Tasks of the age

By age 18 to 21, which is the late adolescence, conflicts between adolescents and their parents are beginning to subside. The major tasks during this period of late adolescence are choosing a career direction and developing more meaningful and lasting emotional relationships.

A few years ago, the general expectation was that older teens would be preparing to go off to college or take a job that would allow them to live independently. Adolescents who chose college then graduate school might stretch their late adolescence years well into their late twenties or early thirties.

More recently, many older teens have either chosen or felt compelled to continue living in their parents; homes. As society and the economy continue to change, the challenges of late adolescence will change, too.

Idealism and innovation

With increased knowledge and independence comes the desire to improve the world, find new methods that will supersede the old, make discoveries, create new art forms, displace tyrants, and right wrongs. A surprising number of scientific advances have been made and masterpieces of art created by individuals on the threshold of adulthood.

They were no smarter than the older people in their fields, and they were certainly less experienced. But they were critical of traditional ways, biased in favor of the new and untried, and willing to take risks. That was enough to do the trick. This is often how the world makes progress.

Finding their way in late adolescence

It sometimes takes youths 5 to 10 years to find their own positive identity. Meanwhile, they may be stalled at a halfway stage, characterized by passive resistance to and withdrawal from mainstream society (which they equate with their parents) or by excessively rebellious radicalism.

They may decline to take an ordinary job as their parents may have done; instead, they adopt unconventional dress, grooming, acquaintances, and residence. To them, these decisions seem like evidence of vigorous independence. But by themselves, these things don’t yet add up to a positive stand on life or a constructive contribution to the world. They are essentially a negative protest against their parents; conventions.

Even when the striving to be independent shows up only in the form of eccentricities of appearance, it should be recognized as an attempted step in the right direction, one that may later lead to a constructive, creative stage. As a matter-of-fact, the young people in their late adolescence who strain so visibly to be free are apt to come from families with unusually strong ties and high ideals.

Other youths, idealistic and altruistic in character, often take a sternly radical or purist view of things for a number of years—in politics, the arts, or other fields. Various tendencies of this age period operate together to draw them into these extreme positions: heightened criticalness, cynicism about hypocrisy, intolerance of compromise, courage, and a willingness to sacrifice in the response to their first awareness of the shocking injustices of the society they live in.

A few years later, having achieved a satisfactory degree of emotional independence from their parents and having found out how to be useful in their chosen field, the individuals in their late adolescence are more tolerant of the frailties of their fellow human beings and readier to make constructive compromises. It’s not that they become complacent conservatives. Many remain progressive, some remain radical. But most become easier to live and work with.

At 15 to 17, middle adolescence have two important tasks. First, they must come to terms with their sexuality and the conflicting emotions aroused as they begin romantic encounters. Second, they must separate emotionally from their parents and find that they can function independently. As a part of this process, the dependence-independence struggles often intensity.

Children in their middle adolescence often complain that their parents don’t allow them enough freedom. It’s natural for children approaching adulthood to insist on their rights, and their parents may need to be reminded that their children are changing. But parents don’t have to take every complaint at face value.

Children in middle adolescence are eager to grow up

At the same time, children in their middle adolescence are afraid of growing up. They are unsure of their capacity to be as knowledgeable, masterful, sophisticated, and charming as they would like to be, but their pride won’t allow them to recognize this doubt.

When they unconsciously doubt their ability to carry off some challenge or adventure, they’re quick to find evidence that it is their parents who are blocking their way, not their own fears. They reproach their parents indignantly or blame them when talking with friends.

You should suspect this unconscious maneuver when your teen suddenly announces a plan for some escapade that is way beyond anything he’s done before. For example, he and some friends—boys and girls—plan to go camping for a weekend without parents.

Teens in their middle adolescence who come up with such schemes may be looking for clear rules and consistency; indeed, they may be asking to be stopped. They are also on the lookout for evidence of hypocrisy in their parents. To the extent that their parents are obviously sincere about their rules and ideals, their children feel obligated to continue to adhere to them.

But if they can uncover hypocrisy in their parents, this relieves them of the moral duty to conform and offers a welcome opportunity to reproach their parents. At the same time, it may undermine their sense of safety.

Jobs and work

Middle adolescence is when many teens first take on serious jobs, beside the occasional babysitting or yard work. In moderation, paid work can build self-esteem, responsibility, and independence. Work also allows teens to widen their social contacts and explore fields that may eventually lead to careers.

