NDD 41205 OUTPATIENT DIETETIC TRAINING II

CASE PRESENTATION:
NUTRITIONAL MANAGEMENT OF FAILURE TO
THRIVE (FTT)
PRESENTED BY ALIA NADHIRAH BINTI ABD RAHIM (047261)

CLINICAL INSTRUCTIOR MDM NIK AINA ASYARAH BINTI HAJI NIK ABD GHANI

PLACE OF ATTACHMENT OUTPATIENT DEPARTMENT HSNZ

DATE OF PRESENTATION 11TH APRIL 2021 1

 PRESENTATION OUTLINE
1.0 INTRODUCTION/CASE 6.0 DISCUSSION
CHRONOLOGY
7.0 CONCLUSION
2.0 MEDICAL DIAGNOSIS
8.0 REFERENCES
3.0 DIET-DIAGNOSIS RELATION

4.0 MEDICATIONS

5.0 NUTRITIONAL
ASSESSMENT/DIAGNOSIS/
INTERVENTION/MONITORING &
EVALUATION (ADIME)
2
1.0 INTRODUCTION
PATIENT’S PERSONAL INFORMATION
Name Ms. A
Age/Sex/Race 9 years old/Girl/Malay
Address Bukit Payong, Terengganu
Occupation Father – Work as a clerk at small company
Mother – Work at kedai kopi from 8-10.00 am
Living situation Currently live with her family and the youngest out of 5
siblings
Education Standard 3 student at SK Bukit Payong
Functional status Lightly active → Always on gadget at home
Smoking history Both parents are non-smoker
Alcohol history Both parents are non-alcoholic
Socio-economic status Middle-socioeconomic status
3
1.0 INTRODUCTION
PATIENT’S PERSONAL INFORMATION
Current medical 1. Well controlled bronchial asthma
diagnosis 2. Poor weight gain possible sec to nutrition
Medical history • Bronchial asthma (since 2018)
• Birth weight at 2.6 kg (full term baby)
Family history • Mother had childhood asthma
• Claimed father small built
• Mostly her siblings also small in size
Reason of referral Individual counselling for weight gain
Discipline Paediatric medical
Case type New case
Date of consultation 1st April 2021
4
 1.1 CASE CHRONOLOGY

3/3/2021
3/6/2012 Came to HSNZ due 1/4/2021
Born at 39 weeks @ 1/5/2018 to episodic viral First visit at diet
birth weight 2.6 kg Pt was dx with wheeze and was clinic
→ Normal bronchial asthma referred to dietitian
(WHO,2011) for counselling of
weight gain

5
2.0 MEDICAL DIAGNOSIS RISK FACTORS:
1. Medical conditions
FAILURE TO THRIVE • Congenital anomalies
(autism/cerebral palsy)
• Gastroesophageal reflux
• Definition: Lack of expected normal physical growth, • Low birth weight (<2.5kg)
failure to gain weight or lack of growth (1). • Poor oral health
• Prematurity (<37 weeks)
• Characteristic: Lack of weight and height gain →
• Tongue tie
weight and height consistently <3rd to 5th percentiles 2. Psychosocial family issues
of growth chart for age and gender • Disordered feeding techniques
• Effect: Developmental delays (stunted growth) and • Family stressors
• Parental or family history of intimate
other long-term effects for the developing child partner abuse or violence
• Poor parenting skills
Etiology: • Postpartum depression
1.Inadequate caloric intake (most common – 80%) • Poverty†
• Social isolation of a caretaker
2.Inadequate caloric absorption
• Substance abuse
3.Excessive caloric expenditure • Unusual health and nutritional
Homan (2016) Failure to Thrive: A Practical Guide. Am Fam Physician. 15;94(4):295-299
beliefs (e.g., restricted diets) 6
 3.0 DIET-DIAGNOSIS RELATION
ASTHMA AND FTT
• Increased metabolic demand due to asthma causes failure to thrive
(1,2).
• Increased energy expenditure may occur during attacks of asthma
when there is a dramatic increase in the energy cost of breathing →
results from abnormal lung mechanics due to airway obstruction (1).
• A reduction in the rate of growth is a consequence of an imbalance
between energy intake (↓) and energy expenditure (↑) (1).
• Children with asthma had changes in taste and eating behaviors where
they required more time to finish food, higher concentration to
perceive taste, and higher frequency of feeding difficulties which lead
to low caloric intake (2).
1. Zeitlin, S. R., Bond, S., Wootton, S., Gregson, R. K., & Radford, M. (1992). Increased resting energy expenditure in childhood asthma: Does this contribute towards

