Failure to thrive

Supervised by Dr.Suzan Sabbar

Presented by:
Rafal Nafa’a Hadi
Sarah khalid khnteel
Alaa hussein alewy
Fatima salim dibdab
Ayat Mashhoot lafta
 1- normal growth and definition of f.t.t

2- etiology

3- protein energy malnutrition and types

objectives 4- approach the FTT

5- Treatment of FTT

6- Complications

7- Prognosis
 Normal growth
•The processes of growth and development are intertwined. However, it is convenient to
refer to growth as the increase in size and development as an increase in function of
processes related to body and mind. Being familiar with normal patterns of growth and
development allows us for to recognize and manage abnormal variations. The genetic
makeup and the physical, emotional, and social environment of the individual determine
how a child grows and develops throughout childhood. One goal of pediatrics is to help
each child achieve his or her individual potential through periodically monitoring and
screening for the normal progression or abnormalities of growth and development.
•Growth is assessed by plotting accurate measurements on growth charts and comparing each
set of measurements with previous measurements obtained at health visit.
•Normal growth patterns have spurts and plateaus, so some shifting on percentile graphs can be
expected. Large shifts in percentiles warrant attention, as do large discrepancies in height,
weight, and head circumference percentiles.
Anthropometric measures
Height for age: is a measure of linear growth, it is affected by chronic malnutrition
Weight for age: is an index of nutritional status of the child
Weight for height: measures the general growth of the child, if it is low the child ca
Body mass index: weight (Kg)/height (m) 2
All these measures have special charts that depend on the age & sex of the child i.
Mid-arm circumference: we measure the circumference of the arm by Shakir tape, i
there are specific growth charts for genetic conditions such as Down syndrome an
• definition
• Failure to thrive (FTT) is a term used to describe inadequate growth or the
inability to maintain growth, usually in early childhood. It is a sign of
undernutrition, and because many biologic, psychosocial, and
environmental processes can lead to undernutrition.
• the most common
defintion is weight that
falls or remains below
3rd centile lines of
growth chart over time or
less than 80% of the
median weight for the
height of the child.
 •The greatest risk of undernutrition (underweight, stunting, wasting, and micronutrient
deficiencies) occurs in the first 1000 days, from conception to 24 mo of age.
Micronutrient deficiencies are another dimension of undernutrition. Those of particular
public health significance are vitamin A, iodine, iron,and zinc:
1-Vitamin A deficiency
is caused by a low intake of retinol (in animal foods) or its carotenoid
precursors, mainly beta-carotene( in orange- colored fruits and vegetables and dark green
leaves. The prevalence of clinical deficiency is assessed from symptoms and signs of xerophthalmia
(principally night blindness and Bitot
spots).Vitamin A deficiency is the leading cause of preventable blindness in children.
2-Iodine deficiency
is the main cause of preventable mental impairment. An enlarged thyroid (goiter) is a sign of
deficiency. Severe deficiency in pregnancy causes fetal loss and permanent damage to the brain
and central nervous system in surviving offspring(cretinism)
It can be prevented by iodine supplementation before conception or
during the first trimester of pregnancy. Postnatal iodine deficiency is
associated with impaired mental function and growth retardation.
3-Iron-deficiency anemia
is common in childhood either from low iron intakes or poor absorption, or
as a result of illness or parasite infestation. Hemoglobin cutoffs to define
anemia are110 g/L for children 6-59 mo, 115 g/L for children 5-11 yr, and
120 g/L for children 12-14 yr.
4-Zinc deficiency
increases the risk of morbidity and mortality from diarrhea, pneumonia,
and possibly other infectious diseases . Zinc deficiency also has an
adverse effect on linear growth.
Etiology
FTT often we described it as multifactorial problem that may
related to decrease intake, increase output and increase calorie
demand.
Also we can divided it into organic and non organic causes:
organic causes:the patients who suffer from
swallowing abnormalities may have serious problem in taking
enough calories to gain weight as we as the patients with
chronic diarrhea may be losing more calories than he
consumes. Lastly, a patient with congenital heart disease may
have increased caloric demands and be unable to keep up.
Inorganic causes: included many reasons that cause failure in
getting the necessary calories such as bad mixing of the
formulas, refusal feeding and parents neglecting.
Inadequate intake:
Food insecurity
• Poor knowledge of child’s needs
• Formula dilution or excessive juice
• Breastfeeding difficulties
• Medical child abuse/caregiver fabricated illness (Munchausen by
proxy)
• Medical neglect
• Food fads including “rice” milk as substitute for formula or cow
milk Child not taking enough food
• Oromotor dysfunction, neurologic disease
• Developmental delay
• Behavioral feeding problem (altered oromotor sensitivity, pain and
conditioned aversion) • Anorexia from systemic causes
Emesis
• Pyloric stenosis
• Gastroesophageal reflux
• Eosinophilic esophagitis
• Vascular rings
• Malrotation with intermittent volvulus
• Increased intracranial pressure and other neurologic disorders
• Inborn errors of metabolism
• Rumination
• Cyclic vomiting
Malabsorption
• Cysticfibrosis
• Celiac disease
• Hepatobiliary disease
• Food protein allergy, insensitivity, or intoleranc.
• Infection (giardiasis)
• Short gut syndrome
 Increased Metabolic Demand
• Insulin resistance (intrauterine growth
restriction)
• Congenital infections (human
immunodeficiency virus, TORCHES)
Syndromes (Russell-Silver, Turner, Down)
• Malignancy
• Chronic disease (cardiac, pulmonary,
renal)
• Metabolic disorders
• Immunodeficiency/autoinflammatory
disorders
• Endocrine (diabetes mellitus, diabetes
insipidus, hyperthyroidism)
CLINICAL MANIFESTATIONS

