1. Failure to Thrive
Ricci, p. 1244

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
Most commonly occurs in children with special needs

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
Malabsorption
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Withdrawn, apathetic, poor eye contact, “radar gaze”, minimal smiling, no stranger anxiety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. Growth Chart Findings

9. 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

10. 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

11. 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

12. 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

13. Nursing Responsibilities
Watch feeding
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

14. Images