Many teens, however, spend so much time on the job that they don’t have time to socialize or do homework and are chronically overtired and cranky. It’s also important to be aware that many jobs carry significant health and safety risks. Patents may need to step in to keep work from getting out of hand.

Sexual experimentation in middle adolescence

Middle adolescence is when many teens experiment with sex or various sorts. Kissing and petting are almost universal; oral-genital sex happens frequently (many teens don’t think of this as real sex); and many experience sexual intercourse. In a large survey from 1983, 55 to 75 percent of 19-year-olds reported that they were non-virgins. Middle teens often date in groups, though some also date one on one.

Romances are often brief, with relationships taking a back seat to attraction and experimentation. This is not to say that all middle-adolescent romances are superficial or of no consequence. The emotions—both joy and misery, elation and dejection—often have an intensity rarely rivaled in later, more settled periods of life.

Realistically, parents are limited in their ability to control their middle adolescence sexual behavior. Educational programs stressing abstinence as the only choice have obvious appeal but have not been shown to reduce teen pregnancy. If teens are intent on sexual experimentation, the rules laid down by parents may not stop them; they may even make the sex seem more exciting and attractive, because it is off limits.

A more effective strategy in dealing with middle adolescence may be for parents to keep communication open, let their children know how they feel about premarital sex, limit opportunities for inappropriate sexual behavior (for ex., no unchaperoned sleepovers), and trust their teens to act responsibility.

Many parents have a hard time talking with their teens about sex. Fortunately, doctors and nurse practitioners are often well trained in having these discussions and can help parents communicate their feelings and concerns in a positive, effective manner.

Homosexuality in middle adolescence

Adolescence is a complex time for any youngster. The pressure of school activities and dating can create a powerful sense of exclusion or differentness in gay and lesbian teens, which may trouble them or make them unhappy. If you think your child is struggling with issues of sexual identity, it’s very important to let him or her feel that there is a place to turn to for help. Sadly, statistics show that a high percentage of teenage suicides and attempted suicides are related to issues of sexual identity.

Heterosexual parents may not know how to begin talking to a teenager about sexual orientation. Remember, it’s likely that your child is as afraid of the subject as you are and may feel threatened if abruptly confronted. To start with, try to make the subject of sexual orientation something that the family can casually discuss.

Introduce books, videos, and music into the family collections that are created by openly gay, lesbian, or bisexual artists or that deal with those themes. (Actually, it’s wise to talk openly about these issues starting from the elementary or middle school years). It’s important to be aware of and critical of homophobia. It’s no help to a gay or lesbian teenager to hear his or her family members tell insulting jokes or tolerate prejudiced comments made by friends or relatives.

For some adolescents who in their middle adolescence, their sexual orientation becomes clear to them quickly, and they embrace it as a strong identity. Other teenagers may go through a phase of experimentation before settling on an identity they feel most comfortable with. Teenagers shouldn’t be pressured into assuming a gay or lesbian identity before they are ready.

If a teenager expresses a sense of alienation, isolation, or deep confusion about his or her sexual orientation, parents should arrange for professional counseling—not to change their teen’s orientation but to help the boy or girl deal with any shame or anxiety that might undermine his or her self-esteem.

The greatest gift a parent can give a child is a sense of pride and dignity. For a gay or lesbian teen, having access to positive role models and the ability to deal with sexual diversity frankly and honestly will go a long way toward building self-esteem.

If you’re raising a gay or lesbian adolescent who is in his or her middle adolescence, you may want to seek support for yourself as well. Organizations such as Parents and Friends of Lesbians and Gays, which has chapters across the country, provide information and advice and hold events.

Most cities and large towns have gay and lesbian switchboards or hot lines that can provide useful information, and gay and lesbian community centers have outreach programs for gay and lesbian youths and their parents. These facilities are listed in the classified telephone directory under “Gay and Lesbians” or “Social and Human Services.”

She will instead hold them and scribble to make beautiful pictures. The 16 month old baby learns to play simple games and may spend most of her time in it. She would love to play games like naming parts of the body, peek-a-boo etc as this is interesting for her at this age.

The child is also developing her memory skills. Earlier, the kid had poor memory where she could not remember the instructions given. Now the child will be able to recollect and remember things which even an adult might not remember on that instance.

The kid has definitely learned what the object is used for; however, they are still unaware about the depth of the stairs or maintaining balance while running. The baby might trip over the stairs or may even trip on his own feet while running. This stage will give a lot of trouble to child in form of grazes, cuts and bumps. Hence, it is advisable to keep the first aid box handy.

