failure to thrive

 Growth less than 3rd centile or crossing 2 major centile in short period

 1- organic

 2- non organic

 Organic= 1- GIS= GER, celiac disease, pyloric stenosis, hepatitis, malabsorption 2- Renal= UTI, RTA, CRF 3- Cardiopulmonary= CHF, asthma, cystic fibrosis 4- Endocrine=DM. hypothyroidism 5- Neurological = MR, cerebral hemorrhage, CP 6- Infection = HIV, TB 7- Metabolic = inborn error of metabolism 8- Congenital = fetal alcohol syndrome 9- others= lead poising

 Non organic (psychosocial) 1- poverty 2- poor maternal-child interaction 3- child abuse 

Clinical feature= From simple FTT, to loss of hair, marasmus, and kwashiorkor . According to WT for age mild(75-90%), moderate(60-74%), sever (less than 60%) According to HT for age mild(90-95%), moderate(85-89%), sever (less than 85%) According to WT for HT, mild(81-90%), moderate(70-80%), sever (less than 70%)

 Diagnosis= history, physical examination, Screening test (CBP, lead level, GUE)

 Approach of FTT according to age Age DX consideration Birth-3month psychosocial, congenital, GER, 3-6month “””””, HIV, GER, milk allergy, cystic fibrosis, RTA 7-12month “””””, delayed introduction of solid diet, GER, RTA 12mo and above “””””, GER 

Approach of FTT according to sign and symptoms sign and symptoms DX consideration Spitting, vomiting, food refusal GER, food allergy Diarrhea, fat stool malabsorption, milk allergy Wheeze asthma Recurrent infection HIV

 Treatment

 Regarding the cause , appropriate feeding atmosphere at home is important. Organic= underlying cause should be treated, type of calorie depend on the underlying cause e.g. CRF (protein).

 psychosocial FTT= 1- meal time 20-30 min 2- solid food should be offered before the liquid 3- environmental distraction should be minimized 4- child should eat with others 5- no force feed 6- intake of water and juice should be minimized 7- high calorie should be required 

Indication of hospitalization 1- sever under nutrition 2- further diagnostic aids 3- luck of catch growth 4- evaluation of child-parent relation

 Prognosis

 1- FTF in the 1st year is ominous sign

 2- 1/3 of psychosocial FTT are delayed development

 3- sever FTT have more than 8fold greater risk of mortality than the normal 

4- moderate FTT, have more than 4-5fold greater risk of mortality than the normal 

5- mild FTT, have more than 2-3fold greater risk of mortality than the normal

 Types of growth failure by using the growth chart

 Type 1= retardation of WT with near normal or slowly deceleration of HT, and OFC . Most common in under nutrition

 Type 2= near proportional of WT ,and HT with normal OFC. e.g. constitutional growth delay, genetic short stature, endocrinopathy, structural dwarfism. 

Type 3= concomitant retardation of all parameters (HT, WT, OFC) e.g. perinatal insult, chromosomal anomalies, and CNS anomalies