Inadequate weight for corrected age, weight for height, and body mass
index, as well as failure to gain adequate weight over a period of time,
help define FTT Growth parameters should be measured serially and
plotted on growth charts appropriate for the child’s sex and age. Growth
charts are also available for some
known chromosomal abnormalities, such as Down syndrome and
Turner syndrome
Clinical Manifestations of Severe Acute
Malnutrition
• Severe wasting: is most visible on the thighs,
buttocks, and upper arms, and over the ribs
and scapulae where loss of fat and skeletal
muscle is greatest. Wasting is preceded by
failure to gain weight and then by weight loss.
The skin loses turgor and becomes loose as
subcutaneous tissues are broken down to
provide energy.
• The eyes may be sunken from loss of retro orbital fat, and
lachrymal and salivary glands may atrophy leading to lack of tears
and a dry mouth.
• Weakened abdominal muscles and gas from bacterial overgrowth
of the upper gut may lead to a distended abdomen. Severely
wasted children are often irritable.
• In edematous malnutrition, the edema is most likely to appear
first in the feet and then in the lower legs. It can quickly
develop into generalized edema affecting also the hands, arms,
and face.
• Skin changes commonly occur over the swollen limbs and
include dark,crackled peeling patches (flaky paint dermatosis)
with pale skin underneath that is easily infected.
• The hair is sparse and easily pulled out and may lose its curl. In
dark-haired children, the hair may turn pale or reddish. The liver is
often enlarged with fat. Children with edema are miserable and
apathetic, and often refuse to eat.
 Nutritioal importance of proteins

Proteins have been traditionally regarded as the “ body building foods”

► 10-15% of total body energy is derived Functions of proteins include..
1. Proteins are the fundamental basis of cell structure& its function.
2. All the enzymes, several hormones, immunoglobulins etc., are proteins.
3. It helps to maintain osmotic pressure, clotting of blood, muscle
contraction etc.
4. In starvation, proteins are the energy sources.
•PEM (protein energy malnutrition)
• Definition
A group of clinical conditions that may result from
varying degree of protein deficiency and energy
(calorie) inadequacy.
 Etiology
1-poverty: cannot purchase adequate amount and quality of food for meeting nutritional
requirements.
2.LBW: Malnourished mothers high incidence of LBW and growth retarded babies
3.Infections: Diarrhea, pneumonia, malaria, measles, whooping cough and tuberculosis
acute malnutrition. (Appetite is impaired. Metabolic demands during infection are
higher.
4.Population growth: Increase in birth rate is disproportionate to increase in food
production.
5.Large families and higher birth order result in higher incidence of malnutrition. Rapid
succession of pregnancy affects nutritional status of mother.
6.Feeding habits: lack of exclusive breast feeding
7.High pressure advertising of baby food: early discontinuation of breast feeding
8.Social factors: Repeated pregnancies, inadequate child spacing, separation child from
parents
Measles and malnutrition
1. Direct Impact on Nutrition: Measles can cause anorexia, leading to reduced food intake. Additionally, the
gastrointestinal symptoms such as diarrhea and vomiting can exacerbate malnutrition by reducing nutrient
absorption and increasing nutrient losses.

