Infant failure to thrive
Failure to Thrive | Johns Hopkins Medicine
Failure to Thrive | Johns Hopkins MedicineWhat is failure to thrive?
Children are diagnosed with failure to thrive when their weight or rate of weight gain is significantly below that of other children of similar age and sex. Infants or children that fail to thrive seem to be dramatically smaller or shorter than other children the same age. Teenagers may have short stature or appear to lack the usual changes that occur at puberty. However, there is a wide variation in what is considered normal growth and development.
Symptoms
In general, the rate of change in weight and height may be more important than the actual measurements.
Infants or children who fail to thrive have a height, weight and head circumference that do not match standard growth charts. The person's weight falls lower than the third percentile (as outlined in standard growth charts) or 20 percent below the ideal weight for their height. Growing may have slowed or stopped after a previously established growth curve.
The following are delayed or slow to develop:
Physical skills, such as rolling over, sitting, standing and walking
Mental and social skills
Secondary sexual characteristics (delayed in adolescents)
Diagnosis
It is important to determine whether failure to thrive results from medical problems or factors in the environment, such as abuse or neglect.
There are multiple medical causes of failure to thrive. These include:
Chromosome abnormalities, such as Down syndrome and Turner syndrome
Defects in major organ systems
Problems with the endocrine system, such as thyroid hormone deficiency, growth hormone deficiency or other hormone deficiencies
Damage to the brain or central nervous system, which may cause feeding difficulties in an infant
Heart or lung problems, which can affect how oxygen and nutrients move through the body
Anemia or other blood disorders
Gastrointestinal problems that result in malabsorption or a lack of digestive enzymes
Long-term gastroenteritis and gastroesophageal reflux (usually temporary)
Cerebral palsy
Long-term (chronic) infections
Metabolic disorders
Complications of pregnancy and low birth weight
Other factors that may lead to failure to thrive:
Emotional deprivation as a result of parental withdrawal, rejection or hostility
Economic problems that affect nutrition, living conditions and parental attitudes
Exposure to infections, parasites or toxins
Poor eating habits, such as eating in front of the television and not having formal meal times
Many times the cause cannot be determined.
Treatment
The treatment depends on the cause of the delayed growth and development. Delayed growth due to nutritional factors can be resolved by educating the parents to provide a well-balanced diet.
If psychosocial factors are involved, treatment should include improving the family dynamics and living conditions. Parental attitudes and behavior may contribute to a child's problems and need to be examined. In many cases, a child may need to be hospitalized initially to focus on implementation of a comprehensive medical, behavioral and psychosocial treatment plan.
Do not give your child dietary supplements without consulting your physician first.
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Symptoms, What to Expect & Ways to Help
Failure to Thrive (FTT) describes an infant or child who does not gain weight at the expected rate. The two kinds of FTT are organic and non-organic. Medical problems such as diarrhea or vomiting that continue may be the cause of organic FTT. If your child has organic FTT, it could be that he or she is not able to take in nutrients from food or formula. Tests will be done to see if there is a medical problem. Sometimes Failure to Thrive has no medical cause and is called non-organic FTT. Infants with non-organic FTT usually begin to gain weight when changes are made in the way the baby is fed, cared for and nurtured.
Symptoms of Failure to Thrive
Your baby may have some of these symptoms:
- Poor sucking (does not feed well)
- Hard to feed
- Vomiting or diarrhea
- Sleeps too much or not enough
- Fussiness
- Weak cry
- Loses weight or does not gain enough weight
- Stiff or "floppy" muscles
- Slow in growth and development
- May not show interest in things around him
- Does not move around much
- Does not make eye contact when being held
If Your Child Is in the Hospital
Please stay with your child and help in his or her care. It is important for you to be with your child during this time. You can help with care and feeding and play with and talk to your baby (Picture 1). The doctor may need to do more tests to find a medical cause for FTT. These tests may include stool samples and blood tests.
