ftt food basket - hsibu.moh.gov.myhsibu.moh.gov.my/hsb.bm/wp-content/uploads/2017/04/early... ·...

3/27/2017

Dr Hii King Ching 1

Early Recognition and intervention of FTT

Dr Hii King Ching

General Paediatrician

Kapit Hospital

April 2017

Outline of FTT presentation

• Normal Growth

• Early Recognition

• Intervention

• Value of Food basket

Dr Hii King Ching 2013

Nutrition Vs Growth

Nutrition – food for growth

Growth & Development – increase in size (Height and Length) of the whole body


Phases of growth


Formula - weight

Age Weight

first 7 - 10 days of life lose 10 - 15%

first 3 months of life 25 gm / day

5 months old Birth weight X 2

1 Year old Birth weight x 3

1 - 9 yrs : Wt (kg) = (Age in yrs + 4) x 2

7 - 12 yrs: Wt (kg) = Age in yrs x 3


Formula - height

Age Length and height

Birth 50 (1/3 adult height)

6 months 68

1 yr 75

2 yr 85 (1/2 adult height)

3 yr 95

4 yr 100

5-12 yr 5 cm/ yr


3/27/2017

Dr Hii King Ching 2

Formula –head circumference (OFC)

Age cm

At Birth 35 cm

1st year Increase by 12 cm

First 3 months 6 cm

Second 3 months 3 cm

6-12 months 3 cm

2nd year Increase by 2 cm


Growth Failure

• 1st affect Weight

• 2nd affect Height

• 3rd affect usually spare OFC


Measurements

• Weight

- weighing scale with clothes removed

• Height

- < 2yrs – measured in lying position (infantometer)

- > 2yrs – standing height

• Head circumference

- occipital frontal circumference x 3 (take the largest)

Dr Hii King Ching 2012 Dr Hii King Ching 2012

Growth charts

• Serial measurement

• Growth pattern

• Percentiles

• Standard Deviation (Z-score) -2SD, -3SD


Non – Organic Failure to Thrive (KZM) -- due to caloric deprivation (whatever reasons)


3/27/2017

Dr Hii King Ching 3


Organic cause – must refer




3/27/2017

Dr Hii King Ching 4

Failure to thrive

Definition:

-Persistent weight loss over time

-Weight < 3rd percentile for age

-Weight crosses two major percentiles downward over any period of time


Etiology of failure of thrive 1

• Feeding problems

–Oral motor dysfunction

–Cardiopulmonary disorders• Inability to suck, swallow or masticate-- CNS

pathology (CP), neuromuscular disease • Poor nutrition use--renal failure, inborn errors

of metabolism • Psycho-social-- poor feeding technique, error

in formula preparation, child neglect (NON-O)• Poor socioeconomic environment (NON-O)• Low levels of food availability (NON-O)


Etiology of failure of thrive 2

• Vomiting - CNS abnormalities (increased intracranial pressure), metabolic toxin ( inborn error of amino or organic acid metabolism)

• Maldigestion/ malabsorption/ regurgitation / increase metabolic rate -cystic fibrosis, celiac disease, chronic diarrhea, GORD, thyrotoxicosis, chronic disease (heart failure), inflammatory lesion (inflammatory bowel disease, SLE)

• Reduced growth potential- chromosomal disorder, skeletal dysplasia, dwarfism


Failure To Thrive

• 95% Non-organic cause

• 5% Organic cause


History Most important part of the evaluation of

children with failure to thrive !!!!!


Antenatal history:

• -smoking

-alcohol

-use of medication during pregnancy

-any illness during pregnancy

-infection


3/27/2017

Dr Hii King Ching 5

Past History

• Past medical history- taking any drug ( anti heart failure, UTI on prophylaxis)

-frequent admission? Reason?

• Past surgical history- history of bowel surgery, short bowel syndrome

• Birth history- prematurity, ventilated or events that subject to brain hypoxic insult

• Family history of chromosomal abnormalities, malignancy disease or chronic infection, TB


Social history

• Family support for special child group

• Social worker

• Registration for “Orang Kurang Upaya”

• Care giver and child interactions (NON-O)

-postpartum depression, maternal depression or social environment with stress and poor social support


Feeding history

• In infancy, feeding difficulties are predominant cause of FTT.

