failure to thrive n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
FAILURE TO THRIVE PowerPoint Presentation
Download Presentation
FAILURE TO THRIVE

Loading in 2 Seconds...

play fullscreen
1 / 38

FAILURE TO THRIVE - PowerPoint PPT Presentation


  • 220 Views
  • Uploaded on

S. U. S. FAILURE TO THRIVE. By William Bithoney Patrick Casey Robert Karp. Failure to Thrive. Abnormal weight status during infant-toddler years and/or Abnormal weight gain (weight growth velocity ). Abnormal weight status Referenced against:.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'FAILURE TO THRIVE' - kylynn-chen


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
failure to thrive

S

U

S

FAILURE TO THRIVE

By

William Bithoney

Patrick Casey

Robert Karp

failure to thrive1
Failure to Thrive

Abnormal weight status during infant-toddler years

and/or

Abnormal weight gain

(weight growth velocity)

abnormal weight status referenced against
Abnormal weight status Referenced against:
  • Genetic growth expectations for family
  • Children of same gender and gestation adjusted age
    • <5% on NCHS curves
  • Child's own length
    • <10-25% on NCHS curves
abnormal weight gain growth velocity
Abnormal weight gain (Growth Velocity)
  • Falling across two standard deviation percentile lines on NCHS curves over 6 month period
  • For at least one to two months
ftt definition includes
FTT Definition includes:

"light"

"thin"

atypical weight gain

cautions regarding definition of failure to thrive
Cautions Regarding Definition of Failure-to-Thrive
  • Genetically small due to parents size
  • Children born small for gestational age (SGA) may never catch up
  • If born larger than long-term genetic potential demonstrate decreased growth rate in first 2 years
ftt definition growth only
FTT Definition: Growth Only
  • Not necessarily associated with developmental/emotional problems in child
  • Not necessarily environmental causation
what s in a name
What's in a name?

Growth Delay

Growth Failure

Failure to Grow

Growth Deficiency

Failure to Gain Weight

ftt of long duration grown older
FTT of long duration (Grown Older)

STUNTED:

  • Abnormal length and head circumference
  • Psychosocial Dwarf?
failure to thrive cause
Failure-to -thrive Cause:

All children with Failure-To Thrive

are

Undernourished

three methods to categorize undernutrition in children
Three Methods to Categorize Undernutrition in Children

McLaren,

Read:

% median

wt/ht

for age ratios

>90

85-90

75-84

<75

Gomez:

% median

weight-

for age

>90

75-90

60-74

<60

Waterlow:

% median

weight-

for-height

>90

80-90

70-79

<70

Degree of

Under-

Nutrition

None

Mild

Moderate

Severe

categorization of undernutrition in 258 children referred for failure to thrive
Categorization of Undernutrition in 258 Children Referred for "Failure to Thrive"

McLaren,

Read

No.

18

38

156

46

Degree of

Under-

Nutrition

None

Mild

Moderate

Severe

Gomez

No.

5

132

112

9

Waterlow

No.

64

149

42

3

%

2

51

43

4

%

25

58

16

1

%

7

15

60

18

clinical subtypes
Clinical Subtypes

I. Medical Cause

  • Organic vs. Non-organic vs. Mixed

II. Clinical Presentation

  • Age of onset
  • Severity
  • Chronicity
slide14
Organic Etiology:
    • medical disease present and clinically judged to be sole cause of FTT
  • Non-organic Etiology:
    • problems in the child's environment judged to be the primary cause of FTT, in the presense or absence of medical disease
  • MIXED Etiology:
    • medical problem and problems in environment in combination are judged to be cause of FTT
problems with organic non organic dichotomy
Problems with Organic/Non-Organic Dichotomy

1. It is often difficult to place a child in either category

2. The dichotomy fails to account for the compounding effect of problems in both the child and the environment

problems with organic non organic dichotomy cont d
Problems with Organic/Non-Organic Dichotomy (Cont'd)
  • 3. Children with either may have symptoms like diarrhea or vomiting
  • 4. Children with either may gain weight while in the hospital
  • 5. Global terminology is not specific enough to develop an individualized management plan
clinical subtypes cont d

0-3 months

4-10 months

11-36 months

Homeostasis

Attachment disorder

Separation

individuation disorder

Clinical Subtypes (Cont'd)

III. Socioemotional

clinical subtypes cont d1
Clinical Subtypes (Cont'd)

IV. Psychiatric Diagnoses

Feeding Disorder

Depression

Reactive Attachment Disorder

V. Mechanical Feeding Disorder

Food Avesion

transactional ftt
Transactional FTT
  • Multiple aspects (overt or subtle) of child, parents, and the proximal and distal environments interact across time to result in FTT.
final diagnosis of 131 cases of failure to thrive
Final Diagnosis of 131 Cases of Failure to Thrive

