Failure to thrive

FAILURE TO THRIVE
BY
DR. C.C IFEZULIKE. FWACP

Introduction
The growth of every child is influenced by
these
Factors.
• Genetic factors
• Nutritional factors
• Environmental factors
• Hormonal factors.
There is usually overlap of the influences
of these factors.
When there is optimal nutritional and
environmental factors, genetic factors, race, sex,
community and family factors determines the final
attainable size of the child.
The child fails to thrive when there is persistent
failure to progress on the child’s growth curve or
persistent downward deviation from the
individuals growth curve.
Definition
Weight or height of less than 3rd percentile for
age of the child in a growth chart OR weight or
length at least 2SD below the mean for children of
the same age and sex.
Notes
• Useful guide when serial growth chart of the
child is not available.
• Does not differentiate between true FTT and
normal children that genetically grow below
3rd percentile for age.
Epidemiology
• Peak incidence b/w the ages of 9months and
24months.
• M:F = 1: 1
• It may occur in neonates or early infancy.
• Rare after the age of 5 years.
• Commoner in lower socioeconomic class.
• More in children of single parents
• More in children of working mothers with long
working periods.
• More in institutional children e.g. Motherless
babies home, mental retarded homes.
Aetiology
May be due to:
(a) Normal variation
(b) Inadequate intake
(c) Organic causes
(A) Normal variants
₋ Genetic or familial
₋ Constitutional factors
(1) Early onset growth retardation
(2) Delayed adolescence
(B) Nutritional Deprivation (inadequate intake)
₋ under feeding
₋ PEM
₋ Congenital malformation
₋ Prolonged dyspnoea from any cause
₋ Emotional disturbances
₋ Other conditions associated with inadequate intake.
(C) Abnormal Losses
(1) Persistent vomiting
- Mechanical causes
• Oesophageal stricture
• Cardio spasm
• Gastroesophageal reflux (hiatus
hernia)
• Congenital hypertrophic pyloric
stenosis
• Pylorospasms
• Hirschsprung disease
₋ Renal tubular acidosis
₋ Metabolic disorders i.e hypercalcaemia,
galactosaemia fructosaemia.
₋ Toxic agents e.g lead poisoning
(2) Malabsorption
₋ Gardia lamblia
₋ Liver diseases
₋ Infectious enteritis
(3) Renal losses of diabetes mellitus
₋ Chronic renal failure
₋ Diabetes insipidus
₋ Renal tubular acidosis
(d) Poor utilization
₋ Chronic infections of TB, UTI,
₋ Metabolic disorders
₋ Endocrine disorders
₋ Chromosomal disorder e.g turners
syndromes.
Clinical manifestations
• Child not doing well
₋ Growth retardation
₋ Wasting
₋ Regression of milestones
• Loss of weight
• Not like other siblings
• Not eating well
• Small for age
• Other signs and symptoms e.g
₋ Vomiting
₋ Chronic diarrhoea
₋ Chronic cough
Recognition
• 20% - 5% unrecognized in Britain/Wales
• More unrecognized in our environment.
Evaluation
• History – must be detailed
• Physical examination
• Simple investigations
History – preterm birth
• Size at birth
• Detailed nutrition including breastfeeding
history
• Socioeconomic status of parents
• Parental size especially height and weight
• Pattern of growth of patient and that of siblings.
• Emotional and maternal deprivations
• History of organic illness e.g
₋ CHD
₋ CRD
₋ Congenital malformations with feeding
difficulties
₋ Mental retardation
₋ Chromosomal disorders trisomies 13, 18,
21, cri – du – cat
Physical examination
• Anthropometric measurements e.g
Weight for age
Height for age
Weight for height
• Mid – upper arm circumference
• OFC
• The measurements will help to establish the
presence of FTT or not.
• Sudden downward deviation in growth chart
indicates acute illness or nutritional deprivation.
• Gradual or slower downward deviations indicates
more chronic illness or persistent underfeeding.
• OFC is usually normal in most mild or moderate
cases.
Degree of declaration of OFC is used to estimate
the chronicity of the factor causing the FTT.
Other signs of severe malnutrition
• Oedema
• Anaemia
• Skin changes
• Emotional apathy of kwashiorkor
Signs of organic disease
• Signs of CHD
• Severe cerebral palsy
• Chronic renal diseases
• severe chronic asthma
• Sub acute bronchiolitis
• SCA
• Malignancies of leukaemia lymphoma e.t.c.
Investigations
• Simple investigations first
• History and findings will guide the choice of
investigations.
Common investigations include
• FBC
• Urinalysis
• Urine culture and sensitivity
• Creatinines and electrolytes.
• C X-rays
• RVD screening.
• Stool analysis and culture
• Blood sugar
• Barium meal and follow through.
• Barium enema
• Hormonal profile.
Treatment
• Depends on the cause
• Counselling in nutritional factors
• Treat organic causes – may include surgery.
• Follow – up is very essential.
THANKS FOR LISTENING

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FAILURE TO THRIVE

DR. C.C IFEZULIKE. FWACP

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