2. Metabolic Demands: The systemic response to measles increases the body's metabolic demands. A child
with measles may require more calories and nutrients to meet these increased demands, further straining an
already compromised nutritional status.

3. Immunosuppression: Measles can suppress the immune system, making the affected individual more
susceptible to secondary infections. These infections can further reduce appetite, increase nutrient
requirements, and hinder nutrient absorption, contributing to failure to thrive.

4. Complications: Severe cases of measles can lead to complications like pneumonia or encephalitis. These
conditions increase metabolic stress and can further impair nutritional status and overall growth.

5. Interference with Growth Hormones: The inflammatory response triggered by measles can interfere with
the production and function of growth hormones, which are essential for normal growth and development in
children.
Normal weight(expected weight

1-Age 1-12mont
age in months+9/2
Example: 6m > 6+9/2=7.5kg

2-Age 1-6 years

(age in years+4)*2
Example: 3years >(3+4)*2=14kg

3-Age 6-12 years

age*3
Example: 7years > 7*3=21kg
• PEM Types
• marasmus (severe wasting) <60% of normal.
• kwashiorkor (characterized by edema) 60-80% of
normal.
• marasmickwashiorkor (severe wasting + edema) <60%
of normal + edema
• ------------------------------------------------------
• Percent of wt=present wt/ expected wt *100%
• For example/
• Patient wt 5kg & 9 month age
• expected wt 9+9/2=9
• Percent=5/9*100%
• =55%Marasmus
In children with FTT, malnutrition initially results in three types

these are wasting, stunting and decresing in head

circumference.
Wasting : is deficiency in weight gain ( low weight for high) and
its usually indicate acute malnutrition.
Severe wasting : is extreme thinned diagnosed by weight for
lenght (or height) below _3 SD of the WHO child growth
standards and its < 60% of ideal body weight
Stunting : deficiency in linear growth( low height for age) and its
indicate chronic malnutrion. Generally occurs after months of
malnutrition. Children with height-for-age Z-score below minus
two standard deviations (−2 SD) from the median of the WHO
reference population are considered to be stunted or chronically
malnourished
Severe stunting : children who are below minus three
standard deviations (−3 SD) from the reference median are
considered severely stunted.
Head circumference is spared, except with chronic Severe
malnutrition
How to approach
Approach to child with FTT History
The hx in any patient with FTT must include a detailed dietary hx
with
observation of maternal-child interaction. Physical examination of
all
systems of body that may affect growth.
Measure periodically all growth parameters including; weight,
length/height & (weight/height) ratio to measure the degree of
FTT. In
malnutrition, weight is the 1st to be affected, followed by height,
whereas
head circumference is lastly affected when malnutrition is
seriously
affect brain growth.
1 -history °
prenatal history
1_ smoking
2_ alcohol consuming
3_prenatal infections
4_teratogenic exposures
5_ any illness during pregnancy

Natal history
Type of delivery ,duration,any complications during delivery,gestational age and
weight of the baby .
Post natal history :
1_neonatal asphyxia
2_ prematurity.
3_ birth size ( weight, length, head circumference)
4_small for gestational age
5_congenital malformations or chromosomal anomalies .

Past medical and past surgical history:

Previous hospitalizations; illnesses (e.g., gastroenteritis, recurrent pneumonia); chronic diseases
(DM, hyperthyroidism, inflammatory bowel disease, celiac disease, renal disease, congenital heart
conditions, Immunodeficiency , esophageal abnormalities and endocrine disorders); previous
surgeries; and investigations
Drug history:
Chronic use of medications, chemotherapy .
Developmental history: if have delayed milestone
Feeding/dietary history:
• For an infant: Type of feeding (breast or formula feeding)
• If a breastfed infant, ask about the number of feedings per day, the duration of each
feeding, satisfaction of the mother and the baby, voiding, vomiting, and stooling. Also
record the baby’s sleep patern ,feeding defficulties (such as poor