• Lactation failure?

1. Solid diet: Inadequate feeding

– variety

– frequency

– Amount

2. Liquid: Breast milk, formula mixing error

– frequency

– Amount Dr Hii King Ching 2012

General Feeding Assessment 1

• Food Recall• Food Diary

• As the child grow, –need for liquid –need for solid

• Frequency of PU, BO

• Serial weight gain pattern


General Feeding Assessment 2 –Compare with the standard

• 6-12 months: max 4-5 times milk, solid 5-6 times

• 1-2 years: maximum 3 times milk, solid 5-6 times

• > 2 years: maximum 2 times milk, solid 5 times

Breast milk no limit (as many time as possible)


Specific Feeding Assessment 1

• Note state (keadaan) before, during and after feeding

• Can infant be brought into appropriate state for feeding? What works? How much assistance is needed?

• Does infant exhibit stress before, during, or after feeding?

• Are reflexes that allow infant to locate and obtain food (rooting and sucking reflexes) and protect airways (cough and

gag) expressed?

• Is there cough during feeding? When does it occur?

• Does the infant exhibit hypersensitive, hyposensitive, or aversive behavioral response to oral tactile input?


3/27/2017

Dr Hii King Ching 6

Specific Feeding Assessment 2

• Is feeding position optimal for this infant? • Evaluate functions of each of the oral structures. • Is infant capable of appropriately timed and organized

suckle, swallow, and breathe? • Are breath sounds noisy during or following feedings? • Are signs of increased respiratory effort observed

during feeding? • Does infant exhibit signs of fatigue before adequate

intake has been achieved? • Does infant demonstrate clear cues about feeding

readiness and satiety? • Does caregiver attend to cues given by infant? • Does caregiver demonstrate affection during feeding?


Physical examination 1

• BW, BH, Mid-arm circumference > 6 m/o, skinfold thickness

• General -- ill looking, dysmorphic features, pallor, hydration status (sunken eyes), respiratory status, rashes, bruises, injury

• Nutritional status -- edematous, muscle wasting (from shoulder down to limb), skin (dry, scaly, rough), hair color changes (brown, dry, brittle, sparse)

• Eye – cornea / bulbar conjunctiva dry, thickening, hazy• Mouth / ENT -- angular stomatitis, smooth tongue and

lips , dental caries, oral thrush, cleft lip, cleft palate• Neck – swollen thyroid



Physical examination 2 – Vit ADEK

• Respiratory system - chest deformities, scars (previous surgery)

• Heart -- murmur / sign of heart failure

• Gastrointestinal system- any surgical scar, distended, mass, hepatomegaly,

colostomy bag, vesicostomy

• Genitalia -ambiguous genitalia (CAH, panhypopituitarism)

• Nail – cyanoses, clubbing

• Skeletal – rickets (widen wrists, bowlegs, rickety rosary)

• Neurology examination - tone increase in cerebral palsy child


KRITERIA MARASMUS

muka seperti orang tua

kaki serta tangannya kurus

tulang rusuk jelas kelihatan

perut yang besar dan tidaksepadan dengan tubuhnya

otot-ototnya kecut

kehilangan lemak di bawahkulit, “baggy pants”


• Marasmus (Protein-Calorie Malnutrition)


3/27/2017

Dr Hii King Ching 7

Definition

• Wasted (Surut): Percentage of underweight (weight-for-age < -2 SD of the WHO Child Growth Standards median) among children aged < 5 years (also weight for height low)

• Stunted (Terbantut): Percentage of stunting (height-for-age < -2 SD of the WHO Child Growth Standards median) among children aged < 5 years (weight also low)

• Severe underweight and stunting: < -3 SD of the weight-for-age & height-for-age

• Weight for Height: Z-scores, severe protein energy malnutrition



Implication

• Stunted growth – result from malnourished mother, fetal development & malnutrition in early childhood

• Public health indicator

• Infections -- greater risks of illness and death

• IQ -- lower

• Stunted children – never re-gain the height lost

– never gain the corresponding body weight

– premature death later in life because vital organs never fully develop during childhood