Life is just not changing for the parents but also the 16 month old baby. The kid is excited and enthusiastic about the changes and challenges around him. He will respond to them with more excitement or sometime may even try to pass the phase by screaming and crying.

Do not stop the baby as this might be a terrible phase for him. The parents have to be more patient with the 16 month baby and have to make sure their presence is felt by the child. The child may need to be with you for comfort or may be just for motivation. The parents have to help the child with what he needs and let the baby get over it himself.

Parents have to take special care of the baby’s teeth. These teeth have to last until the child has permanent teeth. The teeth which come in this age will stay for a longer period. The baby will still not be able to brush his teeth himself and the parents have to make sure they are maintained to make sure they last longer.

The 16 month old baby chooses a lot from the books, pictures, magazines, video CD’s etc. The parents can either show the kid a lot of cartoon stories or picture books that will help him pick up on few things that he might learn by self. The baby will also try to impress the parents by lifting heavy objects or something he cannot do.

The child is very adamant about trying to get appreciation and the parents can encourage the kid by appreciating and applauding so that the child learns to try and succeed with his own motivation.

The child is growing quickly. The baby is walking now and also does a little bit of talking. She will also start using fork and spoon to eat. The growth happens physically and mentally.

The kid will now be able to point fingers at the body parts when asked and will start pointing fingers to tell the parents what she wants. The baby will also learn to place the objects back in place where she picked it from. She will learn to place the objects in containers and remove them out.

The parents will now be able to understand the behavior of the 15 month old baby. The child now starts responding to people and places as per her likes and dislikes. He either mixes up with people easily which shows the adaptive nature of the child might just want to be alone and play alone.

She may also shy away from people, showing that she is not comfortable with lot of people around. The parents can learn the temperament of the 15 month kid this way and understand what she needs. During this period the baby will be dependent on the mother for comfort and she will also try to develop herself.

The food pattern changes for the 15 month old baby. He might be eating everything that is served or may become a choosy eater. If the kid is choosy about what she eats, then the parents might have to worry a bit as the child will not be eating enough food required to maintain a balance diet. The parents can consult the doctor and get a list of balanced diet for the child and serve it as per the child’s requirement.

Traveling is something the 15 month old baby does not prefer at any cost. Hence, the parents have to make sure they carry all the necessary food and toys so that the child does not get disturbed.

In this period, the kid needs to sleep for at least 14 hours during the day. The kid should sleep for minimum 11 and half hours and rest of the 2 and half hours should be covered during the daytime. It is important that the parents make sure the child gets enough sleep to keep him active during the time he is awake.

The 15 month old baby should be given the D-Tap vaccine for immunization. There are few other vaccines as well that needs to be given. Parents can consult the doctor to get a list or a schedule for the vaccines to be given to the child.

The 13 month old baby might take support as well, but it is important he takes the moves by self and not being dependent or waiting for someone to pick her up or push her to move forward. The steps she might take may be unsteady and the parents can encourage the child to walk more.

The 13 old kid achieves a lot during this period. She will be more curious and anxious about everything around her. She will try to explore the world by trying to peek into every single thing. She will move in places where she thinks she wants to find something. The baby will be more curious to know what is in the drawers and what is lying below the table. It’s interesting to watch the little one stand on toes to reach for something which is higher than her hands can reach.

Grasping skills also develop in the 13 month old baby. He will now be able to hold blocks and also understand if she has to place it somewhere or drop it in any container. Some babies also learn to scribble; this shows the development of the grasping skills. You will also notice the child using spoon; however they are not successful yet.

You will notice a change in the eating pattern. During the first year, the baby tends to eat more and puts on more weight. You will also notice an increase of 10 inches in height during the first year. During this period, the child is slow on growing and eats very less food. This is mainly because he starts loosing fat. The 13 month old will eat food she likes and may avoid the food she dislikes and this way the appetite decreases.

This is the right time for the parents to choose the language and words for the 13 month old baby. He has already learned few words and has learned to express her thoughts by actions and by few selective words.

During this time, the baby will learn the language spoken at home and if the parents speak in two languages together the baby will be confused. If the mother speaks one language and the father another, He will learn the same and communicate in the same language.

The parents have to get immunization vaccines for the child. When the baby is 13 month old, she has to be given immunization vaccines for measles, mumps, rubella etc. You can consult the doctor for the list of vaccines.

Parents can now be ready with their camera to shoot the little things that their kid does. The baby will now take her first steps on her own without any support. Some babies might take some more time before they can start walking by self. However, most of the babies take their first steps in this age.