2.
growth failure?
Mey, J. T., Matuska, B., Peterson, L., Wyszynski, P., Koo, M., Sharp, J., … Mulya, A. (2021). Resting energy expenditure is elevated in asthma. Nutrients, 13(4), 1–17.
7
4.0 MEDICATIONS

Drug MDI Fluticasone MDI Salbutamol

Dosage 1 puff OD 10 puff PRN
Indication To treat asthma To treat asthma
Adverse effect Nausea, vomiting, mouth and Nausea, vomiting, mouth and
throat irritation throat irritation

8
5.0 NUTRITIONAL ASSESSMENT
ADIME – ANTHROPOMETHRY
Parameter Date/Value Remarks
3/3/21 1/4/21
Height (cm) 118 119 Ht showed increment of 1 cm within 1 month but still below
3rd percentiles according to CDC growth chart stature-for-age
Girls (2 to 20 years)
Weight (kg) 17.0 17.7 Wt showed increment of 0.7 kg within 1 month but still below
3rd percentiles according to CDC growth chart weight-for-age
Girls (2 to 20 years)
BMI (kg/m²) 12.2 12.5 BMI showed increment of 0.3 but still below 3rd percentiles
according to CDC growth chart BMI-for-age Girls (2 to 20 years)
Ideal value Ht = 133 cm According to CDC growth chart for respective
Wt = 29 kg age and PA @ 50th percentiles
Ideal range Ht = 125 – 137 cm According to CDC growth chart for respective
Wt = 24 – 33 kg age and PA @ 10th – 75th percentiles 9
 CDC GROWTH CHART FOR 2 TO 20 YEARS:GIRLS

5.0 NUTRITIONAL ASSESSMENT

ADIME – ANTHROPOMETHRY
75th

50th

25th
10th
3rd

✓ Current wt: 17.7 kg

below 3rd percentiles
✓ Wt at 50th
percentiles: 29 kg
✓ Ideal wt range at 10th
–75th percentiles: :24-
33 kg

10
 CDC GROWTH CHART FOR 2 TO 20 YEARS:GIRLS

5.0 NUTRITIONAL ASSESSMENT

ADIME – ANTHROPOMETHRY
75th
50th
25th
10th
3rd ✓ Current ht: 119
cm below 3rd
percentiles
✓ Ht at 50th
percentiles: 133
cm
✓ Ideal ht range at
10th – 75th
percentiles:
125-137 cm

