Failure to Thrive (FTT)

Often called pediatric undernutrition or protein- energy malnutrition.

Is a unique syndrome in which infants weight is less than the norms for their gestation corrected age, sex, genetic potential, and medical condition.

Weight below the 5th percentile for age and sex

Weight for age curve falls across two major percentile lines Inadequate physical growth diagnosed by observation of growth over time using a standard growth chart.

1. Syndromes that can be explained because of organic causes which occurs when there is an underlying medical cause , such as cardiac disease. 2. Syndromes that can occur because of a disturbance in the parent-child relationship, resulting in maternal role insufficiency ( a nonorganic cause). 3. Idiopathic Failure to thrive -unknown cause .

 Weigh all child at routine health assessments, and plot and compare their weight with standard growth curves. Take a detailed pregnancy history because in many instances a breakdown in the development of parenting began in the prenatal period.

Predisposing factor Age Sex Genetics Race

Precipitating factor Medical Psychosocial Behavioral

Inorganic cause

Organic cause

Inadequate calorie- protein intake Calorie- protein deficiency

Adequate response of adrenal cortex Depletion of adipose tissue or fat tissue Optimal Increase in plasma cortisol Growth hormone response inhibited Growth retardation

Loss of lean body tissue

Weight loss , decreased energy , reduced body movement and weaknesses

Failure to thrive

 Lethargy with poor muscle tone, a loss of subcutaneous fat, or skin breakdown. Lack of resistance to the examiners manipulation, unlike the response of the average infant. Rocking on four excessively, as if seeking stimulation, if emotionally deprived. Possibly a reluctance to reach for toys or initiate human contact than is demonstrated by the average infant.

 Starring hungrily at people who approach them as if they are starved for human contact. Some health care personnel have an uneasy feeling when caring for these infants because the eye contact is so intense.
Little cuddling or conforming to being held by the second month of life. Markedly delayed or absent speech because of lack of interaction. Diminished or non existent crying.

 A child may contribute to the poor parenting interaction by being Irritable Fussy Colicky Difficult child

lack of appropriate weight gain irritability easily fatigued excessive sleepiness lack of age-appropriate social response (i.e., smile) avoids eye contact lack of molding to the mother's body does not make vocal sounds delayed motor development

Potential complications
Persistent short stature Secondary immune deficiency Increased susceptibility to infection, establishing an infection-malnutrition cycle since illness decreases appetite and nutrient intake, which leaves the child vulnerable to severe or prolonged infections Permanent damage to various parts of the brain and CNS

Normal growth in infants Average birth weight = 3.3kg Weight drops as much as 10% in first few days of life (likely due to loss of excess fluid) Birth weight should be gained back by 10 days of age. Birthweight should be doubled by age 4 months and tripled by age 12 months.

 On average, infants gain:

26-31grams per day from 0-3 months
17-18 grams per day from 3-6 months

12-13 grams from 6-9 months

9-13 grams per day from 9-12 months 7-9 grams per day from 1- 3 years

 Length increases by: 25cm during the 1st year 12.5 cm in the 2nd year 5-6cm/year between 4 years old and puberty Up to 12cm/year around puberty Head circumference average at birth = 35cm Head circumference increases, on average, to: 47 cm by age 1 year 55 cm by age 6 years

Diagnostic and evaluation test

Denver Developmental Screening Test used to show any delays in development. Growth chart

The following tests may be done: Complete blood count (CBC) Electrolyte balance Hemoglobin electrophoresis to check for conditions such as sickle cell disease Hormone studies, including thyroid function tests X-rays to determine bone age

Urinalysis

Treatment
Treatment depends on the underlying cause High calorie diet for catch up growth 150% of recommended daily caloric intake based on expected weight +/- Feeding behavior modification Psychosocial involvement/ intervention Close follow up Physical and cognitive delays Hospitalization when necessary Correct any vitamin or mineral deficiencies Identify and treat any other medical conditions

Prevention
Regular check-ups can help detect failure to thrive in children

 Imbalanced nutrition less than body requirements related to inadequate intake secondary to emotional deprivation

 Monitor carefully intake and output Assess stool for pH and reducing substances (glucose) to be certain that the child is absorbing nutrients.
If a stool tests positive for glucose or has an acid pH (less than 7.0), it suggests that not even carbohydrates , the easiest food to absorb, are being processed..

 Evaluate how the infant sucks or is able to take food from a spoon and swallow. Record any symptoms, such as pulling up the legs or crying after eating, that suggest gastrointestinal discomfort. Nurture the child

Support and encourage the parents

Impaired parenting skills

Provide consistent care Involve parents in care Teach parents positive feeding techniques. Maintain face to face posture with the child Talk to child encouragingly during feeding Give positive feedback Demonstrate and reinforce responding to childs cues

 Parental behavior May need reassurance to help with their own anxiety Encourage, but dont force, child to eat Make meals pleasant, regular times, dont rush May need to schedule meals every 2-3 hours Make the child comfortable Encourage some variety and cover the basic food groups Snacks between meals