Number

59

46

22

4

Percent

45

35

16.7

3.3

Non-organic

Interactional

Organic

Unknown

frequency of organic systems causing failure to thrive

Most Common

Least Common

Frequency of Organic Systems Causing Failure to Thrive

Gastrointestinal

Neurological

Respiratory-Pulmonary

Cardiovascular

Endocrine

Other

prevalence of failure to thrive
Prevalence of Failure to Thrive
  • 3.5% of admissions to children's hospitals
  • 10% of clinic visists in urban and rural outpatient settings
  • up to 16% 0-4 year olds in low income populations are "stunted"
failure to thrive2
Failure to Thrive
  • Weight is abnormally 2 standard deviations below the mean for gestation corrected age -- and/or
  • weight crossess percentile curves by two standard deviations
  • weight to height ratio is depressed
failure to thrive spectrum of causes

Problem in

the Child

ORGANIC

Problem in the

Environment

NON-ORGANIC

Failure to Thrive: Spectrum of Causes

Interactive

Effects

parent functioning
Parent Functioning
  • Child Outcomes
  • Development
  • Learning
  • Behavior
  • Growth
  • Health
goals of clinical evaluation
Goals of Clinical Evaluation

Identify conditions which:

1. Negatively affect growth potential (disease)

2. Increase basic caloric needs (e.g. chronic infection)

3. Decrease availability/utilization of calories (e.g., malabsorption)

4. Negatively affect parents ability to meet nutritional needs (can't/won't eat)

diagnostic evaluation
Diagnostic Evaluation

1. Growth assessment

  • confirm the diagnosis with weight and height, present and past

2. History

  • predisposing factors

3. Physical examination

  • significant findings other than malnutrition
diagnostic evaluation cont d
Diagnostic Evaluation (Cont'd)
  • 4. Development-Behavioral Assessment
    • Assess delays in cognitive, language, or motor functioning
    • Identify any behavioral abnormalities
  • 5. Laboratory Evaluation
    • Varies for each child
    • Stepwise approach is recommended
laboratory evaluation
Laboratory Evaluation
  • Should be directed by findings from the history and physical examination
  • Document nutritional status:
    • albumin, iron, zinc
  • Child may have endemic problem:
    • Tbc, AIDS, giardia
diagnostic evaluation cont d1
Diagnostic Evaluation (Cont'd)
  • 6. Nutritional and Feeding Evaluation
    • Content and structure of mealtimes
    • Feeding techniques
  • 7. Social History
    • Identify parental/family strengths and weaknesses
slide32

Diagnostic Evaluation (Cont'd)

  • 8. Parent/Child Interaction
    • Especially as it relates to feeding
  • 9. Psychiatric Evaluation
    • Important if the caregivers emotional state is adversely affecting parent-child interaction
hospitalization vs outpatient care
Hospitalization vs. Outpatient Care
  • Advantages of hospitalization:
    • Able to observe and control feeding
    • Able to observe the parent-child interaction
    • Medical evaluation can be done easily
  • Disadvantages of hospitalization:
    • Cost
    • Child (and parent) are away from their normal environment
indications for hospitalization of children with failure to thrive
Indications for Hospitalization of Children with Failure-to-Thrive

1. Evidence of physical abuse

2. Extreme failure to thrive (starvation)

3. Extremely dysfunctional parent-child relationship or family

4. When distance and transportation issues mean outpatient management is not practical

5. When outpatient management has failed

management of the child with failure to thrive
Management of the Child with Failure-to-Thrive

1. Nutritional asessment and intervention

2. Improved parent-child interaction

3. Developmental stimulation

4. Treatment/management of medical conditions

5. Support and intervention for social and family problems

6. Mental health referrals where indicated

7. Regular follow-up care

best predictors of prognosis
Best Predictors of Prognosis
  • Age of onset, chronicity
  • Ongoing quality of the home environment
interactional model of failure to thrive

PARENT

  • Economic Status
  • Health
  • Knowledge
  • Emotional State
  • Past Experience
  • CHILD
  • Appearance
  • Health
  • Neuro developmental maturity
  • Ease of Caregiving

Endocrine-Cellular

Dysfunction

Nutritional

Deficiency

Interactional Model of Failure-to-Thrive

Parent-Child Interaction

Failure-to-Thrive

environmental characteristics supports and stressors
Environmental Characteristics: Supports and Stressors
  • Home
    • -Marital Relationship
    • -Physical Quality
    • -Organization
    • -Stability
    • -Economic Resources
  • Family
  • Neighborhood and Work