FAILURE TO THRIVE

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Slide 1 : FAILURE TO THRIVE (FTT) Emmanuel Kemoh Salia ORDER OF PRESENTATION INTRODUCTION DEFINITIONS EPIDEMIOLOGY AETIOLOGY CLINICAL MANIFESTATIONS EVALUATION OF A CHILD WITH FTT HISTORY PHYSICAL EXAMINATION INVESTIGATIONS TREATMENT
Slide 2 : INTRODUCTION   Commonly, many general practitioners and paediatricians are faced with the challenge of elucidating the cause of, and managing a child who the parents worry has failed to grow as they expected. In many cases, the physician may note that the child brought to him for some other common medical consultation like acute respiratory infection or malaria has severely failed to thrive. The parents may either not have noticed or have paid little attention to the growth failure. The physician therefore has the task of directing the emphasis to this hitherto unappreciated important developmental problem
Slide 3 : . Also frequently, the physician tends, wrongly, to rely on a battery of laboratory and other investigations in an attempt to determine the various causes of failure to thrive. This is usually unnecessary. Most cases of children with FTT can be solved by taking a good history, carrying out careful physical examination of the child, including anthropometry, observing the mother and baby, and simple laboratory tests
Slide 4 : DEFINITIONS     The growth of a child is influenced by genetic, nutritional and environmental factors, although these tend to over lap to a large extent. Assuming optimal nutritional and other environmental condition the final attainable size of a child, the rate and pattern of his growth are determined by such genetic influences as race, sex, community and family factors.
Slide 5 : Within this limits the individual child has his own unique growth pattern. For the particular child, this pattern can be determined by making multiple prints along the growth curve through sequential measurement on this manner. When subsequent measurements indicate downward and persistent deviation from this individual growth curve, the child is said to be failing to thrive.
Slide 6 : Statistically, when the weight (or length) of the child is less than the 3rd percentile for age of this child in a growth chart, the child is said to have FTT. It is also defined as weight (or length) of least two standard deviation below the mean for children of that age and sex. These statistical definitions become useful guides when serial records of the child’s weight (or length) are not available. However, it does not differentiate between the child who truly has FTT and that whose normal size as genetically determined is below the 3rd percentile for age. It most be emphasized that FTT is a symptom or sign rather than a diagnosis. Effort should made in each case to find out the cause.
Slide 7 : EPIDEMIOLOGY In practice, the peak incidence of FTT in childhood is within the ages of 9 and 24 months. There is no significant sex difference. FTT also occurs in the neonatal and early infancy periods. It is relatively uncommon after the age of 5 years. The condition occurs across socio-economic strata, although it is relatively more common in the poorer communities. It is also more common in children of single teenage mothers, working mother with long working hours and children in institutions e.g. motherless babies homes and homes for mentally retarded children.
Slide 8 : AETIOLOGY There are many reasons why a child may fail to thrive. At least 85% of all cases of FTT would fall under the groups of normal variant and inadequate intake. organic cause of FTT are relatively uncommon. The list of causes below is not exhaustive
Slide 9 : Causes of failure to Thrive
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Slide 12 : FTT Causes (alternative classification) Non organic Organic A- FTT-Non organic causes x Feeding Problem-insufficient breast milk or poor technique x Maternal Stress-malnourished, Tense x Financial difficulties x Lack of stimulation & undernutrition x Munchausen’s syndrome by proxy B- FTT-organic causes 1) Inability to feed x Mechanical Problem-cleft palate x Lack of coordination-cerebral palsy 2) Poor retention of food x Vomiting x Gastro-esophageal reflux 3) Illness induced anorexia x Cystic fibrosis x Renal failure x Congenital heart disease
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