While your child is in the hospital, nurses will keep track of:
- How often and how much your child eats at each feeding
- How much urine, stool and vomiting he may have
- Your child’s weight every morning before the first feeding (without clothes or diaper)
- Your child’s behavior
- How he gets along with caregivers
The dietitian (a person who is trained to give advice about what to eat) will look at the food or liquid your child eats or drinks each day. It is important to know how many calories your child is getting. A feeding schedule may be set up so your child can gain enough weight.
A social worker may visit with you and help to get formula or help to solve other problems. An occupational therapist (a person who is trained to help with your child's development) will visit with you and your child.
Ways to Help at Home
- Follow the home feeding schedule or the diet your child’s doctor has given you for him or her as closely as possible for the first 24 hours. After that, make changes only when suggested by the doctors, nurses and dietitians.
- Hold your baby upright during bottle feedings (a nurse will show you if you need help). Smile and speak softly to your baby (Picture 2).
- Never put your baby to bed and "prop" the bottle because it can lead to choking, tooth cavities and ear infections.
- Feed solid foods from a spoon if the doctors and dietitian tell you to.
- Talk and play with your baby whenever you can. Bath time, feeding time and diaper changes are great times for gentle hugs, talking to your baby and playing peek-a-boo. Your baby will really enjoy this!
- Bonding between you and your baby is very important in his development.
- Be sure to ask your nurse and doctor questions. We want to help you with your child.
When to Call the Doctor
Call your doctor if your child has any of these symptoms at home:
- Decreased appetite (is not eating as much as usual)
- Diarrhea (if bowel movements are always watery)
- Sleepiness
- Vomiting (more than just spitting up a little)
- Weight loss or poor weight gain
Follow-Up Appointment
- Be sure to keep all your appointments with your child's doctor. This is very important.
- We will weigh your child at each visit so you will know if he is growing as he should.
Important Phone Numbers
If you have any questions, be sure to ask the health professional, or call:
Your child's doctor__________________________ phone________________
Your child’s nurse__________________________ phone_________________
Your child’s dietitian_________________________ phone________________
Failure to Thrive (PDF)
HH-I-147 5/91, Revised 10/15 Copyright 1991, Nationwide Children’s Hospital
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Adizes organization life cycle model: we analyze it in detail - PowerBranding.
ruFundamentals → The best tools for strategic analysis → Modern models of company life cycle management → The Adizes life cycle model in practice
Itzhak Adizes is the world's leading expert in the field of improving the efficiency of companies. His work "Corporate Lifecycles" in 1988 influenced a significant increase in the popularity of the idea of "the need to manage the life cycle of an organization." Itzhak believed that every company is forced to go through certain stages of the organization's life cycle and consistently solve emerging problems caused by business growth, changing competition, technology and the environment. In the works of Adizes, you will find the following recommendations for working with the organization life cycle model:
Recommendation | Detailed description of |
There are always problems in the company. | The appearance of problems is a natural and even desirable process. If a company has no problems, it is simply dead. The reward of a good manager for solving current problems is a list of new problems caused by the growth of the company. The higher the rate of company growth and market changes, the more problems and more difficult tasks. |
Problems need to be recognized as quickly as possible. | The role of the leader is not to prevent problems, but to solve them quickly. Focus all efforts on ensuring that the company can quickly understand, recognize and solve problems that arise. Subsequently, the speed of reaction to problems and the ability to quickly resolve any complex issue will become your competitive advantage. |
Solve anomalous problems first. | In your work you will encounter problems of varying complexity. Some of the problems will be natural, and some will be anomalous. Natural problems are the complexities of the company that correspond to its life cycle. Abnormal problems are difficulties that are not expected in the current life cycle of the enterprise. In resource-constrained settings, always start solving anomalous problems. Natural problems may disappear on their own, but anomalous difficulties will lead to a drop in efficiency. |
No need to reinvent the wheel. | Most of the problems that arise are the same for all organizations. You will save a lot of time by using the enterprise life cycle model in business management. Knowing the steps and requirements that are needed to transition between different phases of a company's development will help reduce the impact of problems on sales and smooth the transition. |
Heyday is the most important stage and the main source of youth for the company. | The only difference between the life cycle of an enterprise and the life cycle of a person is that living beings inevitably die, but organizations can live forever. The age of the company in the life cycle concept is not related in any way to the chronological age of the business, the number of employees and the size of assets. The age of the company in the Adizes life cycle theory is determined by the balance between flexibility and control. When an organization is in its heyday stage, it has achieved a balance between flexibility and control, which means it can live forever if it can maintain this balance. |
Adizes in his model distinguished 10 stages of the life cycle of an organization, which can be represented in the form of the following graph:
cycle of a living organism. Let's consider each stage in more detail.