The 12 month old baby will learn to feed herself. She will start helping herself using the spoon and bowl. He also develops the grasping skills and will learn to pick objects using the forefinger and thumb. This can be improved in the baby by helping her with different activities involving toys.

The 12 month old baby still finds crawling easier and would prefer to crawl than to walk. The baby discovers her strength and stamina and believes she can help herself with many more activities.

As per psychologists, the child has a developed brain which can relate the past to present. She will start differentiating the objects based on the color, shape and appearance. She will start giving preferences to the objects she likes.

The 12 month old kid will be more active than any other age as she will be exploring all the objects that come her way. She will try to examine and probe the objects she finds. She will also be able to remember the events and instructions for a longer period and will also learn to solve problems using the trial and error method.

He will now blabber sentences. They will try to make sense out of the words they construct and this might sound an alien language. The baby will be able to respond to simple questions. He also understands and judges her answer by the expression parents give before the baby replies.

It is the right time to teach the 12 month old some discipline and manners. This can be done by helping the child with simple instructions. The baby will also learn to connect with the objects with the help of names and colors.

The 12 month old baby will also have issues with her sleeping. He is too much into playing during this time and this may stand as a hurdle in her sleep. The parents have to spend some extra time on making sure the child gets proper sleep.

Another reason the baby might sleep is because of teething. Parents can consult the doctor to overcome the teething problem. The kid might have issues with the food and this is one of the negativities in this age. He refuses to eat same food each day and she may also insist and demand on self feeding.

Earlier, the parents had to take care of every single thing and now the child helps the mother. The 11 month old baby will help the mother by holding her arm and leg out while getting dressed. The kid will also be able to hold the cup or bottle with both the hands without any problems. However, the kid has to be still fed with hand.

To grab attention, the 11 month old baby might start dropping objects for others to pick it up and start talking to her. The baby’s brain develops and they will be able to use more clear words and during this time, the parents can encourage by responding to the words used by the child. The memory can be increased by helping him play games like peek-a-boo and pat-ta-cake.

The 11 month old will now love to learn through pictures. The parents should get more books with pictures and read it to the child. This way the kid will learn gestures. The baby will try to understand more with the help of pictures and try to clear her doubts by looking at the pictures again and again. She will also have favorite book that she wants to have a look at.

The baby now starts securing herself. She will start engaging herself with her siblings. She might not play with them, but she will be playing around the same place where the siblings are. She will have a favorite blanket, toy etc and that will make her feel that she has security.

It is now time to set limits for the 11 month old baby. He has to be give strict instructions on what is harmful and what the child needs to avoid. He might sometimes forget the instruction, but being a little more stern with the child will make her cautious. The parents can be stern by giving her strict looks and by saying no again and again. It might not be easy for the parent; however, this is the correct age to start setting boundaries for the child.

The child can now be given foods like lactogen and nestle. Lactogen is more preferred by most of the parents. It is also advised that the parents should consult the doctors for the diet chart to help with the appropriate nutrients needed by the child.

The 11 month old baby takes two naps in this age. He sleeps for 2 to two and half hours during the day and takes a nap of 12 hours during the night. He sleeps throughout the night without any feed. It is advisable that the baby should be fed once during the night to have longer hours of sleep.

Changing bodies and minds

From twelve to about fourteen, the main psychological challenge is to come to terms with rapidly changing bodies—one’s own and one’s peers’. These years also see the widest variations in physical development.

early-adolescence

The average girl is nearly two years ahead of the average boy in development—towering over him in height and more sophisticated in her interests. She, in her early adolescence, may be interested in going to dances and being treated as if she were glamorous while he is still an uncivilized little boy who thinks it shameful to pay attention to her. During this whole period it may better for social functions to include different age groups for a better fit.

Children in their early adolescence are acutely self-conscious about their bodies. They may exaggerate and worry about defects and they often believe that everyone else is focused on their bodies, too. If a girl has freckles, she may think they make her look horrible. A slight peculiarity in the body or how it functions can easily convince an adolescent that he is abnormal.

Those who are in their early adolescence may not be able to manage their new bodies with as much coordination as previously, and the same is true of their new feelings. They are apt to be touchy and easily hurt when criticized. At one moment, they feel like grown-ups and want to be treated as such. The next moment, they feel like children again and expect to be cared for.

Friendships

Individuals in their early adolescence often feel ashamed of their parents for a few years, particularly when their friends are present. This is partly related to their anxious search for their own identities, and it partly reflects the extreme self-consciousness of the age period. They have an intense need to be just like their friends and to be totally accepted by them. They fear that they might face ridicule and rejection by their friends if their parents deviate in any way from the neighborhood pattern.