KRITERIA KWASHIORKOR

wajah muram atau sedih

oedema terutamanya dibahagian lengan, tangan, kaki dan tapak kaki

muka, perut dan kemaluanmungkin akan bengkak

kulit pucat, kering, gelap, bertompok, pecah-pecahdan menggelupas


Refer when

• Edema of both feet

• Marasmus

• Kwashiorkor

• Persistent poor weight gain after 2 months intervention with 2 weekly follow up


http://en.wikipedia.org/wiki/Malnutrition

http://en.wikipedia.org/wiki/Childhood

3/27/2017

Dr Hii King Ching 8

Prevention of Underweight

• Early recognition

• Early intervention

• Best time is between 4-6 months


Value of Food Basket



Pakej 13 (Stok Pukal) – upon registration

BAHAN SETIAP BAKUL KUANTITI

SUSU PENDIETAN FORMULA (PEDIASURE) Berat : 400 g/ Tin

3 Tin

SUSU TEPUNG PENUH KRIM Berat : 2 Kg/ Bungkus

1 Bungkus

SIRAP MULTIVITAMIN WITH LYSINE (100 ml) 1 Botol



BIHUN (Berat : 350g / Bungkus) 6 Bungkus

BISKUT KRIM KRAKERS (Berat : 428g / Paket)

5 Paket

MARJERIN (DAISY)(Berat : 250g/ Pek) 1 Pek

IKAN SARDIN DALAM TIN KECIL Berat : 155g /Tin

8 Tin

BIJIRIN SARAPAN JENAMA NESTLE'/ KELLOGS ( Berat : 150g/ Kotak)

3 Kotak

SERBUK COKLAT MILO (Berat : 1 Kg/ Bungkus

1 Bungkus


1 Bungkus

MULTIVITAMIN WITH LYSINE JENAMA: CHAMPS (60 Biji/ Pek)

1 Pek

Pakej 5 (Ganjil)

Pakej 8 (Genap)


BERAS 5% (Berat : 5 Kg / Bungkus) 1 Bungkus

BISKUT BISKUAT TIGER (Berat : 198g / Paket)

4 Paket

MINYAK MASAK DALAM BOTOL Berat : 1 Kg/ Botol)

2 Botol

IKAN BILIS GRED A (Berat : 500g /Bungkus) 2 Bungkus

BIJIRIN SARAPAN JENAMA NESTLE'/ KELLOGS ( Berat : 150g/ Kotak)

3 Kotak

SERBUK COKLAT MILO (Berat : 1 Kg/ Bungkus

1 Bungkus


1 Bungkus

MULTIVITAMIN WITH LYSINE JENAMA: CHAMPS (60 Biji/ Pek)

1 Pek

MonthlyAlternating

Pro for Food Basket

1. Basic food supply for poor family

2. Child-orientated food content

3. High protein


Cons for Food Basket

1. Limited variety

2. Limited supply

3. Shared with family


3/27/2017

Dr Hii King Ching 9

Philosophy is• Supply food basket is LESS better • TEACHING them how to prepare and cook Nutritious

food is MUCH betterDr Hii King Ching 2012

Cooking Demonstration – the lost art

• Teaching cooking skills by cooking demonstration regularly – every 2 weeks or every week

• Gotong-royong style

• Building rapport through cooking class –sharing individual experience

• Cooking competition


Cooking Demonstration – the lost art

• Peer effect – both mother and child life example

• “Meal Time” to hope in clinic


Perception

• Asking the parents their perception of their child's health and find out more details – very different from what we assume

• Root cause: –healthcare workers do not have knowledge

–not aware of correct practise & prevention

–Do not practise COOKING DEMOSTRATION


Poor Nutrition or KZM cases

• 95% cannot find medical cause

poor food intake – frequency, variety and amount

mostly due to psychosocial factors or

environmental deprivation

• Only 5% has medical problem

Cooking Demo with Food Basket + = GrowthDr Hii King Ching 2012 Dr Hii King Ching 2012

Thank you

ftt food basket - hsibu.moh.gov.myhsibu.moh.gov.my/hsb.bm/wp-content/uploads/2017/04/early... ·...

Documents