swallowing), fatigue during feeding, and lactation failure. Age adjusted and age dependent
dietary details milk,solids,vitamins, other supplements,food allergy or intolerance If a
formula-fed infant, then ask about the type of milk used (commercial or homemade
formula)The mixing process (to ensure appropriate dilution) should be reviewed (as adding
too much water to powdered formula results in inadequate nutrition). Also, the number of
ounces that the baby takes in a 24-h period and the number of diapers wet per day (6–8
diapers).
Family history
Family history : Relationship of parents , the ages at which the parents
achieved puberty, biologically related siblings with poor growth, deaths of
siblings or relatives during early childhood (metabolic or immunological
disorders), cystic fibrosis
Social history: Parental histories of abuse or neglect in childhood, parental
substance abuse, parental depression , current stresses, housing, the family’s
social supports , parents’ educational levels .
Review of system :
Polyuria, polydipsia, jaundice, cough, snoring or mouth
breathing, cyanosis, irritability, skin rash, arthritis,
weakness, Diaphoresis or fatigue while eating, poor suckin
swallowing difficulties.
Physical examination

is essential with four main goals:

(1) Identification of dysmorphic features suggestive of a genetic
disorder impeding growth
(2) Detection of underlying disease that may impair growth
(3) Assessment for signs of possible child abuse; and
(4) Assessment of the severity and possible effects of malnutrition.
The severity of a child's under nutrition can be determined most easily by
using the Gomez criteria. By comparing the child's current weight for
age with the expected weight (50th percentile) at that age, the degree of
malnutrition can be assessed. If the weight is less than 60 % of expected
weight, FTT is considered severe, 61 to 75 % denotes moderate FTT, and
76 to 90 % is mild.
Investigations

CBC ( to screen for iron defiency anemia and lead toxicity).

urinalysis

urine culture

serum electrolytes ( to asses renal function or dysfuction).

thyroid stimulating hormone.

liver function test.

protein purified derivative test ( to screen for tuberculsis)..

human immunodeficiency virus testing.

 Line of treatment.
There are 10 steps of treatment, which are separated into 2
phases referred to as stabilization and rehabilitation.
The aim of the Stabilization phase is to
•Repair cellular function.
•Correct fluid and electrolyte imbalance.
•Restore homeostasis.
•Prevent death from the interlinked triad of hypoglycemia,
hypothermia, and infection.
The aim of the Rehabilitation phase is to restore wasted
tissues (i.e., catch-up growth).
 Stabilization:
It includes 7 steps. Giving broad-spectrum antibiotics and feeding frequent
small amounts of F75 (a specially formulated low-lactose milk with 75 kcal
and 0.9 g protein per 100 mL to which potassium, magnesium, and
micronutrients are added), will reestablish metabolic control, treat edema,
and restore appetite.
The parenteral route should be avoided; children who lack appetite should
be fed by nasogastric tube, as nutrients delivered within the gut lumen help
in its repair.
• Dehydration status is easily misdiagnosed in severely wasted children, as the
usual signs (such as slow skin pinch, sunken eyes) may be present even
without dehydration.
STEP 1 : Prevent/treat hypoglycemia (blood glucose <3 mmol/L)