2 3 4 5 6 7 8 9 11
5.0 NUTRITIONAL ASSESSMENT
ADIME – BIOCHEMICAL
• No data available
When having
constipation
ADIME – CLINICAL
When having
Comments on clinical assessment:
normal BO
• No latest clinical data available
• Patient was healthy and accompanied by her
mother
• She was physically active girl
• Mother claimed bowel open daily but sometimes
having constipation (Type 1 Bristol chart)
12
 5.0 NUTRITIONAL ASSESSMENT
ADIME – DIETARY INTAKE
Time Food Exch Freq. CHO Pro Fat Fiber Ca Calorie
(g) (g) (g) (g) (mg) (kcal)
BF Dutch lady full cream milk (2 7/7 11.6 7.6 7.8 - 337 148
7.00 am @ home scps)
MT Nasi goreng telur (1 scp) 1C+ 1P + 1F 5/7 15.5 9 11.5 0.3 - 204
10.00 am @ recess
Nugget (1 pcs) ½C + ½ P +1F 3/7 7.5 4.5 7.3 0.2 - 115
at school canteen
Milo (1 pack) 1SS 3/7 20 3.5 3.0 0.8 90 124
LN Nasi ayam (1/2 pack) 1C + 1P + 1F 5/7 15.5 9 9.5 0.3 - 185
1.30 pm @ Kafa
Air kosong (1 glass) - -
DN Nasi goreng ayam (1 scp) 1C + ½ P + 1F 4/7 15 5.5 7.5 0.3 - 153
9.00 pm @ outside
Sup kosong (2 tbs) 1F 4/7 - - 5 - - 45
food
Total intake 85.1 39.1 51.6 1.9 427 974
Percentage of intake (%) 35 16 48 960 (±)
Percentage of requirement (%) 33 74 87 7 43 55 13
5.0 NUTRITIONAL ASSESSMENT
ADIME – DIETARY – FOOD CHECKLIST
Food/beverage Portion/exchange Frequency
Biscuits 1 pcs 3/7
Chocolates 2-3 pcs 3/7
Junkfood Nil Nil
Dutch lady full cream milk 1 glass 7/7
Green leafy vegetables Nil Nil
Fruits Nil Nil

14
5.0 NUTRITIONAL ASSESSMENT
ADIME – ASSESSMENT
Comments on dietary intake:
• Patient is picky eater due to only prefer of certain food such as nasi goreng,
nasi ayam and less preferences of fruits and vegetables.
• Allergic on seafood
• Drinks Dutch lady full cream milk recently, 1x/day for weight gain purposes.
• Mother claimed only taking small amount of food due to early satiety
• Mother claimed patient eat white rice with soup only
• Prefer chicken than fish due to preferences
• More prefer fried foods such as nasi goreng and ayam goreng
• Poor consumption of fiber such as fruits and vegetables due to less
preferences
• Less taking junk food, only eat when available in small portion
• Unable to finish 500 ml of plain water 15
❖ Environment
❑ The youngest out of 5 siblings
❑ Live with family
❑ Middle-socioeconomic status

❖ Functional
❑ Lightly active
• Always play with phone
during leisure time

❖ Knowledge, Attitudes &

Practices
❑ Not seen by dietitian before,
thus caregiver has food and
nutrition related knowledge
deficit on increasing energy
intake.
❑ Caregiver was at contemplation
stage where she aware of the
problem
16 and motivated to follow
the intervention given. 16
5.1 NUTRITIONAL DIAGNOSIS
ADIME – DIAGNOSIS
1. Inadequate energy intake (NI-1.2) related to food and nutrition
related knowledge deficit of caregiver concerning energy intake as
evidenced by estimated energy intake is 974 kcal/day @ 55% from
energy requirement.
2. Increased nutrient needs (NI-5.1) (protein) related to increase
demands for nutrients due to failure to thrive (FTT) as evidenced by
estimated protein requirement of 3.0 g/kg BW.

