logging in or signing up Failure To Thrive hussein1950 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 870 Category: Entertainment License: All Rights Reserved Like it (2) Dislike it (0) Added: February 20, 2010 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: bhaijan (19 month(s) ago) cpool Saving..... Post Reply Close Saving..... Edit Comment Close By: antarpatel (22 month(s) ago) please allow me to download Saving..... Post Reply Close Saving..... Edit Comment Close By: kingman121211 (26 month(s) ago) hhi Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript FAILURE TO THRIVE : By William Bithoney Patrick Casey Robert Karp FAILURE TO THRIVE Failure to Thrive : 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 Degree of Under- Nutrition None Mild Moderate Severe Gomez: % median weight- for age >90 75-90 60-74 <60 Waterlow: % median weight- for-height >90 80-90 70-79 <70 McLaren, Read: % median wt/ht for age ratios >90 85-90 75-84 <75 Categorization of Undernutrition in 258 Children Referred for "Failure to Thrive" : Categorization of Undernutrition in 258 Children Referred for "Failure to Thrive" Degree of Under- Nutrition None Mild Moderate Severe Gomez No. 5 132 112 9 % 2 51 43 4 Waterlow No. 64 149 42 3 % 25 58 16 1 McLaren, Read No. 18 38 156 46 % 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 : 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) : Clinical Subtypes (Cont'd) III. Socioemotional Clinical Subtypes (Cont'd) : 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 Non-organic Interactional Organic Unknown Number 59 46 22 4 Percent 45 35 16.7 3.3 Frequency of Organic Systems Causing Failure to Thrive : 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 visits in urban and rural outpatient settings up to 16% 0-4 year olds in low income populations are "stunted" Failure to Thrive : 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 "My baby is just small for her age" : "My baby is just small for her age" -Parent Failure to Thrive: Spectrum of Causes : 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'd) : 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 : 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 Diagnostic Evaluation (Cont'd) 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 : 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 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Failure To Thrive hussein1950 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 870 Category: Entertainment License: All Rights Reserved Like it (2) Dislike it (0) Added: February 20, 2010 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: bhaijan (19 month(s) ago) cpool Saving..... Post Reply Close Saving..... Edit Comment Close By: antarpatel (22 month(s) ago) please allow me to download Saving..... Post Reply Close Saving..... Edit Comment Close By: kingman121211 (26 month(s) ago) hhi Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript FAILURE TO THRIVE : By William Bithoney Patrick Casey Robert Karp FAILURE TO THRIVE Failure to Thrive : 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 Degree of Under- Nutrition None Mild Moderate Severe Gomez: % median weight- for age >90 75-90 60-74 <60 Waterlow: % median weight- for-height >90 80-90 70-79 <70 McLaren, Read: % median wt/ht for age ratios >90 85-90 75-84 <75 Categorization of Undernutrition in 258 Children Referred for "Failure to Thrive" : Categorization of Undernutrition in 258 Children Referred for "Failure to Thrive" Degree of Under- Nutrition None Mild Moderate Severe Gomez No. 5 132 112 9 % 2 51 43 4 Waterlow No. 64 149 42 3 % 25 58 16 1 McLaren, Read No. 18 38 156 46 % 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 : 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) : Clinical Subtypes (Cont'd) III. Socioemotional Clinical Subtypes (Cont'd) : 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 Non-organic Interactional Organic Unknown Number 59 46 22 4 Percent 45 35 16.7 3.3 Frequency of Organic Systems Causing Failure to Thrive : 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 visits in urban and rural outpatient settings up to 16% 0-4 year olds in low income populations are "stunted" Failure to Thrive : 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 "My baby is just small for her age" : "My baby is just small for her age" -Parent Failure to Thrive: Spectrum of Causes : 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'd) : 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 : 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 Diagnostic Evaluation (Cont'd) 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 : 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