Failure To Thrive

(FTT)

Parisa Zarei Shargh

MSC student of nutrition science

Dec2014

Defenition of FTT

growth parameters (height and weight ,sever condition,

head circumference)

Fall over 2 or more percentiles

Are persistently below the third or fifth percentiles

Are less than the 80th percentile of median

• Severe:Height and weight at or below the 3rd percentile.

• Moderate :Either height or weight at or below the 3rd

percentile, but not both.

• Mild :Both height and weight between the 3rd and 10th

percentiles.

• None :Height and weight both above the 10th percentile.

Coleman-Jensen etal.2010Drotar etal.2000

FTT

ORGANICMajor medical

illness

NON ORGANIC

Psychological neglect

Malnutrition

Impaire immono

competence

Jeopardize growth

Deficits in cognition

Deficits in

socioaffective

compotence

Nonorganic FTT grow in the hospital, whereas organic FTT do not

Why children?

fewer reserves

higher resting energy expenditure.

are in a growth and development phase

Infants and children are very susceptible to problems of nutrition.

Nutrition-related factors contribute to about 45% of deaths in

children under five years of age.

Causes?

Social

Poverty

Food insecurity

Prematurity Despite faster linear growth rates, even late preterm children

(34-36 weeks' gestational age) are at increased risk of stunting compared with term peers

preterm and small-for-gestational-age infants are more likely to show persistent deficits in growth and in cognitive

and academic achievement at 8 years of age

The most common cause of growth faltering in former

preterm infants is inappropriate diet for corrected age.

early discontinuation of the nutrient-dense formula (preterm infant formula until they weigh at least 2000g.some data: 18month

In general; until 6 months' corrected age or when weight for length is

maintained above the 25 percentile)

initiation of solid feedings at 6th months for infant at 28

weeks whose corrected age is only 3 months

(SGA) infants are conventionally defined as

those with birth weight less than he 10th

percentile for gestational age.

Heavy use of caffeine prenatally is associated in

some studies with depressed intrauterine growth

Heavy cigarette exposure during pregnancy and

statistically significant decrements in stature at

school age, but the magnitude of the deficit (I to

2 cm)

Use of fluoxetine in breastfeeding women

was associated with some reduction in

infant weight gain between 2 weeks and

6 months of age

Fetal alcohol syndrome cases Length and head

circumference are more depressed than weight.

very low birth weight infants, children

oral-motor difficulties may limit caloric intake,

unless gastrostomy tubes are placed

inadequate care and nutrition

Though consumption of less than 15 drinks per week was not proven

to cause FAS-related effects

Pregnant women who consume approximately 144 grams of pure

alcohol per day have a 30–33% chance of having a baby with FAS.[38]

Marijuana, like smoking tobacco,

increases maternal carbon

monoxide levels and decrease fetal

oxygenation

Postnatal medical issuemost common previously undiagnosed conditions affect the

gastrointestinal tract:

chronic nonspecific

diarrhea

celiac disease

food allergies

Gastro esophageal reflux

cystic fibrosis

lactose intolerance

Subtle neurologic dysfunction manifested as fine motor and

oral motor

urinary tract infections and renal

tubular acidosis as potentially

clinically silent contributors to FTT

METABOLIC RESPONSE TO CRITICAL ILLNESS

Children, similar to adults, rely on the

metabolic breakdown and transfer of protein,

carbohydrates, and lipid to meet the catabolic

demands of critical illness

The constipation and intense food

selectivity that are more prevalent in

children with autism

infection-malnutrition cycle. With each illness,

the child's appetite and nutrient intake

decrease while nutrient requirements increase

as a result of fever, diarrhea, and vomiting

Physical Examination EvaluationPhysical Examination Evaluation

Anthropometric evaluation

weight for age

height for age

weight for height

mid-arm circumference

birth weight

Laboratory test

complete blood cell

Iron deficiency with or without anemia is a

common finding. In cases in which the CBC count

is unrevealing, measures of iron indicators.

Iron deficiency, with or without associated anemia,

is Seen in as many as one half of all children

presenting with FFT

blood urea nitrogen, creatinine and serum

electrolytes, and urine pH

renal function

renal tubular acidosis

are mandatory in children with recurrent or

persistent vomiting or diarrhea, clinically

obvious dehydration, or severe malnutrition,

which is often associated with hypokalemia.

serum albumin and pre albumin (transthyretin) to assess

protein status

determine serum alkaline phosphatase, calcium and

phosphorus concentrations.

A decreased alkaline phosphatase concentration suggests

zinc deficiency; an increased concentration, especially if

associated with a decrease of phosphorous

concentration, is suggestive of rickets

Albumin:

high specificity but low sensitivity

long plasma half-life (14-20 days)

It is not a good parameter for monitoring

nutritional status due to its low sensitivity

to acute changes.

Serum albumin concentrations may be

affected by albumin infusion, dehydration,

sepsis, trauma, and liver disease,

independent of nutritional status

Pre albumin

short half-life of two days

very sensitive and specific to changes in

the nutritional status.

Pre-albumin is a useful parameter for

monitoring, and the evolution of

nutritional status of the seriously ill

patient.

Transferrin

half-life of eight to ten days

Its value as a nutritional indicator is

lower than that of pre-albumin due to

its low sensitivity and specificity.

Its levels are altered in liver disease,

iron deficiency anaemia, nephrotic

syndrome, and the administration of

aminoglycosides and cephalosporins.

Retinol binding protein

Very short half-life of 12 hours

Its levels fall with malnutrition,liver

disease, infection, and with intense stress.

Retinol binding protein is a good marker

of the nutritional status evolution, but is

not of value in patients with renal failure.

HIV test

Serum lgA and anti-tissue trans glutaminase antibodies

screen for celiac

Serum lgE testing for food allergies

Nutritional evaluation

Feeding history adjusted for age

Breast- or formula-fed

Age solids introduced

Age switched to whole milk

Food allergy or intolerance

Vitamin or mineral supplements

Current feeding behaviors

Difficulties with sucking, chewing. or swallowing

Frequency of feeding

Duration offeeding episodes

Who feeds

Where fed (alone or held, with or separate from family, lap or high

chair)

Perceived appetite

Pica

Caregiver's nutrition knowledge

perceived as dangerous?

Adequacy offinancia l resources for food purchase

WIC

Adequacy of earned income

Recent change i n food budget (cuts or increases in benefits, new mouths to

feed, job gain

or loss)

Family's knowledge of how to budget food purchasing

Material resources for food preparation and storage and Refrigeration

Cooking facilities

Running water

24-h dietary recall : was yesterday typical?

Food frequency

Breastfeeding difficulties

Over dilution of formula

behavioral feeding problems (eg spitting out

food, tantrums during meals, food refusal)

and determine how the

parents have tried to manage the child's

problems

difficulty in the timing of feedings (restricting

a toddler to 3 meals a day), constant feedings

(grazing), and lack of a consistent feeding

schedule

Nutritional interventionThe goal of nutritional intervention in FTT

is to achieve "catch-up" growth, that is,

growth at a faster-than-normal rate for age

so that the child's relative deficit of body

source is restored

Depending on the severity of the initial

deficit, 2 days to 2 weeks may be required

to initiate catch-up growth

TNX FOR YOUR ATTENTIONS.