FAILURE TO THRIVE

Atan Baas Sinuhaji

Department of ChildHealth School of Medicine,University Of Sumatera Utara Medan

FAILURE TO THRIVE ( FTT ) =1=

GROWTH

Increase in the mass of body tissues

Anthropometric measurement

Body Weight
ABS-BIKA FKUSU

Body Lenght
3

Head Circumference

Development

Skill

ABS-BIKA FKUSU

Anthropometric asessment

At the spesific time

Repeated visit

Poor

Poor

Malnutrition

FTT
5

WATERLOW

Table 1. WATER LOWS CLASSIFICATION NORMAL WASTED STUNTED

WEIGHT/ AGE % WEIGHT/ HEIGHT % HEIGHT/ AGE %

100 100 100

70 70 100

70 100 87

F.T.T
SUBOPTIMAL OF GROWTH

REPEATED VISIT

GENETIC

MALNUTRITION
PSYCHOSOCIAL

FTT

Malnutrition : inadequate nutrients

Malnutrition is the sine qua non of the failure to thrive

ABS-BIKA FKUSU

10

CALORI / NUTRIENTS
Intake Stools Absorption Utilization
Basal Metabolism Peripheral Utilization

Growth

BASAL UTILIZATION
MALABSORPTION

IMPAIRED OF PERIPHERAL UTILIZATION

NUTRIENTS
INTAKE

NUTRITION INADEQUATE
MALNUTRITION

Etiology of growth disorders

4. 1. Inadequate intake of calories/nutrients 2. Excessive calories/nutrients losses Vomiting Malabsorption 3. Basal metabolism Fever Hyperthyroidea Hyperkinesia Infection Impaired of peripheral utilization Chronic infection Malignancy Congenital heart diseases Anemia Inborn errors Hormonal

CALORIES / NUTRIENTS

DISEASES

GROWTH

IMMUNITY
ABS-BIKA FKUSU 14

Tabel 2. Complication relative to loss of lean body mass *)

Lean body mass % loss of total 10 20 30 40
ABS-BIKA FKUSU

Complication (related to lost lean body mass) Impaired immunity, increased infection Decreased healing, weakness, infection Too weak to sit, pressure sores, pneumonia, no healing Death usually from pneumonia
15

Associated mortality (%)

10 30 50

100

*) assuming no preexisting loss

Immunity
Infection (e.g. Measles)

Anorexia Fever Diarrhoea Protein losing enteropathy

ABS-BIKA FKUSU

Malnutrition

Natural (innate) Host defense

External : skin, gut motility,etc

Internal

Humoral: natural Ab,etc

Celluler :NK cell, phagocytic

Acquired (Spesific)

Humoral: active&passive Immunity

Celluler : cytotoxic T-cell, killer cell,

ABS-BIKA FKUSU 17

Lymphokine activated macrophage

INADEQUATE CALORY INTAKE

-QUALITY -IGNORANCE

-ANOREXIA

FTT CAUSED BY BOWEL DYSFUNCTION

EXCESSIVE CALORY LOSS

-VOMITING -MALABSORPTION -PROTEIN LOSING ENTEROPATHY

INCREASED NEED

- FEVER

DISORDER OF DIGESTION

MALDIGESTION MALABSORPTION

MALABSORPTION

FAILURE OF THE DIGESTIVE SUBSTRACTS ACROSS LUMEN INTO

MUCOSE
BLOOD

VESSELS
LYMPH

MALABSORPTION
1.MALDIGESTION

2.HYPEROSMOTIC
3.PERISTALSIS 4. ABSORPTION AREA
- SHORT GUT

- MUCOSAL INJURY