- Origin
- Infancy
- High activity stage
- Youth
- Heyday
- Stages of an aging company according to Adizes
Courtship
The birth stage is the first stage in the evolution and development of an organization. At this stage, the company exists solely in the form of an idea that was formed in the head of the founder of the company. This period of enterprise evolution is based on dreams and opportunities, and the main task of the leader is to create and develop a deep commitment to the idea. The higher the risk and uncertainty of the project, the stronger the belief in the result should be. Hired managers at this stage of the company's development will be useless
Business problems in the nascent stage
In the nascent stage, any idea is subject to active criticism and can lead to the closure of the business if the founder of the company does not withstand its pressure and gives up at the first problems and difficult questions.
Natural problems and errors | Abnormal problems and errors |
Excessive anxiety, fear and uncertainty | Complete lack of fear and low commitment |
Fuzzy problems and function mixing | Excessive time to think over details and procrastination |
Problems in choosing priorities: change the world or make money | Overemphasis on making money |
A Recipe for Successfully Passing the Inception Stage
In order for a company to pass the inception stage and move into the infancy stage, the owner must have strong confidence in his idea. The sooner the idea is evaluated, the idea is finalized to a “finished” state, and all the evidence in favor of creating a business is collected, the faster the company will begin to develop. The founder must, at this stage in the development of the organization, put all his efforts into developing his idea and give it a clear look, and then make a bold decision to create a company.
Infancy
The infancy stage begins at the moment when the owner of the idea founds a company and assumes financial risks and obligations. The idea is transformed into concrete actions, the time for discussion is running out, and clear results are already required from the company. An organization in its infancy requires two things: a periodic infusion of working capital and boundless love and support from the founders.
The performance of the new company is at a low level, it is just learning how to function effectively in the industry. Quite often, crises and problems of a different nature appear, the solution of which accumulates work experience and increases its efficiency. Employees and managers of the company constantly work to the limit of their capabilities (7 days a week, 24 hours) in order to compensate for the lack of experience and achieve the required results.
Business in infancy is very dependent on its founders: if they lose faith in the idea or are unable to solve problems, the young company ends its activity. In a young company, the delegation process has not yet been formed, there are no processes for transferring and managing information, so everything is limited to the manager, who takes part in every event of a small company.
Business problems in infancy
Lack of stress and problems is usually a sign that the company is not functioning properly and is dying. Let's consider natural and abnormal problems for the given stage of development of the company. Natural and abnormal business problems during infancy include:
Natural problems and errors | Abnormal problems and errors |
Problems related to the first experience of using a product or service by end customers | Failure of the company to get customer feedback and solve problems with the product |
Difficulties with the release of the finished product (violation of the release dates and difficulties at the stages of development of the finished product) | Permanent product release postponement due to minor edits |
The desire to obtain additional financial resources from the sale of non-core goods and services | Putting a "raw" product on the market |
Initial product concept change during development | Failure to attract people with the required level of competence |
Lack of rules and procedures for effective management | Excessive control that paralyzes work |
Frequent mistakes by employees and the head of the company | Lack of tolerance for mistakes and repetitive mistakes |
Lack of management skills and delegation | The leader does not listen to feedback and does not make contact |
Making decisions quickly without knowing all the subtleties of the issue leads to new problems | Slow decision-making and over-analysis of the situation |
Negative cash flow | Unpredictable and spasmodic negative cash flow |
High workload on company employees | Misuse and inefficient use of investments |
Lack of problem solving leads to "infant mortality", in other words to the liquidation of the organization at an early stage. The main reasons for the early closure of the company are: lack of cash and inability to cover the negative cash flow; loss of faith in the idea of leaders. Long-term functioning of the company at the stage of infancy also leads to the termination of its activities.