17
5.2 NUTRITIONAL INTERVENTION
ADIME – INTERVENTION
Comparative standard
Weight for calculation
Height for calculation
Energy requirement
1. Peterson equation,1984
2. RNI,2017
3. Dorothy for Sick Children,
1987
Energy range
Chosen energy
Homan (2016) Failure to Thrive: A Practical Guide. Am Fam Physician. 15;94(4):295-299
29 kg @ IBW at 50th percentiles (CDC growth chart)
119 cm (current height)
ER= RDA Energy for wt-age (kcal/kg) x IBW (kg)
RDA FAO/WHO/UNU, 1991 for 4 y/o = 95 kcal/kg BW
ER= 95 kcal/kg x 29 kg = 2755 kcal/day
For age 7-9 years old with PAL 1.4 (lightly active)
ER= 1410 kcal/day
For age 7-12 years, energy factor= 100 kcal/kg BW
ER= 100 kcal/kg x 17.7 kg = 1770 kcal/day
1410 – 2755 kcal
1770 kcal/day for appropriate growth velocity (Homan Gretchen J, 2016)
18
5.2 NUTRITIONAL INTERVENTION
ADIME – INTERVENTION
Comparative standard
Protein requirement
1. Peterson PR= RDA Protein for wt-age (kcal/kg) x IBW (kg)
equation,1984 RDA FAO/WHO/UNU, 1991 for 4 y/o = 1.1 g/kg BW The protein requirements
PR= 1.1 g/kg x 29 kg = 32 g/day of stunted infants and
children are estimated to
2. RNI,2017 For age 7-9 years old, protein requirement = 23 g/day
be between 9–11.5% of
3. Dorothy for Sick For age 7-12 years old, protein factor= 2.5 -3.0 g/kg BW the total energy,
Children, 1987 PR= 44 – 53 g/day depending on the rate
and composition of
Protein range 23 – 53 g/day
weight gain required
Chosen protein 53 g/day @ 3.0 g/kg BW @ 12% ER (King and Davis 2010)
King, C., and T. Davis. 2010. “Nutritional Treatment of Infants and Children with Faltering Growth.”
European Journal of Clinical Nutrition 64 (S1): S11–13. https://doi.org/10.1038/ejcn.2010.41.
19
5.2 NUTRITIONAL INTERVENTION
ADIME – INTERVENTION
Macronutrient requirement:
Carbohydrate Protein Fat
53% ER 53 g 35% ER
= (53/100) x 1770 kcal = 53 g x (4 kcal/g Protein) = (35/100) x 1770 kcal
= 938 kcal/ (4 kcal/g CHO) = 212 kcal/1770 kcal = 620 kcal/ (9 kcal/g Fat)
= 235 g = 12% ER = 69 g

Fluid & micronutrient requirement:

Fiber Calcium Vitamin D Fluid requirement
IOM, 2005 for RNI, 2017: RNI, 2017: Holliday MA and Segar WE 1957
9-10 y/o girls: 1000mg/day 15mcg/day First 10 kg = 1000 ml/day
26 g/day Next 10 kg = 50 ml/kg
50 ml/kg x (17.7 – 10 kg) = 100 ml/day
Total: 1000 ml + 100 ml = 1385 ml/day 20
 5.2 NUTRITIONAL INTERVENTION
ADIME – INTERVENTION
Objective Principals
Short- 1. To provide adequate 1. Educate on high caloric and high protein diet
term goals energy intake of 1770 ‒ Eat small and frequent, 6x/day
kcal/day @ 100 kcal/kg ‒ Emphasize on healthy balance meal (CHO, protein, fat and fiber)
BW and protein intake ‒ Suggest on recipe modification to increase calorie intake such as stir-fry
of 53 g/day @ 3.0 g/kg ingredients before making porridge/soup
BW ‒ Encourage fiber intake by adding vegetables in food and made fruit ice cream
2. To promote healthy homemade.
height and weight gain ‒ Add snack in pt’s meal time to increase calories intake
according to CDC ‒ Variety the protein sources in pt’s diet such as chicken, tofu, and egg
Growth Chart ‒ Encourage caregiver to cut protein sources in small sizes to enable pt to finish
protein sources.
Long-term 1. To maintain nutritional 2. Suggest on complete balanced formula such as Nutricia Milnutri Sure
goals status through healthy ‒ Suggest to alternate Dutch lady full cream milk (4/7) with Nutricia Milnutri Sure
balanced diet (3/7) with following regime:
2. To achieve ideal body Nutricia Milnutri Sure (6 scps) + H20 -→ 220cc, 1x/d
weight and height at Energy: 213 kcal/d @ 12% from ER
50th percentile Protein: 6g/d @ 11% from PR
according to WHO Strength: 1.0 kcal/ml
Growth Chart 3. Suggest on MCT oil
‒ Suggest to take 17 ml/day by adding it on fried rice or milk 21
 5.2 NUTRITIONAL INTERVENTION
ADIME – MENU PLANNING
Energy: 1770 kcal Carbohydrate: 235 g @ 53% ER Protein: 53 g @ 12% ER Fat: 69 g @ 35% ER

