Failure to Thrive (Nutrition)

Failure to Thrive Nutrition Definition-Failure to Thrive • FTT describes a syndrome in which and infant falls below the 5th percentile in height and weight on the growth chart. • In elderly persons is defined by as weight loss of more than 5%, decreased appetite, poor nutrition, and physical inactivity • Can be organic-related to organic cause such as AIDS, PKU, congenital heart disease, cystic fibrosis or other physical cause. • 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 Risk Factors: Populations at Greatest Risk • All individuals are potentially at risk • Socioeconomic status and race or ethnicity can influence risk • Populations at greatest risk for problems with nutrition are – Very young children – Elderly adults 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 • In older adults,Dehydration, depression, immune dysfunction, and low cholesterol. 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 • Failure to thrive is not a single disease or medical condition; rather, it's a nonspecific manifestation of an underlying physical, mental, or psychosocial condition. At Diagnosis Vs. After Interventions 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 Assessment Findings (con’t) • 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 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 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 Nursing Interventions (con’t) • Assess parent/child interaction especially during feedings • Assesses feeding interaction of infants up to 12 months of age • Child should have consistent nurse(s) caring for them • 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 Question 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 Question 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 shift c. Assign same nurses to care for infant each d. Measure vital signs every hour for changes in status