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Failure to Thrive

Failure to Thrive. Ricci, p. 1172. Pathophysiology. AKA growth failure, pediatric undernutrition Wt below 5 th 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

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Failure to Thrive

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  1. Failure to Thrive Ricci, p. 1172

  2. 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)

  3. Etiology • Combination of parental and infant behaviors and conditions • May be organic (physical cause) or inorganic (psychosocial)

  4. 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

  5. Inorganic Causes • 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

  6. Manifestations • Growth failure • Malnutrition • Delays • Poor hygiene • Withdrawn, apathetic, poor eye contact, “radar gaze”, minimal smiling, no stranger anxiety • Feeding resistance, vomiting, anorexia • Stiff and resistant body posture or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

  7. Diagnostics • 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

  8. Management • 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

  9. 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

  10. 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

  11. Factors Affecting Recovery • 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

  12. Nursing Responsibilities • 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

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