Food group Exc CHO Protein Fat Calorie

(g) (g) (g) (Kcal)
Nutricia Milnutri Sure 6 scps 25.8 5.5 9.5 213
Fruits 2 30 - - 120
Sugar 1 15 - - 60
Cereals 11 165 22 5.5 825
Vegetables FREE
Meat/Meat substitutes 3 - 21 12 195
Egg 1 0.5 7 6 84
Fat 7 - - 35 315
Total 236.3 55.5 68.0 1812
Total kcal 945 224 612 1781 (±31)
Percentage (%) 53 13 34 100
22
 5.2 NUTRITIONAL INTERVENTION
ADIME – MENU SUGGESTION (WEEKDAY 1)
Meal Time Menu Suggestion Food Group BF MT LN AT DN
BF • French toast (2 pcs white bread + 1 nos egg + ½ Nutricia Milnutri Sure* 1
7.00 am glass milk + chopped spinach)
Fruits 1 1
• Nutricia Milnutri Sure ( ½ glass)
Sugar 1
MT • Fried rice (2 ½ scps flat white rice + 1 small pcs
10.00 am chicken + chopped mustard leaves + carrot) Cereals 2 2½ 2 2 2½
• Teh O + Sugar (1 tbsp) Vegetables 1 1 1
LN • White bread (2 pcs + 1 tsp peanut butter + 1 pcs Meat/Meat substitutes 1 1 1
1.00 pm banana)
Egg 1
• Plain Water (1 glass)
Fat 2 2 1 2
AT • Pau ayam (1 nos)
4.00 pm • Plain water (1 glass) *Alternate with full cream milk

DN • Bihun goreng (2 ½ scps + 1 small pcs chicken +

8.00 pm chopped spinach + carrot)
• Orange juice (1 glass)
23
 5.2 NUTRITIONAL INTERVENTION
ADIME – MENU SUGGESTION (WEEKDAY 2)
Meal Time Menu Suggestion Food Group BF MT LN AT DN
BF • Nutricia Milnutri Sure (1 glass) Nutricia Milnutri Sure* 1
7.00 am • Cornflakes (1 cup)
MT • Nasi ayam (2 scp butter rice + 1 small pcs chicken) + Fruits 1 1
10.00 am Sup kosong (1 small cup) Sugar 1
• Plain water (1 glass)
Cereals 2 2½ 2 2 2½
LN • Sandwich (2 pcs white bread + 1 boiled egg + 1 tsp
1.00 pm mayonnaise + 1 tsp soft margarine + chopped salad) Vegetables 1
• Grapes (8 nos)
Meat/Meat substitutes 1 1 1
• Plain water (1 glass)
AT • Karipap ayam (2 pcs) Egg 1
4.00 pm • Plain water (1 glass) Fat 2 2 1 2
DN • White rice (2 scp flat)
*Alternate with full cream milk
8.00 pm • Homemade chicken ball (1 small pcs chicken +
Blended vegetables)
• Sup kosong (1 small bowl)
• Watermelon juice (1 glass) 24
 5.2 NUTRITIONAL INTERVENTION
ADIME – MENU SUGGESTION (WEEKEND 1)
Meal Time Menu Suggestion Food Group BF MT LN AT DN
BF • Pancakes (6 tbsp oats + 1 nos egg + 1 nos banana) + Nutricia Milnutri Sure* 1
7.00 am honey (1 tbs) + Soft margarine (1 tsp)
Fruits 1 1
• Nutricia Milnutri Sure (1 glass)
Sugar 1
MT • Apam (2 nos)
Cereals 2 2 2½ 2 2½
10.00 am • Plain water (1 glass)
Vegetables 1 1 1
LN • Fried rice (2 ½ scps flat white rice + 1 small pcs
Meat/Meat substitutes 1 1 1
12.00 pm chicken + chopped mustard leaves + carrot)
• Apple juice (1 glass) Egg 1