if conscious:
1. 10% glucose (50 mL), or a feed (see step 7), or 1 teaspoon sugar
under the tongue-whichever is quickest
2. Feed every 2 hr for at least the first day. Initially give 1/4 of feed
every 30 min
3. Keep warm
4. Start broad-spectrum antibiotics
If unconscious:
1. Immediately give sterile 10% glucose (5 mL/kg) by IV
2. Feed every 2 hr for at least first day. Initially give 1/4 of feed every
30 min. Use nasogastric (NG) tube if unable to drink
3. Keep warm.
4. Start broad-spectrum antibiotics
STEP 2 : Prevent/treat hypothermia axillary <35°C ,rectal <35.5°CTreated by
Actively rewarm
1. Feed
2. Skin-to-skin contact with carer (“kangaroo technique”) or dress in warmed
clothes, cover head, wrap in warmed blanket and provide indirect heat (e.g. heater;
transwarmer mattress; incandescent lamp)
3. Monitor temperature hourly (or every 30 min if using heater)
4. Stop rewarming when rectal temperature is 36.5°C (97.7°F)
Note : Hypoglycemia and hypothermia often coexist, and are signs of
severe infection
STEP 3 : Prevent/treat dehydration Do not give IV fluids
unless the child is in shock.
1. Give ReSoMal 5 mL/kg every 30 min for first 2 hr orally or NG tube
2. Then give 5-10 mL/kg in alternate hours for up to 10 hr. Amount
depends on stool loss and eagerness to drink. Feed in the other
alternate hour.
3. Monitor hourly and stop if signs of overload develop (pulse rate
increases by 25 beats/min and respiratory rate by 5 breaths/min .
increasing edema; engorged jugular veins)
4. Stop when rehydrated (3 or more signs of hydration: less thirsty,
passing urine, skin pinch less slow, eyes less sunken, moist
mouth,tears, less lethargic, improved pulse and respiratory rate).
STEP 4 :
Correct electrolyte imbalance—deficit
of potassium and magnesium, excess
sodium
Give extra potassium (4 mmol/kg/day)
and magnesium (0.6 mmol/
kg/day) for at least 2 wk
STEP 5 :Prevent/treat infections
Treated by :
Infections are often silent. Starting on the 1st day, give broad spectrum
antibiotics to all children.
1. For antibiotic choices/
◆ If no complications :
Amoxicillin oral 25 mg/kg twice daily for 5 days
◆ If complications (shock, hypoglycemia, hypothermia, skin lesions, respiratory
or urinary tract infections, or lethargy/sickly):
Gentamicin (7.5 mg/kg IV or IM) once daily for 7 days
and
Ampicillin (50 mg/kg IV or IM) every 6 hr for 2 days, then oral amoxicillin (25-40
mg/kg) every 8 hr for 5 days.
2. Ensure all doses are given, and given on time
3. Cover skin lesions so they do not become infected
Note: Avoid steroids as they depress immunity
STEP 6 :Correct micronutrient deficiencies
Do not give iron in the stabilization phase
Iron therapy is usually not started in this initial phase of Rx because it
interfere with the patient's host defense mechanisms as well as free iron
may exacerbate oxidant damage, precipitating infections (e.g. malaria) or
clinical kwashiorkor in a child with clinical marasmus. Thus some are
recommend an antioxidant with iron therapy.

1. Give vitamin A on day 1 (under 6 mo 50,000 units; 6-12 mo

100,000 units; >12 mo 200,000 units) if child has any eye signs of
vitamin A deficiency or has had recent measles. Repeat this dose
on days 2 and 14
2. Folic acid 1 mg (5 mg on day 1)
3. Zinc (2 mg/kg/day) and copper (0.3 mg/kg/day).These are in the
electrolyte/mineral solution and Combined Mineral Vitamin mix
(CMV) and can be added to feeds and ReSoMal
4. Multivitamin syrup or CMV
STEP 7 : Start cautious feeding
1. Give 8-12 small feeds of F75 to provide 130 mL/kg/day,100
kcal/kg/ day and 1-1.5 g protein/kg/day
2. If gross edema, reduce volume to 100 ml/kg/day
3. Keep a 24-hr intake chart. Measure feeds carefully.
4. If child has poor appetite, encourage to finish the feed.
If unfinished, reoffer later. Use NG tube if eating 80% or less of the
amount offered
5. If breastfed, encourage continued breastfeeding but also give
F75
6. Transfer to F100 when appetite returns (usually within 1 wk) and
edema has been lost or is reduced
7. Weigh daily.
◆ Rehabilitation
The signals for entry to this phase are reduced/minimal edema
and
return of appetite.
A controlled transition over 3 days is recommended to prevent the
“refeeding syndrome.”
To make the transition, for 2 days replace F75 with an equal volume of
F100 and then increase each successive feed by 10 mL until some
feed remains uneaten (usually at around 200 mL/kg/day).
Add iron(3 mg/kg/day).
If breastfed, encourage continued breastfeeding.
 ,

After the transition, unlimited amounts should be given of a high-

energy, high protein milk formula such as F100 (100 kcal and 3 g
protein per 100 mL), or ready-to-use therapeutic food (RUTF), or
family foods modified to have comparable energy and protein
contents.

RUTF is specially designed for rehabilitating children with severe

acute malnutrition at home.
It is high in energy and protein and has electrolytes and micronutrients
added.
The most widely used RUTF is a thick paste that contains milk
powder, peanuts, vegetable oil, and sugar.
Pathogens cannot grow in it because of its low moisture content.
Criteria for discharge from hospital:

• Return of appetite
• good oral intake
• Gaining weight constantly without edema
• All infections treated
• Immunization initiated
• Mother educated about treatment
Community-based treatment: Many children with severe acute
malnutrition can be identified in their communities before medical
complications arise. If these children have a good appetite and are
clinically well, they can be rehabilitated at home through
community-based therapeutic care, which has the added benefit of
reducing their exposure to nosocomial infections and providing
continuity of care after recovery
Follow up (7th wk till recovery )
Carefully monitor growth parameters and
overall development.Continue weekly
weight checks using the same clinic scale
until sustained growth is documented for
months and By feeding to cover catch-up
growth and also the provision of emotional
stimulation with the aid of family & the
community.
• Refeeding Syndrome

