Failure to Thrive
Download
Report
Transcript 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)
Etiology
Combination of parental and infant
behaviors and conditions
May be organic (physical cause) or
inorganic (psychosocial)
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
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
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Withdrawn, apathetic, poor eye contact, “radar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
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
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
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
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
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
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