FTT and Projectile Vomiting in Children

• FTT stands for Failure to Thrive.
• Projectile vomiting is forceful expulsion of stomach contents.
• The priority intervention is to prepare parents that the child will need surgery.
• This combination of symptoms (FTT and projectile vomiting) in a child strongly suggests a condition requiring surgical intervention.
• Parent education and preparation are key aspects of care.

Failure to Thrive (FTT)

• FTT is a condition where infants or children do not gain weight or grow as expected.
• It can result from inadequate caloric intake, inadequate absorption, or excessive caloric expenditure.
• FTT is defined as weight less than the 5th percentile for age, or weight for length less than the 5th percentile, or a decrease of two major percentile lines on a growth chart.
• FTT is not a diagnosis itself, but a sign of an underlying problem.
• Possible causes for FTT include medical conditions, environmental factors, and/or behavioral issues.

Projectile Vomiting

• Projectile vomiting is the forceful expulsion of stomach contents, often travelling a significant distance.
• It differs from normal regurgitation or spitting up.
• Projectile vomiting can be a symptom of various gastrointestinal disorders.
• In infants, a common cause of projectile vomiting along with FTT is pyloric stenosis.
• Other potential causes include increased intracranial pressure or gastroesophageal reflux.

Pyloric Stenosis

• Pyloric stenosis is a condition in infants where the pylorus (the muscular valve between the stomach and the small intestine) thickens.
• The thickening narrows the pyloric channel, obstructing the flow of stomach contents into the small intestine.
• Pyloric stenosis typically presents between 2 and 12 weeks of age.
• Key signs include projectile vomiting, often described as non-bilious (lacking bile).
• Infants with pyloric stenosis typically exhibit "hungry vomiting," meaning they are eager to feed again shortly after vomiting.
• Palpation of an "olive-shaped" mass in the abdomen may be possible.
• Diagnostic confirmation is usually obtained through ultrasound.
• The primary treatment for pyloric stenosis is surgical correction via pyloromyotomy.
• Pyloromyotomy involves incising the thickened pyloric muscle to widen the channel.

Implications for Failure to Thrive

• Projectile vomiting can lead to FTT due to the loss of nutrients and calories.
• The underlying cause of the vomiting must be identified and addressed to resolve the FTT.
• In some cases, FTT may be the primary presenting symptom that leads to the discovery of the vomiting.

Surgical Intervention

• In the context of FTT and projectile vomiting, surgical intervention is often needed to correct the underlying cause like pyloric stenosis.
• The specific type of surgery depends on the underlying condition.
• For pyloric stenosis, pyloromyotomy is the standard surgical treatment.
• Preparation for surgery includes ensuring the infant is adequately hydrated and electrolyte imbalances are corrected.

Pre-operative and Post-operative Care

• Pre-operative care may include placement of a nasogastric (NG) tube to decompress the stomach.
• Post-operative care focuses on gradual reintroduction of feeding and monitoring for complications.
• Parents should be educated about the surgical procedure, expected outcomes, and potential complications.
• Assess the infant's pain and administer analgesics as prescribed.
• Monitor the surgical site for signs of infection.

Parent Education

• Parents should be informed about the diagnosis and the need for surgery.
• Explaining the surgical procedure and expected outcomes is crucial to alleviate anxiety.
• Parents should receive instructions on pre-operative and post-operative care.
• Education on feeding techniques and monitoring for complications is also essential.
• Providing emotional support to the parents is important, as they may be anxious and worried about their child's health.