FAILURE TO THRIVE.ppt

Causes of FTT in pediatrics

1. HishamAhmed Aly
Prof. of pedeatrics
Al-AzharUniversity

5. FAILURE TO THRIVE

6. Definition:
FTT usually referred to grow
below 3rd or 5th percentiles

10. Weight
for
Height

11. Thomas

12. Other definition
Change of growth that has crossed two
major growth percentiles (i.e. from above the
75th percentile to below the 25th).

13. Attained growth
Weight <3rd percentile on NCHS growth
chart
Weight for height <5th percentile on NCHS
growth chart
Weight 20% or more below ideal weight for
height
Triceps skinfoldthickness < 5 mm

14. Rate of growth
Depressed rate of weight gain
<20 g/d from 0 to 3 months of age
<15 g/d from 3 to 6 months of age
Falloff from previously established growth curve
Downward crossing of >2 major percentiles on
NCHS growth chart
Documented weight loss

15. Organic Causes
Non-Organic Causes

16. Patterns of FTT
BW, L, H.C.
Pattern 1:
Pattern 2
Pattern 3

17. Primary
Secondary

18. CAUSES OF INADEQUATE
WEIGHT GAIN
Inadequate intake
Inability to utilize calories
Calorie wasting
Increased caloric requirements

19. CAUSES OF INADEQUATE
WEIGHT GAIN
1) Inadequate intake
a)Lack of appetite
Chronic disease (eg, CNS pathology, GIT disorders,
chronic infections)
Anemia (eg, iron deficiency
Psychosocial problems (eg, apathy)

20. b)Difficulty with ingestion
Feeding disorder
Psychosocial problems(eg, apathy,
rumination)
Craniofacial anomalies(eg, choanal
atresia, cleft lip and palate, micrognathia)

21. Dyspnea (eg, congenital heart disease,
pulmonary diseases)
Tracheoesophagealfistula
Neurologic disorders(eg, cerebral palsy,
hypertonia, hypotonia, generalized muscle
weakness)

22. c)Unavailability of food
Inappropriate feeding technique
Insufficient/inadequate volume of food
Inappropriate food for age
Withholding of food (abuse, neglect)

30. 2) Inability to utilize calories
(Assimilation disorders)
Prenatal insult
Chromosomal abnormality/genetic
syndrome
 Endocrinopathies

31. 3) Calorie wasting
1)Vomiting
 CNS pathology (increased intracranial pressure)
 Intestinal tract obstruction (eg, pyloric stenosis,
malrotation)
 Gastrointestinal reflux
 Metabolic problems
 Drugs/toxins

34. 2)Malabsorption
Primary gastrointestinal diseases: biliary
atresia/cirrhosis, celiac disease
Inflammatory bowel disease, enzymatic deficiencies,
food (protein) sensitivity/intolerance, Hirschsprung
disease
Cystic fibrosis
Immunologic deficiency
Infections
Endocrinopathies
Drugs/toxins

36. 3)Renal losses
Renal tubular acidosis
Diabetes

37. CAUSES OF INADEQUATE
WEIGHT GAIN
Inadequate intake
Inability to utilize calories
Calorie wasting
Increased caloric requirements

38. COMPONENTS OF EVALUATION
Growth data
History: Problem context, Medical,
Nutritional, Psychosocial,
Developmental/behavioral
Physical examination
Developmental/behavioral assessment
Observation of a feeding
Laboratory studies
Hospitalization

39. Growth data
Current growth parameters
Growth curves over time
Relationship of growth parameters to each
other

40. History
Problem context
When growth problem first became a
concern
Previous interventions attempted

41. Medical history
Prenatal care and complications (infection,
maternal nutrition, drug exposure)
Gestational age and growth parameters at birth
(SGA, prematurity)
Perinatalcomplications (infections, CNS
insults, anomalies)

42. Previous hospitalizations, illnesses, and surgery
Current medications
Review of systems (vomiting, stoolingpatterns,
mechanics of feeding/swallowing, anorexia,
distress/tiring with feeds)

43. Nutritional history
Caloric intake
Breast-fed: schedule and length of feeds; maternal
cues to prefeedingengorgement, milk let-down, and
drainage postfeeding; maternal diet, rest, stress, and
medications
Formula fed: type, method of preparation; feeding
schedule; amount offered and consumed
Mixed diet: 3-day diet history (food/beverage type,
method of preparation, quantity consumed)

44. Schedule and length of feedings
Daily feeding/mealtime environment
Location/positioning during feedings
Perceptions of suck, swallow, and grasp of nipple
Caregivers involved with feedings

45. Amount and type of mealtime
supervision

Behavior during feeding
History of progression to solid/table foods
Favorite/disliked foods
Parental knowledge/beliefs regarding
child/infant feeding
Family eating practices and beliefs
Financial constraints affecting food
availability

46. Psychosocial
Caregivingenvironment
Family support systems
Family finances
Stability of parents and their relationship
Family/household composition

47. Parent and child relationship
Attitudes toward parenting
Content/structure of typical day for child
Parents' perceptions of child's needs

48. Developmental / behavioral
Age-related behavior problems (eg, attachment,
autonomy)
Developmental milestones: gross/fine motor,
language, social/emotional, cognition
Parents' perception of child's
temperament/behavior

49. Physical examination
Physician and child interaction
Skinfold measurements
Complete physical examination

50. Observation of a feeding
Feeding environment (home observation)
Type and amount of food offered
Duration of feeding
Child's oromotorand fine motor skills

51. Laboratory studies
Diagnostic tests directed by positive findings
on history, physical, and review of growth
date
@complete blood count,
@serum electrolytes,
@serum creatinine, urinalysis (±culture),
total protein/albumin, bone age (if height
growth also poor)

52. Hospitalize if:
Evidence of physical abuse and/or severe
neglect
High risk for abuse and neglect, very disturbed
parent & child interaction, poor parent functioning,
and/or an extremely stressful environment
Severe malnutrition and/or medically unstable
Outpatient management failure