Recipe for successful infancy
Companies in the early stages of development require high attention and a strong management hand. The head of the company should by his example show involvement in work and focus on results, act as a guarantor of clarity, certainty and stability for hired personnel. What a baby company needs most is sales growth (including repeat sales growth) that can stabilize cash flow. All efforts should be focused on creating products, improvements, working with customers. The company needs a rigid centralized decision-making system, there is no time for decentralization and the search for compromise solutions. A company in its infancy may use outsourcing as a way to acquire valuable staff and solve key tasks.
When a company's product becomes stronger in the market, demand grows and repeat sales appear, the organization moves to the next stage of its development - the stage of high activity ("Go-go" stage according to Adizes).
High activity stage (Go-Go)
In the high activity stage, the company's product is highly popular and has high loyalty. Sales are skyrocketing, allowing the company to thrive. Success gives rise to excessive confidence and arrogance of the leader. The business acquires an unbridled appetite for growth and a process of strong diversification begins. Decisions are made so quickly, and any opportunities for growth are exploited so rapidly, that decisions are made hastily, without accurate calculations and analysis. The company assumes obligations that it cannot fulfill given the available resources.
At this stage of the development of the organization, the internal processes in the company are weak, accounting for costs, income and cash flow is rude. At the stage of high activity, the company does not always have a clear idea of the real profitability of its products. Functions are not yet fully assigned to specific people, tasks are set out of habit and may conflict with previously set tasks. The lack of clear goals and objectives, increased workload cause dissatisfaction among the company's staff. New employees are hired at a rapid pace, but usually with limited experience and skills.
The company does not have well-established processes for information exchange, decision-making and control. The infrastructure of the company turns into a house of cards and develops chaotically as new tasks appear and the need to solve new problems. The result of such work is a managerial crisis, in which the company significantly reduces its efficiency and may begin to lose loyal customers. All members of the organization want one thing - centralized control, prioritization, assignment of responsible and correct setting of tasks.
Business problems at the stage of high activity
At the stage of rapid growth and activity of the company, a "founder trap" (founder trap) occurs. The term means the high dependence of the company on its founder, who closes all the processes in the company, but he himself is not able to allocate time for the analysis and solution of all problems. The founder of the company becomes the bottleneck in the organization. The founder trap occurs in three cases: when the head of the company ceases to meet the requirements of the organization and no longer has the necessary skills to manage a large business; when the head of the company does not delegate part of the functions to employees; when the manager seeks to understand all the processes and projects of the company.
The founder trap often occurs in family traps. In such a situation, the main positions in the company are occupied by members of the same family, but they very often do not have the necessary experience and competencies to solve problems in accordance with the priorities of their position.
Natural problems and errors | Abnormal problems and errors |
Overconfidence of the company in success | Arrogance from leadership positions |
Confusion about priorities, responsibilities and functions | High priority for each task |
Sales become more important than profits | Premature focus on profitability |
Lack of cost control, budgeting and cash flow analysis | Lack of cost control, budgeting and cash flow analysis |
Low managerial competence of the manager | Delegation deficiency and remote guidance |
Mismatch between the number of tasks and the amount of human resources | Exit of key people of the company |
- | Weak selection, training and adaptation of personnel |
Recipe for Success in the High Activity Stage
Flexibility is the most important element of strategy in managing a high activity stage company. The head of the company must determine the main priorities of the work and reject all non-priority issues. Companies at the stage of high activity need continuous restructuring. Managers must constantly review and update the organizational structure, review the functions and KPIs of employees, monitor the quality of work of internal processes for information exchange and cash flow control.
