2. Definition
Failure to thrive is failure to gain adequate weight or to
achieve adequate growth during infancy.
This can be defined in terms of
- weight consistently below the 3rd percentile for age
- weight < 80% of ideal weight for height for the age
Progressive fall-off in weight below the 3rd percentile
3. definition
A decrease in expected rate of growth along the child’s
previously defined growth irrespective of its relationship to
the 3rd percentile
Note that weight is used as the growth parameter because it
is the most sensitive indicator of nutritional status
4. definition
Inhibition of expected height growth rate usually indicates
more severe and prolonged malnutrition
A decrease in head circumference growth rate is a late
finding because of preferential brain sparing of protein and
energy utilization
A decrease in head circumference indicates extreme or
chronic malnutrition
5. definition
It is important to remember that 3% of “normal children”
will consistently have weight below the 3rd percentile.
6. Definition
Failure to thrive: is used to designate growth failure both
as a symptom and as a syndrome.
As a symptom, it occurs in patients with a variety of acute or
chronic illnesses that are known to interfere with normal
nutrient intake ,absorption, metabolism or excretion.
The energy requirements are greater than the energy
required to sustain or promote growth. It is then referred to
as organic FTT.
7. definition
As a syndrome, it mostly commonly refers to growth failure
in the infant or child who suffers from environmental neglect
or stimulus deprivation.Then designated non organic
FTT.(no physiological disorder)
8. definition
There is the mixed aetiology group who have both organic
and non organic FTT, e.g. a child born prematurely but with
disproportionate growth failure in later infancy.
9. Aetiology and Pathology
In FTT of any aetiology, the physiologic basis for impaired
growth is inadequate nutrition to support weight gain.
In organic FTT, increased metabolism needs or decreased
ability to ingest, absorb or retain foods is the primary defect.
In organic FTT there is an underlying medical problem
10. definition
Nonorganic (psychosocial) failure to thrive occurs in a child who is
usually younger than 2 years old and has no known medical condition
that causes poor growth.
There are usually psychological, social, or economic problems within
the family of inorganic failure to thrive.
Inorganic FTT, lack of food may be due to impoverishment, poor
understanding of feeding techniques, improperly prepared formulae or
inadequate supply of breast milk.
Emotional or maternal deprivation is often related to the nutritional
deprivation.The mother or primary caregiver may neglect proper
feeding of the infant because of preoccupation with the demands or care
of others, her own emotional problems, substance abuse, lack of
knowledge about proper feeding, or lack of understanding of the infant's
needs.
11. Risk factors for developing inorganic
FTT
Infants born into families with psychological, social, or economic
problems are more at risk of developing nonorganic failure to thrive.
Inorganic FTT occurs when maladaptive behaviors develop in both the
infant and the primary caregiver.
Maladaptive behaviors may develop around problems establishing
regular, calm feeding routines, problems of attachment between the
mother and the infant, and/or problems of separation.
Other risk factors that put a child at risk for developing nonorganic failure
to thrive include mother or primary caregiver with any, or several, of
the following conditions present
depression
alcohol or drug abuse
psychosocial stress
lack of affection or warmth shown toward infant
12. definition
Non- organic FTT
may be due to a lack of a stimulating person e.g. a mother
secondary to loss of or depression, poor parenting skills,
sense of hostility towards child or response to other
stresses(financial difficulty, marital dysfunction)
16. Causes: Organic
5.Increased energy requirements
-Tumour, catabolic state
6.Metabolic
-Hyperthyroidism
-Congenital adrenal hyperplasia
17. Causes: Non organic
1.Undernutrition
-Poor parental understanding
-low income
-poor social support
2.ChildAbuse
-Deliberate starvation
-Parental Psychiatric illness
18. The following are the most common symptoms of failure to
thrive. However, each child may experience symptoms differently.
Symptoms may include:
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
19. Diagnosis - history
History:
1.growth chart-from birth
2.Meticulous dietary history including techniques of
milk/food preparation, adequacy of breast milk, weaning
time, schedule for feeds etc.
20. Diagnosis
observation of care givers during feeding time will give vital
information. Easy fatigability may indicate underlying
exercise intolerance. Disinterest on part of caregiver – a sign
of depression.
21. Diagnosis
3.Assessment of child elimination pattern to determine
abnormal losses through urine, stool, or emesis should be
undertaken to investigate for underlying renal disease,
malabsorption syndrome, pyloric stenosis or gastro
oesophageal reflux.
22. Diagnosis - history
4. Past medical history: to evaluate intra uterine growth
retardation, prematurity with uncompensated growth,
chronic infections, neurological problems e.g. Cerebral palsy,
cardiac problems e.g. Congenital heart disease, pulmonary
disease and renal disease
Family history to evaluate
- growth patterns
- recent deprivation of caregiver
23. Diagnosis – Physical examination
Should include careful observation of child’s interaction with
individuals in the environment, evidence of self-stimulatory
behaviours e.g. Rocking , banging)
24. Diagnosis - Laboratory
Investigations to be done include:
- FBC, Esr, urinalysis including ph and specific gravity, U/E,
serum creatinine, urine culture, examination of stool for
parasites and reducing substances, odor, colour consistency
and fat content
-Thyroxine levels if patients growth in height is more
severely affected than growth in weight
26. Treatment
Goal: to provide sufficient health and environmental
resources to promote satisfactory growth.
A nutritionally appropriate diet containing adequate calories
– for catch up growth – 150% normal kcal requirement
/kg/24hr
Individualised medical and social support
Education and emotional support to caregiver to deal with
psychosocial issues
27. Treatment
Involve parents in participation to in making decisions
concerning child
Foster care placement may be necessary. Return to biological
parents only if demonstrates ability and resources to
adequately care for the child
28. Diagnosis - history
Social history – acceptance of pregnancy, family composition,
socio-economic, financial difficulties