In trying to establish their identity, individuals in their early adolescence often turn away from their parents, a move that threatens to leave them feeling alone. To counter this they often make intimate ties with friends of the same age, more often at first ties to those of the same sex. Close friendships support the one in early adolescence during a period when she gives up her identity as her parents’ child and before she finds her own.

Sometimes a teen finds himself through finding something similar in his friend. He mentions that he loves a certain song, hates a certain teacher, or craves a certain article of clothing. His friend exclaims with amazement that he has always felt the very same way. Both are delighted and reassured. Each has lost a degree of his feeling of aloneness and peculiarity and gained a pleasurable sense of belonging.

As another example, two girls may talk constantly all the way home from school, talk for another half hour in front of the home of one of them, then finally reluctantly separate. As soon as the other reaches her home, she telephones her friend, and they resume the mutual confidences.

The importance of appearance

Many who are in their early adolescence help to overcome their feelings of aloneness by slavishly conforming to the styles of their classmates—in clothes, hairdos, language, reading matter, songs, entertainers. These styles have to be different from those of their parents’ generation. And if they irritate or shock their parents, so much the better.

It is revealing, though, that even those youths who adopt an extreme style to differentiate themselves from their parents will still conform to the style of at least a few of their friends or perhaps of some idolized figure, such as a rock star.

Parents can be most helpful to their children who are in early adolescence by trying to understand their behavior then helping them to understand themselves. If you explain why you object to certain styles, you may be able to persuade your children to change without your having to issue an “or else” order. Or, the teenager who feels free to discuss and argue with her parents may end up persuading them to accept her point of view.

Adults tend to be slower than youths in accepting new styles. What may horrify or disgust us one day may later become as acceptable to us as to our children. This was true with the long-hair styles and dungarees introduced by youths in the 1960s, the pants for girls that so upset school authorities at one time, and even fluorescent hair colors.

Early teen sexuality

Most early teens fantasize about sex, and many experiment with kissing and petting. A minority of those in their early adolescence experience actual intercourse. Masturbation is nearly universal, and depending on family religious teachings, it may bring with it varying degrees of guilt or shame.

Erections, either spontaneous or in response to sexual fantasies, make many boys who are already quite self-conscious even more uncomfortable. Most boys also experience ejaculation of semen during sleep (wet dreams). One boy takes these in stride; another worries there might be something wrong with him.

Sexual feelings and experimentation are not always directed towards the opposite sex. The issue of homosexuality is often confusing and frightening to both teens and parents. Individual who are in early adolescence tend to be intolerant of anything that suggests homosexuality.

The intensity of this homophobia probably has to do with secret fears in some teens that they might themselves be homosexual. It’s not unusual for teens in their early adolescence to engage in same-sex genital touching, then worry that they are gay. Some will indeed go on to develop a primarily homosexual orientation; others will not.

Given the strong antigay bias in mainstream American culture, it’s difficult for teens to show affection for same-sex friends, let alone talk about sexual feelings that might hint at homosexuality. A sensitive doctor or nurse practitioner can sometimes provide information and reassurance.

One reason why every early adolescence teen should have a chance to talk confidentiality with their doctor without a parent present is so much sensitive conversations can take place. Homosexual adolescents face special stresses and need special support.

Tips for teens in their early adolescence

The team: Child guidance is a team-work comprising of psychiatrist, clinical psychologist, educational psychologist, psychiatric social worker, pediatrician, public health nurses, speech therapist, occupational therapist and a neurologist.

The psychiatrist is the most important member of the team who, with others, arrives at a diagnosis and formulates the management plan. Pediatrician’s role is important in identification of problem, exclusion and treatment of physical causes as well as timely referral to the child guidance clinic.

Target problems: The individual problems attended in Child Guidance Clinic usually include mental retardation, learning disorders, habit disorders, personality disorders, psychosomatic disorders, antisocial behavior and established psychiatric disorders like autism and Attention deficit hyperactivity disorder.

Activities: Important functions of Child Guidance Clinic include —

a) Evaluation of new cases

b) Periodic follow-up of old cases

c) Comprehensive therapy

d) Parental counseling for home management

e) Training of medical and paramedical workers

f) Propagation of research.