AT • Chicken nugget (2 pcs) Fat 2 2 2 1

4.00 pm • Plain water (1 glass) *Alternate with full cream milk
DN • Spaghetti with tomato sauce (1 ½ cup spaghetti + 1
7.00 pm small pcs chicken + blended vegetables)
• Plain water (1 glass)
25
5.3 NUTRITIONAL MONITORING & EVALUATION
ADIME – MONITORING & EVALUATION

Aspect Focus Goal

Anthropometry Monitor and re-assess changes in To achieve recommended height
height and weight and weight gain
Dietary Monitor pt’s dietary intake and To ensure that pt comply to the
compliance dietary modification have made

26
 6.0 DISCUSSION NUTRITIONAL
MANAGEMENT
FAILURE TO THRIVE ✓ Provide high caloric and
1st
VISIT PROBLEM
Height and weight below 3rd high protein diet (100
(1/4/2021) percentiles according to CDC kcal/kg BW and 3.0g/kg
growth chart BW)
✓ Suggest formula
CAUSED BY supplementation until
catch up growth is
OTHER FACTOR achieved (Nutricia Milnutri
Inadequate nutritional INADEQUATE CALORIC INTAKE
Sure)
knowledge of caregiver (Jeong, 2011; Cole & Lanham,
✓ Suggest MCT oil for caloric
(Jeong, 2011) 2011)
dense
✓ Increased in dietary fiber –
to reduce constipation
Goal of treatment: ✓ Sufficient fluid intake to
To achieve the greatest rate of meet hydration needs
weight and height gain (Jeong, 2011; Larson-Nath &
Biank, 2016) 27
 6.0 DISCUSSION
• Interventions in a child with FTT are aimed at optimizing growth through increased
caloric and protein provision (1) → can be increased by adding fats and oils to foods
and add protein in every meal time.
• Besides, formula supplementation has been suggested in FTT management until
catch-up growth is achieved → instructed on how to make energy-dense formula by
concentrating the ratio of formula to water (increased caloric provision) (2)
• In addition, MCT oil also was suggested → Improvement in the increase of body
mass and increase of the skin fold thickness in infants born with low body mass,
induced by MCT formula (3)
• An increased intake of fluids and fibers can help soften stools (4)
• This accelerated growth must be maintained for 4-9 months to resolve FTT and
achieve appropriate weight for height (5)
1. Larson-Nath, C., & Biank, V. F. (2016). Clinical review of failure to thrive in pediatric patients. Pediatric Annals, 45(2), e46–e49.
https://doi.org/10.3928/00904481-20160114-01
2. Cole, S. Z., & Lanham, J. S. (2011). Failure to thrive: An update. American Family Physician, 83(7), 829–834
3. Łoś-Rycharska, E., Kieraszewicz, Z., & Czerwionka-Szaflarska, M. (2016). Medium chain triglycerides (MCT) formulas in paediatric and allergological
practice. Przeglad Gastroenterologiczny, 11(4), 226–231. https://doi.org/10.5114/pg.2016.61374
4.
5.
28
Nurko, S., & Zimmerman, L. A. (2014). Evaluation and treatment of constipation in children and adolescents. American Family Physician, 90(2), 82–90.
Physician, A. F. (2016). Failure to Thrive : A Practical Guide.
 6.0 DISCUSSION
FCM VS FORMULA MILK
Full cream milk Milnutri Sure
2 scps (30g) 6 scps (45g)
Energy (kcal) 148 213
Carbohydrate (g) 11.6 25.8
Protein (g) 7.6 5.5
Fat (g) 7.8 9.5
Calcium (mg) 337 237
Price (RM) RM25.10/900 g; Last RM50/600 g; Last
30 days 13 days

Features of Dutch Lady Milk: Features of Milnutri Sure:

