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

1Failure To Thriveby Cathy B. Herbert, MSN,RNConcept: Development

2ObjectivesBy 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.

3DefinitionFTT Describes a syndrome in which an infant falls below the 5th percentile in height and weight on growth chartCan be organic- r/t organic cause such as AIDS, PKU, Congenital Heart Disease, Cystic Fibrosis or other physical cause

4Definition (cont.)Most cases of FTT are nonorganic- related to psychosocial factors such as disturbance in maternal-infant attachment; inadequate nutritional informationAlso called feeding disorder of infancy or early childhood

5Risk FactorsPre-term and small-for-gestational-age babiesParents suffering from depression, below-normal intelligence, substance abuse, history of abuse, who are socially isolated, not responsive to infants hunger cues, lack knowledge of infant nutritional and/or G&D needsInfant has chronic illness or deformity

6PathophysiologyComplex 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

7Child with Failure to Thrive (feeding disorder of infancy or childhood)

8Assessment FindingsInfant height and weight at or below that expected for chronological ageAltered body posture: child is stiff or floppy, doesnt cuddle; radar gazeDelayed psychosocial behavior: reluctance to smile or talk, avoidance of eye contactHistory of inadequate feeding techniques, such as bottle propping or insufficient burping

9Assessment Findings (cont.)History of medical problemsHistory of insufficient stimulation and lack of parental G&D knowledgeHistory of sleep disturbancesPsychosocial family problemsRegurgitation of food after almost every feeding

10Diagnostic FindingsNegative nitrogen balance indicates inadequate intake of protein or caloriesOther tests to rule out organic cause i.e. Upper GI series, stool test for malabsorptionMost other laboratory testing not helpful in diagnosing FTT

11Medical ManagementMultidisciplinary approach (physician, nurse, dietician, child life specialist, social worker, mental health worker)High-calorie diet with vitamin and mineral supplementsParent counselingRespite care for childStructured feeding regime with specific volume needed per feeding

12Child with FTT before and after intervention

13Nursing InterventionsAdmission weight for baseline data and daily weightsAccurate intake and output measurementCalorie countAssess G&D with appropriate tool i.e. DDSTMaintain structured care regimeProvide age-appropriate visual and auditory stimulation

14Nursing 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 ageChild should have consistent nurse(s) caring for them

15Nursing Interventions (cont.)Teach parent effective parenting skills to increase parents knowledge of child care and growth and developmentSERVE AS A ROLE MODEL FOR PARENTNurses role is not to criticize or lecture, but to help them be better parentsFamily and child need supportFollow-up in home

16Review 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. Hirschsprungs disease

172. 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

183. 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

19ANSWER KEY1. C2. A3. C

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