Ask any mother, "Are you satisfied with the growth of your child?"
"No!" Pat comes the reply.
Perceptions apart 'Failure to Thrive' remains an important issue, both for Pediatricians and Parents. During the first year of its life, a baby triples its birth weight, i.e. a newborn weighing 3 Kg should weigh 9 Kg at one year. This never happens again in life, so don't miss out on this unique opportunity. If you feel your child is not growing well, failing to gain height and weight, don't wait! Consult your doctor. Undue delay can cause permanent stunting.
Broadly speaking, F.T.T. is diagnosed when the physical growth of a child is significantly less than that of his/her pears. These children may also have developmental delays and poor I.Q. (Intelligence Quotient) and E.Q. (Emotional Quotient).
True F.T.T. is measured by calculating each growth parameter (weight, height and weight/height ratio) as a percentage of the mean value for age. Serial measurements are more important than a single recording done randomly.
Growth Parameter
Failure To Thrive
Mild
Moderate
Severe
Weight
75 - 90%
60 - 74%
Less than 60%
Height
90 - 95%
85 - 89%
Less than 85%
Weight/Height ratio
81 - 90%
70 - 80%
Less than 70%
Example 1:
Expected mean weight at 1 year is 10Kg. If a child weights 8 Kg (80%) we will call it mild F.T.T. But if the weight is 5.5Kg (55%) it will be labeled severe F.T.T.
Example 2:
Expected mean height at 3 years is 100 cm. If the child is 83cm tall (83%) we will call it severe F.T.T.
Standards for weight, height and weight/height ratio are available with Pediatricians and should be used to confirm the diagnosis whenever F.T.T. is suspected. Table containing age appropriate weight and height indices for boy and girls is provided in the appendix of this book.
Causes
F.T.T. basically results from -
*
Failure of parents to offer adequate calories
*
Failure of the child to take sufficient calories
*
Failure of the child to retain sufficient calories
Traditionally, the causes of F.T.T. are clubbed under two broad headings, I - Psychosocial (non-organic), and II - Medical (organic).
I -
Psychosocial causes
Psychosocial F.T.T. is most often due to poverty or poor child-parent interaction. If calories and protein are not being supplied to the body cells in adequate amounts, growth will fail. The worst forms of F.T.T. are Marasmus (lack of calories), Kwashiorkor (lack of proteins) and Marasmic Kwashiorkor (a combination of both). There is still a huge load of children with these conditions in developing countries.
Surprisingly, poverty is not always the major determining factor for F.T.T. It might appear strange, but lack of knowledge and wrong dietary practices on the part of parents and other caregivers may be responsible for a vast number of cases of F.T.T., especially in young babies. We have come across innumerable mothers who were giving diluted milk to their babies, because they felt that the little baby won't be able to digest 'thick milk'. It will produce gas, colic, vomiting and what not.
Poor child-parent interaction, family dysfunction, maternal depression and child abuse are some of the more important causes of psychological F.T.T. It occurs in a child who is generally less than 5 years old and has no known medical condition that causes poor growth. An environment of hostility, low stimulation, neglect or brutal reprisals for minor misdemeanors can play havoc with the growth of the child. An unloved and uncared child goes into a shell, with stunting on both fronts - physical and emotional. It has been well documented that children facing maternal deprivation manifest self-stimulation, poor growth and rumination (self-induced vomiting).
II - Medical Causes
There are numerous medical conditions responsible for F.T.T. We have clubbed them in five broad groups according to the system involved.
System
Cause
Gastro intestinal:-
Chronic Diarrhea
Mal-absorption
Gastro esophageal reflux
Worm infestation
Respiratory:-
Asthma
Tuberculosis
Cystic fibrosis
Obstructive sleep apnea (snoring)
Endocrine:-
Hypothyroidism (Cretin)
Diabetes Mellitus
Growth hormone deficiency
E.N.T.:-
Chronic Tonsillitis
Adenoid enlargement
Miscellaneous:-
Congenital Heart Disease
Inborn errors of metabolism
Urinary Tract Infection
AIDS
Constitutional growth delay
Chronic diarrhea and worm infestations are a common cause of growth failure in developing countries. Mal-absorption or intestinal allergy when diagnosed responds to appropriate diet, and the growth resumes its normal course.