Delegation is becoming an especially important skill in a company. Since managers do not have the necessary experience in the field of delegation of functions, it is recommended to start delegating not to one person, but to a group of people. Encouraging teamwork helps to strengthen the corporate spirit and create a cohesive team in the company. When the delegation process is successful, the manager can gradually move to the process of decentralization of management (transfer of responsibility for decision-making).
Stage of youth (Adolescence)
At the stage of youth, according to Adizes, the company is experiencing its second birth. This stage is characterized by the decentralization of power, the transition from entrepreneurship to professional management and the definition of a clear focus of the company. At the stage of adolescence, the most striking problem is the birth of internal conflicts in the company, which (if they are not resolved) can lead to premature aging of the business or to the loss of leadership authority.
At the stage of adolescence, the culture of company management must be transformed from an absolute monarchy to a constitutional monarchy. In fact, decentralization of power should take place, since the company already has employees who are able to take on the solution of individual issues. But business leaders are wary of the new pitfalls and problems that decentralization of control can cause because of the lack of proper processes in the organization. Such fear often provokes the creation of additional institutions of governance.
At the stage of adolescence, a professional manager takes the place of the founder of the company, who changes the approach and style of decision-making. Instead of the usual "Go-go", the new manager is more likely to answer "no-no", as he seeks to organize existing projects and processes in the company. The new manager often meets opposition in the face of the "old" employees of the company, who, in the absence of an established information storage system, become the owners of valuable data and receive excessive power.
The last group of problems at the stage of a company's youth is related to the need to reconsider business goals. At the stage of high activity, the main focus of the company's work is sales growth; at the stage of youth, this emphasis should be shifted to profit growth. The company must learn how to increase its profitability of sales and start working smarter. New tasks and projects are accepted if they not only increase sales, but also increase the profitability of sales. Such switching of goals is possible only with the revision of the principles and priorities of the work of each division in the company.
Business problems at the stage of adolescence
Growing tension within the company and the development of internal conflict between old and new employees, between the founder and the hired professional manager of the company, between employees and the founder can lead to one of two situations:
- the hired manager quits and the founder of the business again "takes the helm"
- a hired manager gains excess power and, through the Board of Directors, excludes the founder from the business
In the first case, the company runs the risk of returning to the previous stage of its development and, as a result, failing. In the second case, the company will most likely stop developing, sales will stagnate, and the business will begin to age prematurely.
Natural problems and errors | Abnormal problems and errors |
Low corporate spirit and employee morale | Decreased respect and trust in management |
Enmity between old and new employees | Departure of valuable employees from the company |
Lack of goals and focus on profit | Inability to control the profitability of the business |
Profit growth with sales stagnating | Increasing profits with declining sales |
Low level of delegation of authority and decentralization of management | Complete lack of delegation of authority and decentralization of management |
Periodic (temporary) slowdown of the company as a result of changing goals | Lack of development and "paralysis" of the organization as a result of a change in management style |
Reduced focus and poor management of sales growth | Decreased investment in business development |
Recipe for Adolescence Success
In order to achieve sustainable business development in the adolescence stage, a company must limit the flexibility that was so encouraged in previous stages and improve the company's internal management processes. The company should develop clear procedures and move all important functions of the company (marketing, sales, product development, finance) into separate departments. The company must clearly define the functions, priorities, responsibilities and levels of authority of each department.
After creating a solid structure, it is important to build trust in it and find the right people to fit into such a structure. At this stage, the mission and values of the company (which used to be only in the head of the founder) acquire high importance. Creating a new infrastructure within a company takes time and can cause fluctuations in sales and profits. At the moment when the created infrastructure is able to once again provide a stable income growth, the company moves to the next stage of its development - to the stage of prosperity.
