Failure To Thrive by Cathy B. Herbert, MSN,RN

2. Concept: Development Failure To Thriveby Cathy B. Herbert, MSN,RN

3. Objectives • By the end of this module students should be able to: 1. Describe the clinical manifestations and therapeutic management of the child with Failure to Thrive (FTT). 2. Develop a nursing care plan to meet the emotional and physical needs of the child with growth failure.

4. Definition • FTT Describes a syndrome in which an infant falls below the 5th percentile in height and weight on growth chart • Can be organic- r/t organic cause such as AIDS, PKU, Congenital Heart Disease, Cystic Fibrosis or other physical cause

5. Definition (cont.) • Most cases of FTT are nonorganic- related to psychosocial factors such as disturbance in maternal-infant attachment; inadequate nutritional information • Also called feeding disorder of infancy or early childhood

6. Risk Factors • Pre-term and small-for-gestational-age babies • Parents suffering from depression, below-normal intelligence, substance abuse, history of abuse, who are socially isolated, not responsive to infant’s hunger cues, lack knowledge of infant nutritional and/or G&D needs • Infant has chronic illness or deformity

7. Pathophysiology • Complex dynamic between parent and child - Parent may feel little or no emotional attachment to child - Parent may offer insufficient food - Child may sense parental detachment - Child may contribute by being irritable, fussy, or colicky

8. Child with Failure to Thrive (feeding disorder of infancy or childhood)

9. Assessment Findings • Infant height and weight at or below that expected for chronological age • Altered body posture: child is stiff or floppy, doesn’t cuddle; “radar gaze” • Delayed psychosocial behavior: reluctance to smile or talk, avoidance of eye contact • History of inadequate feeding techniques, such as bottle propping or insufficient burping

10. Assessment Findings (cont.) • History of medical problems • History of insufficient stimulation and lack of parental G&D knowledge • History of sleep disturbances • Psychosocial family problems • Regurgitation of food after almost every feeding

11. Diagnostic Findings • Negative nitrogen balance indicates inadequate intake of protein or calories • Other tests to rule out organic cause i.e. Upper GI series, stool test for malabsorption • Most other laboratory testing not helpful in diagnosing FTT

12. Medical Management • Multidisciplinary approach (physician, nurse, dietician, child life specialist, social worker, mental health worker) • High-calorie diet with vitamin and mineral supplements • Parent counseling • Respite care for child • Structured feeding regime with specific volume needed per feeding

13. Child with FTT before and after intervention

14. Nursing Interventions • Admission weight for baseline data and daily weights • Accurate intake and output measurement • Calorie count • Assess G&D with appropriate tool i.e. DDST • Maintain structured care regime • Provide age-appropriate visual and auditory stimulation

15. Nursing Interventions (cont.) • Assess parent/child interaction especially during feedings; Child Assessment Satellite Training (NCAST) Feeding Scale Assesses feeding interaction of infants up to 12 months of age • Child should have consistent nurse(s) caring for them

16. Nursing Interventions (cont.) • Teach parent effective parenting skills to increase parent’s knowledge of child care and growth and development • SERVE AS A ROLE MODEL FOR PARENT • Nurse’s role is not to criticize or lecture, but to help them be better parents • Family and child need support • Follow-up in home

17. Review Questions 1. A mother brings her 4-week-old infant to the clinic because he has not been eating well and does not seem to want to be held. The child has lost 8 oz. since birth but has no other symptoms and is healthy. Which condition is the pediatrician likely to diagnose? a. Celiac disease b. Imperforate anus c. Failure to thrive d. Hirschsprung’s disease

18. 2. Which nursing diagnosis would be most appropriate for the infant admitted with inorganic failure to thrive? a. Impaired social interaction b. Risk for infection c. Alteration in bowel elimination d. Impaired parenting

19. 3. Which nursing intervention would be most appropriate for the infant hospitalized with a diagnosis of inorganic failure to thrive? a. Cluster nursing activities b. Weigh infant after each feeding c. Assign same nurses to care for infant each shift d. Measure vital signs every hour for changes in status

20. ANSWER KEY • 1. C • 2. A • 3. C