It usually complicates the acute nutritional rehabilitation

after aggressive enteral or parenteral alimentation due to the
development of severe hypophosphatemia after
• the cellular uptake of phosphate
during the 1st wk of starting therapy. Other features of Refeeding
syndrome include: hypokalemia, hypomagnesemia, sodium retention,
hyperglycemia, & vitamins deficiency (especially thiamin).
Clinical manifestation of hypophosphatemia, especially when serum Pi is ≤
0.5 mmol/L
include: weakness, rhabdomyolysis, neutrophil dysfunction, hemolysis
thrombocytopenia, seizures, altered consciousness, arrhythmias,
cardiorespiratory failure, & sudden death.
Investigation; Monitor serum Pi, K, Mg & Ca frequently in the 1st 2 wk
after
.
Treatment : Slowly ↑ feeding with supplementation of minerals (especially
phosphate) & vitamins (especially thiamin) as well as the correction of
other electrolytes disturbances, especially hypokalemia &
hypomagnessemia.
• COMPLICATIONS OF FTT:
FTT has acute and long-term complications which influence the outcome.
Acute complications
Systemic or local infections
Bleeding disorders
Severe dehydration
hepatic dysfunction
Shock
hypoglycemia
Convulsions
Hypothermia
• Long-term complications:
• Sudden infant death syndrome (SIDS)
• Cachexia
• Growth retardation
• Mental subnormality
• Visual and learning disabilities
• xerophthalmia
• heart failure
• Long-Term Health Risks: Prolonged FTT during critical periods of growth can have long-
lasting effects on health, increasing the risk of chronic conditions such as obesity, diabetes,
and cardiovascular disease in adulthood.
• Why f.t.t cause metabolic disorders in adulthood
1. Programming of Metabolic Pathways: including increased insulin resistance, abnormal lipid metabolism, and
alterations in renal function. These changes can contribute to the development of hypertension.

2. Reduced Nephron Number: Malnutrition during infancy can result in the inadequate development of nephrons.

3. Imbalance of Renin-Angiotensin System: Malnourished infants may have elevated renin levels and an imbalanced
renin-angiotensin system, leading to increased peripheral vascular resistance and hypertension in later life.

4. Inflammation and Oxidative Stress: Malnutrition can lead to chronic inflammation and oxidative stress in the
body. These factors contribute to endothelial dysfunction and vascular remodeling, leading to increased arterial
stiffness and hypertension.
Several mechanisms have been proposed to explain this association. One possibility is that EFFT may
lead to developmental programming of the cardiovascular system, resulting in alterations in the
structure and function of the heart and blood vessels. This can lead to an increased risk of
cardiovascular disease and hypertension later in life.
In addition, EFFT may also result in changes in the metabolism of lipids and glucose. Research has
shown that individuals with EFFT are more likely to have abnormalities in lipid metabolism, including
higher levels of triglycerides and lower levels of HDL cholesterol. They may also be more likely to
develop insulin resistance and glucose intolerance, which can increase the risk of type 2 diabetes.
Other factors that may contribute to the increased risk of cardiovascular disease and metabolic
abnormalities in individuals with EFFT include genetic factors, environmental exposures, and lifestyle
factors such as diet and physical activity.
Overall, the association between EFFT and increased risk of cardiovascular disease and metabolic
abnormalities underscores the importance of early detection and management of fetal growth
restriction. This may include interventions to improve fetal nutrition and growth, as well as long-term
monitoring of cardiovascular and metabolic health in individuals who experienced EFFT in utero.
PROGNOSIS

FTT in the 1st yr of life (regardless of cause) is ominous, because maximal postnatal
brain growth occurs in the 1st 6 mo of life as well as brain grows as much in 1st yr
as in the rest of the child's life. Thus all patient with FTT require frequent
monitoring & assessment.
Prognosis of patients with organic FTT is variable, whereas ≈ 30% of children with
psychosocial FTT may develop developmental delay with social and emotional
problems.
Bad Prognostic Signs
Severe dehydration ,
Bleeding diathesis,
Xerophthalmia ,Hepatic dysfunction
Seizures ,Altered sensorium ,Extreme weight loss