At the stage of adolescence, it is not worth giving a strong importance to process automation, since key processes have not yet been created or are missing.
Business Prime
The Prime is a golden age for business. The company occupies an optimal position on the life cycle curve and achieves a certain balance between flexibility and tight control in management. The company has clear goals, each department has clear priorities and all employees consistently, persistently and clearly perform their tasks. The company's mission, strategy, structure, information management processes, resource allocation and reward system have been aligned. The company works smoothly, as a single mechanism.
Problems of a business in its heyday
The biggest problem of any business in its heyday is the desire to keep everything as it is. “So everything works well”, “We have a good product and a good market share, we don’t need to invent something new”, “It’s not worth taking risks and experimenting” are the most common statements of management when a business reaches its peak. But this is the biggest mistake. A company, even at its peak, must make daily efforts that will slow down the obsolescence of technologies and prolong the “golden age”. The market and competitors are always moving forward, constantly evolving and developing new ways to optimize costs, release better products, implement better processes and business practices.
The second important business problem at the stage of prosperity is the lack of personnel with the required level of competencies and skills. Often in such a situation, companies begin to grow personnel within the organization, but this takes time.
The Recipe for Successfully Passing the Heyday
The recipe is simple - continuous development, improvement and investment in growth. At the heyday stage, a successful company begins to develop new divisions and separate business units, to master new industries, which also gradually go through the stages of infancy, high activity and youth.
As soon as a company begins to "stand still" and ceases to make any effort to develop new sources of growth, it begins to age. In the initial period of aging, the company's management may not notice the decline, since this process is quite smooth and can be very stretched in time. The company's sales and profitability are still positive for a long time, but the growth rate is slowing down, gradually turning into stagnation.
Stages of an aging company according to Adizes
The life cycle curve of an aging company gradually changes its direction and becomes downward. The processes and problems of aging organizations are approximately the same and are present at all stages of aging (stability, aristocracy, early bureaucracy and bureaucratization). The stages of aging differ only in the intensity and scale of the problems.
Business stability stage (Stable)
The business stability stage is the first step towards the aging of a company. At the stage of stability, sales no longer grow, but they do not begin to decline yet, and the company feels confident and calm. The company's management calmly follows the success of the business and completely ceases to follow the changing needs of customers. The company practically loses contact with the outside world and ceases to listen to the recommendations and trends of the external market. Often an aging company is a fairly large organization that loses its flexibility and begins to slowly respond to market changes.
Short-term goals and objectives begin to predominate in the company. Long-term projects are stopped, investment in research and development is reduced.
Aristocracy
If a company at the stage of stability stops investing in new sources of growth and stops responding to market changes, the business moves to the stage of development of the aristocracy. The aristocracy is characterized by the intensive development of a "heavy" and massive administrative apparatus. Therefore, even in the case of the acquisition of new business units for sales growth, the established administrative apparatus of the parent company suppresses all possible potential.
A business at the stage of development of the aristocracy begins to improve the head office and create excessively comfortable working conditions for management personnel. The company's management is increasingly moving away from understanding the target market, is beginning to realize the trend of declining sales, but does not seek to report this to the shareholders and founders of the company. All information is presented in a positive way and the company until the last moment refuses to admit the loss of its power and share in the industry.
Early Bureaucracy
The eighth stage of the Adizes life cycle model changed its name several times and was called "Salem City" for a long time. At this stage, the decrease in business efficiency and the lack of sales growth become obvious to the founders (or shareholders). An active search for those responsible for the drop in sales and profits begins. Of course, as in any bureaucratic structure, everyone starts blaming each other. This process ends with the dismissal of part of the management staff, which diverts the company's attention from the need to solve current problems and market problems.
Bureaucratization (Bureaucracy)
If a company does not begin active business reorganization after going through the early bureaucracy and purging the management staff, the business enters the bureaucratization stage.