Failure to Thrive

To understand what constitutes Failure to Thrive and how to manage?

1. FAILURE TO THRIVE CSN Vittal

2. FTT - DEFINITION “Failure to gain weight or a persistent fall in weight from the child`s normal centile diagnosed by observation of growth over time using a standard growth chart ” This excludes Constitutionally light child Transient weight loss associated with acute illness CSN Vittal Descriptive term, not a Specific Diagnosis

3. DEFINITION In a child below 3yrs age

4. Failure To Thrive

5. 75% of median wt

6. A boy of 15 mo age who is 79 cm length as 50 th percentile

7. A boy of 15 mo age who is 79 cm length as 50 th percentile , Ideally should weigh 10 kg If he is only 6.7 kg, = 67%

8. A boy of 15 mo age who is 79 cm length as 50 th percentile, Ideally should weigh 10 kg If he is only 6.7 kg, = 67 %

9. FTT - Classification 1. Organic G.I. Renal Cardio Pulmonary Endocrine CNS Infection Metabolic 2. Non Organic Maternal Deprivation Maternal Depression Crisis In The Family Neglect Regarding Nutrition Ignorance Child Rearing Feeding Technique 3. Mixed (25%)

10. ETIOLOGY - PRACTICAL APPROACH

11. Approach To A Child With FTT Classification & Etiological Diagnosis Group 1 Normal HC Wt > Ht reduced Malnourished – Def.intake or Malabsorbtion Group 2 Normal or Increased HC, Wt mod. Reduced in proportion to Ht Constitutional dwarfism Endocrinopathies Structural dystrophies Group 3 Subnormal HC, Wt & Ht decreased in proportion Primary CNS defect, IUGR

12. HISTORY - FTT Routine – antenatal, natal, perinatal Pregnancy – planned or unplanned Was it a preterm delivery ? IUGR – worse prognosis History of TORCH Dietetic history – detailed Social & family history CSN Vittal

13. PHYSICAL EXAMINATION - ORGANIC FTT CSN Vittal Thorough general & systemic examination Assessment of nutrition Marasmus Kwashiorkor Vitamin deficiencies Nutritional Anthropometry Weight , Height , Head Circumference Skin fold thickness , Mid arm Circumference Neuro developmental assessment

14. LABORATORY AIDS TO DIAGNOSIS CBC & ESR Complete Urine Analysis Stool Examination & Mantoux Test X Rays – to r/o PC, Child Abuse , Bone Age Estim . Evaluation of Malabsorption – Stool Fat, Chymotrypsin , Sweat Chloride, Small Bowel Biopsy, Upper G.I. Contrast Studies Barium Enema, IVP, Sigmoidoscopy LFT Electrolytes, pH, Glucose, BUN, Serum & Urine Amino acids

15. MANAGEMENT GOALS Nutritional rehabilitation Eating pattern Care giver skills Regular follow-up Find and treat organic cause if any Address psycho social and developmental issues

16. MANAGEMENT - monitoring Acceptable weight gain per day as per age Age in Months Wt gain (gm/Day) Birth to < 3 mo 20 –30 3 to < 8 mo 15 – 22 6 to < 9 mo 15 – 20 9 to < 12 6 – 11 12 to < 18 5 – 8 18 to 24 3 – 7

17. INDICATIONS FOR ADMISSION Weight for height less than 70 % of the median Detailed evaluation for suspected organic disorder Suspected child abuse or neglect Non response to out patient management

18. PROGNOSIS FTT in first year of life regardless of etiology – prognosis is ominous Maximal brain growth occurs during the first six to twelve months of age . One third of children with Psycho social FTT have developmental delay, social & emotional problems Prognosis for organic FTT - variable - depends on the etiology

19. PREVENTION Exclusive breast feeding for early pregnancy Community effort P arental education Early detection of FTT and intervention Prevention of low birth weight Neonatal screening for treatable metabolic disorders

20. Malnutrition Trap Liquid Diet Breast Feeding Solid Diet Family Pot Feeding

21. 3 Plank Protein Bridge Available Animal Protein Prolonged Breast Feeding Vegetable Protein Mixture Safety Net

22. Safety Net Supplementary Feeding Group eating Akshayapatra

23. Management Summary

24. Thank Q - CSN Vittal