Download Failure to Thrive

Failure to Thrive
Ricci, p. 1172
Pathophysiology
AKA growth failure, pediatric
undernutrition
 Wt below 5th percentile or decline in
previously stable pattern by 2 %ile lines
 If both ht and wt are low, malnutrition has
been going on for a long time
 May be developmental delays or retardation
(may be caused from malnutrition)
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Etiology
Combination of parental and infant
behaviors and conditions
 May be organic (physical cause) or
inorganic (psychosocial)
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Organic Causes
Systemic disease such as cardiac,
pulmonary, GI
 Sensory or motor delays
 Prolonged mechanical ventilation and/or
prolonged tube feedings leading to sucking
and swallowing problems or food refusal
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Inorganic Causes
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Neglect and/or abuse
Parental mental illness/MR
Poor bonding and interaction
Lack of maternal response to infant needs; inability to
recognize cues
Family stress
Parental drug abuse
Poor parental role models
Infant temperament
Poverty
Manifestations
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Growth failure
Malnutrition
Delays
Poor hygiene
Withdrawn, apathetic, poor eye contact, “radar
gaze”, minimal smiling, no stranger anxiety
Feeding resistance, vomiting, anorexia
Stiff and resistant body posture or flaccid &
unresponsive
Diagnostics
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Goal is to determine cause
Anthropometric measurements
Health history
Dietary history and dietary rituals
Behaviors and interactions
Observe feeding if possible
Developmental assessment
Social history
Labs to rule out organic causes
Management
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Need interdisciplinary team
Reverse malnutrition—may require oral or tube
feedings or TPN
Relieve stressors (family may just need to find
food source)
Behavior modification at mealtime
Family therapy
Child may need temporary placement
If organic, treat disease process in addition to
correcting nutritional deficits
Nutritional and Fluid Needs
120 kcal/kg/day needed for proper wt gain
 Formula or other liquid nutritional
supplement
 Rice cereal
 Vegetable oil
 Vitamins and minerals
 Daily weights
 Strict I & O
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Reasons for Hospital Admission
Measurements indicate severe malnutrition
and/or there is significant dehydration
 Child abuse or neglect
 Caretaker substance abuse or psychosis
 Presence of serious infection or disease
process that needs attention
 Tx not responsive to previous outpatient
mgmt
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Factors Affecting Recovery
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Early onset of FTT
Young or uncooperative parent
Low income
Low parental educational level
Severe feeding resistance from child
Quality of follow-up—child needs home visits
with observations and measurements
Whether parents get therapy
Nursing Responsibilities
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Foster + eating environment—calm, quiet
Core of same nurses
Teach successful eating strategies—persistence,
eye contact, give child directions, create structure
Teach parent infant caloric needs
Teach parent to recognize cues
Teach parent to hold, rock, stroke, talk to child
Developmental stimulation for child
Give positive reinforcement to parent