Common therapeutic interventions in these clinics are —

a) Psychotherapy, which may be administered individually or in groups, to the child a well as parents;

b) Drug therapy as an adjuvant to other forms of therapy,

c) Creative & play activities to develop alternative areas of performance like clay/sand molding, painting etc.,

e) Speech therapy, and

f) Family therapy, Transactional analysis, Gestalt therapy, relaxation methods and hypnosis are also used in selected cases.

1. Lack of growth i.e. weight < 3 percentile,
2. Sustained weight loss
3. Reduced growth velocity i.e. weight dropping at least two major percentiles below the previous values (e.g. from 75Lh to percentile).

Although weight is a defining criteria, other parameters of growth like height, are frequently affected.

Etiologically it may be due to non-organic or organic causes.

Non-organic is more common up to 80%, usually seen in under-5 children due to nutritional or emotional deprivation.

Organic Failure to thrive may develop at any age due to identifiable causes e.g. —

• Decreased food intake despite availability e.g. mechanical or neuro muscular problems in sucking, eating or swallowing,
• Impaired digestion/absorption of nutrients,
• Increased metabolic requirements e.g. chronic diseases or infections, and
• Increased losses of ingested food e.g. chronic diarrhea or vomiting.

Clinically these children present with —

• Malnutrition e.g. growth failure, anemia, vitamin and mineral deficiencies.
• Behavioral changes e.g. apathy, social withdrawal, poor eye contact response to cuddling.
• Developmental retardation
• Recurrent/persistent infections
• Signs of primary disease e.g. chronic infections, illnesses, emotional deprivation etc.

Diagnostic approach in Failure to thrive may be divided into three steps i.e. —

• preliminary clinical evaluation and investigations
• evaluation of response to the trial feeding and
• revaluation with more exhaustive investigations in cases, refractory to trial feeding.

Step 1: Preliminary evaluation which includes —

a) Detailed history, specially related to dietary intake, preceding infections like diarrhea etc., child abuse/ neglect and developmental history. Available case records like growth charts should be reviewed to estimate the age of onset for Failure to thrive.

b) Physical examination, specially related to anthropometric values and signs of malnutrition, vitamin/mineral deficiencies, systemic infections/ illnesses and abuse/neglect etc.

c) Baseline investigations to exclude common causes i.e.

• Complete hemogram for anemia, infections etc.
• Urine analysis for UTI, chronic renal disease etc.
• Stool analysis for malabsorption, worms etc.
• X-ray chest and Tuberculin test for TB.
• Skeletal survey to assess bone age.

Step 2: Trial feeding: Although many cases may be managed at home with nutritional counseling and periodic followup, hospitalization is indicated in cases with:

• Severe under nutrition with weight < 60%
• Suspected child abuse/neglect
• Suspected organic disease
• Doubtful dietary intake.

In hospital, all cases should receive trial feeding i.e. supervised, unlimited high caloric diet (150-200 call kg/day) for a minimum of 14 days, if necessary by nasogastric tube, along with daily weight record.

A weight gain of 50 gm/day from 45th day onward and sustained for at least a week is considered as satisfactory, suggestive of non-organic etiology. Absence of satisfactory weight gain on trial feeding indicates organic Failure to thrive.

Step 3: Re-valuation with detailed investigations is indicated in non-responsive cases to trial feeding and include —

• Biochemical investigations e.g. Blood sugar, Serum proteins, liver/renal function tests, screening tests for renal tubular acidosis/aminoaciduria.
• Endocrinal studies e.g. Thyroid function tests, growth hormone assays including somatomedin C levels, cortisol levels etc.
• Genetic studies for inborn errors of metabolism, including molecular studies and enzyme assays in selected cases.

Management of Failure to thrive targets not only to nutritional rehabilitation but also to resumption of appropriate emotional environment & treatment of the underlying organic cause. In most cases, A multi-disciplinary approach is required which includes —

• Nutritional therapy with increasing volume, frequency and caloric density of meals, avoidance of low-caloric foods and dietary supplementation.
• Psychological support and modification of home environment.
• Treatment of underlying cause & associated problems e.g. vitamin deficiencies, anemia etc. All children should be immunized to their age-appropriate level.
• Parental counseling regarding correct nutritional and hygienic practices.
• Periodic growth monitoring and regular follow-up after discharge, as Failure to thrive frequently recurs due to persistence of etiological factors.

Prognosis: Although initial catch-up growth is excellent in most of the adequately treated cases, it tends to slow down over time and recurrence of Failure to thrive is not uncommon. Long-standing Failure to thrive in early life may lead to persistent development problems like cognitive, behavioral and language disorders, as more than 90% of brain growth completes in infancy.