As regards growth retardation in asthma, it is known that the growth hormone is produced in surges in sleep and during vigorous exercise. As both these activities may be disrupted by uncontrolled asthma, this is perhaps the reason for growth retardation seen in asthmatic children.
Inadequate thyroid hormone leads to stunting of growth (Cretin child), as this hormone is required by all body cells for optimal function. If the cells of the pituitary gland have been destroyed by a tumor or inflammation there will be deficiency of growth hormone resulting in dwarfism (Pituitary dwarf). A diabetic child with uncontrolled blood sugar levels, who keeps losing glucose in his urine would not be nourished well enough to grow.
Chronic tonsillitis with repeated bouts of fever and difficulty in swallowing remains a common cause of poor weight gain. Although, this problem has been somewhat overcome by the advent of good antibiotics.
Congenital heart diseases with cyanosis (bluish discoloration due to mixing of non-oxygenated and oxygenated blood) would retard growth because of lack of oxygen to the tissues.
Urinary tract infection should always be ruled out in a child who is failing to grow and gets frequent bouts of fever. AIDS has emerged as an important cause of failure to thrive in recent times. Children with AIDS have compromised immune status and are very prone to develop a variety of infections lading to growth failure. Inborn errors of metabolism are rare and largely untreatable.
Retarded growth with delayed puberty runs in some families. This is known as constitutional growth delay and needs nothing more than reassurance. Bone age is usually delayed, but ultimate height is within normal limits.
Diagnosing F.T.T.
Anthropometry (measuring body parameters like height, weight etc) is the most important tool in diagnosing F.T.T. Serial measurements of weight, height and weight/height ratio as discussed earlier give a fair idea of growth failure. This will of course, require the help of your doctor, but we would like to give you certain tips which will give an early indication of F.T.T.
Tips for Parents
•
In the first year of life, average daily weight gain is 30 grams/day during the first four months, 20 grams/day during the next four months and 10 grams/day during the last four months.
Monthly Weight Gain
1 - 4 months
-
900 gm / month
5 - 8 months
-
600 gm / month
9 - 12 months
-
300 gm / month
Note:
These are average figures only. Weight gain may vary from child to child.
•
Between 4 to 12 years average weight gain is about 2 Kg per year.
•
A child measures approximately 50 cm at birth. Height increases by 25 cm in first year, 12.5 cm during second year, 7.5 - 10 cm in third year and subsequently it varies between 5.0 - 7.5 cm per year, till the growth spurt of puberty occurs.
•
It is possible to predict ultimate adult height of children with an error of plus/minus 4 cm. Tanner has suggested that anticipated adult height is approximately double of height at 2 years or 1.87 time of height at 3 years.
Laboratory Evaluation of children with F.T.T. is often inconclusive and expensive and therefore should be done judiciously. Because there are numerous causes of F.T.T., the list of investigations is also long -
•
A complete blood count (CBC)
•
Urine Routine and Microscopic exam
•
Stool Routine and Microscopic exam
•
Chext X-ray
•
Thyroid function studies
•
Blood Sugar
•
Growth hormone analysis
•
Elisa for AIDS
•
Bone age determination by X-ray
•
USG of abdomen
•
ECHO, Color Doppler
•
Tests for gastro-esophageal reflux and mal-absorption
•
Tests for organic and amino acids
•
Sweat test for chloride content (more than 60 m Eq/L in Cystic fibrosis)
Management
Treating a child with psychological (non-organic) F.T.T requires an understanding of all the factors that contribute to a child's growth: a child's nutritional status, family situation and the child-parent relationship. Whatever the cause, appropriate dietary practices are essential for the growth of a child. For children with medical (organic) F.T.T. the underlying disease must be diagnosed and treated.
General Principles
•
The type of caloric supplementation must be based on the severity of F.T.T.
•
Mealtimes should be pleasurable and at least 30-40 minutes long.
•
Environmental distractions should be minimized.
•
Children should eat with other people and not be force fed.
•
Solid foods should be offered before liquids.
•
The intake of water, juice and low-calorie beverages should be limited.
•
High-calorie foods, such as butter, whole milk, cheese and dried fruits should be emphasized.
•
Readymade high-calorie supplements available in the market may be required in some cases.
•
Parent education regarding appropriate foods and feeding practices are absolutely essential.
•
A team consisting of the treating doctor, dietician, medico-social worker and parents is necessary to restore the child to health.
Source: http://www.associatedcontent.com/article/1658641/failure_to_thrive_is_yo...
