakness,

infection30

30 Too weak to sit, pressure sores,pneumonia, no healing

50

40 Death usually from pneumonia 100

*) assuming no preexisting loss

Tabel 2. Complication relative to loss of lean body mass *)

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ABS-BIKA FKUSU

Immunity

Infection

(e.g. Measles)

• Anorexia

• Fever 

•

Diarrhoea• Protein losing enteropathy

Malnutrition

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ABS-BIKA FKUSU 17

Host defense

Acquired

(Spesific)

Natural

(innate)

Celluler : cytotoxic T-cell, killer cell,

Lymphokine activated macrophage

Internal

External : skin, gut motility,etc

Humoral: natural Ab,et

Celluler :NK cell, phagocyti

Humoral: active&passive Immunity

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FTT CAUSED

BY BOWEL

DYSFUNCTION

INADEQUATE

CALORY INTAKE-QUALITY

-IGNORANCE

-ANOREXIA

EXCESSIVE

CALORY LOSS-VOMITING

-MALABSORPTION

-PROTEIN LOSINGENTEROPATHY

INCREASED

NEED - FEVER

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DISORDER OF DIGESTION

MALDIGESTIONMALABSORPTION

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MALABSORPTION

FAILURE OF THE DIGESTIVE

SUBSTRACTS ACROSS LUMEN INTO

MUCOSE

VESSELSBLOOD

LYMPH

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MALABSORPTION

1.MALDIGESTION

2.HYPEROSMOTIC

3.PERISTALSIS

4. ABSORPTION AREA- SHORT GUT

- MUCOSAL INJURY