✓ Packed with protein for building muscles
and strong bodies
✓ More than 130mg Calcium per 100ml
✓ Zero added sugars for plain milk
✓ Is a source of Vitamins B2, B9, B12, & D
✓ Complete nutrition formula and high in calories
✓ Highest DHA 88mg/100g for brain nutrient
✓ Contain prebiotic (Inulin & ICFOS) to promote good
intestinal system
✓ Rich in calcium and vitamin D to help build strong bones
✓ Zero sucrose 29
6.0 DISCUSSION
FCM VS FORMULA MILK
• For 1 serving size, FCM had lower nutritional content such as energy,
carbohydrate and fat but high in protein and calcium when compared
with Milnutri Sure.
• Milnutri Sure was suggest to patient since it is complete balanced
catch-up growth formula which suitable for child who are faltering in
growth.
• However, since caregiver may face financial constraints, alternate FCM
(4/7) and Milnutri Sure (3/7) was suggested to reduce the dependent
towards Milnutri Sure.
• By suggesting this method, Milnutri Sure can last up to 1 months
instead of 13 days.

30
6.0 DISCUSSION
MCT OIL
✓ MCT oil are more readily hydrolyzed and absorbed than
long-chain fats hence provides instant energy
✓ MCT oil are absorbed directly into the portal circulation
and do not require bile salts for emulsification→ makes it
a good source of calories in the setting of malabsorption
✓ MCT feeding improves the nature and number of stools
and the amount of flatus passed → improved
constipation
✓ Improvement in the increase of body mass and increase
of the skin fold thickness in infants born with low body
mass, induced by MCT formula

Łoś-Rycharska, E., Kieraszewicz, Z., & Czerwionka-Szaflarska, M. (2016). Medium chain triglycerides (MCT) formulas in paediatric and
allergological practice. Przeglad Gastroenterologiczny, 11(4), 226–231. https://doi.org/10.5114/pg.2016.61374 31
7.0 CONCLUSION
• FTT is a common but potentially serious growth problem
requiring early recognition to avoid possible long-term morbidity.
• During periods of catch up growth, it is important to provide
adequate caloric and protein intake for accelerated growth.
• Long term good nutrition to prevent malnutrition or overnutrition is
required for patient to grow and develop normally

32
 8.0 REFERENCES
• King, C., & Davis, T. (2010). Nutritional treatment of infants and children with faltering growth. European Journal of
Clinical Nutrition, 64(S1), S11–S13. https://doi.org/10.1038/ejcn.2010.41
• Cole, S. Z., & Lanham, J. S. (2011). Failure to thrive: An update. American Family Physician, 83(7), 829–834.
• Jeong, S. J. (2011). Nutritional approach to failure to thrive. Korean Journal of Pediatrics, 54(7), 277–281.
https://doi.org/10.3345/kjp.2011.54.7.277
• Larson-Nath, C., & Biank, V. F. (2016). Clinical review of failure to thrive in pediatric patients. Pediatric Annals,
45(2), e46–e49. https://doi.org/10.3928/00904481-20160114-01
• Łoś-Rycharska, E., Kieraszewicz, Z., & Czerwionka-Szaflarska, M. (2016). Medium chain triglycerides (MCT) formulas
in paediatric and allergological practice. Przeglad Gastroenterologiczny, 11(4), 226–231.
https://doi.org/10.5114/pg.2016.61374
• Nurko, S., & Zimmerman, L. A. (2014). Evaluation and treatment of constipation in children and adolescents.
American Family Physician, 90(2), 82–90.
• Physician, A. F. (2016). Failure to Thrive : A Practical Guide.
• Zeitlin, S. R., Bond, S., Wootton, S., Gregson, R. K., & Radford, M. (1992). Increased resting energy expenditure in
childhood asthma: Does this contribute towards growth failure?
• Mey, J. T., Matuska, B., Peterson, L., Wyszynski, P., Koo, M., Sharp, J., … Mulya, A. (2021). Resting energy
expenditure is elevated in asthma. Nutrients, 13(4), 1–17. https://doi.org/10.3390/nu13041065 33
THANK YOU!
34