13.7 Aggression and Failure to Thrive (FTT)

Question 1

Aggression

Answer 1

• Behavior that attempts to hurt a person or destroy property
• Different from anger (temporary emotional state).

Risk Factors
- Biological
- Sociocultural
- Family norms

• The difference between normal and problematic aggression is not the behavior itself but the quantity, severity, onset and duration of how the aggressive behavior manifests.
• Children are usually admitted when a big event has occurred such as getting kicked out of school or harming someone at home.

Question 2

Failure to Thrive

Answer 2

• Term used to describe inadequate growth (inability to attain or use calories appropriately to grow as we should)
• Inadequate calories (parent is not preparing formula appropriately or family is in poverty, or child is refluxing), absorption, metabolism (hypermetabolic conditions such as malignancies, COPD, cystic fibrosis, down syndrome, immunodeficiency), or utilization (child is not eating appropriately or not getting appropriate hunger cues.

Definition - There is some sort of decline/deceleration in both height and weight (weight is usually more affected)
- Below 5% for weight or drop 2 growth curve’s on the growth chart.

Risk Factors
- Premature Birth
- IUGR
- Lack of prenatal care
- Family stress or poverty
- Child has feeding inadequacy (not latch appropriately or suck/swallow appropriately)
- Parents may also not offer enough food for a child (neglect/abuse)

Question 3

FTT Clinical Manifestations

Answer 3

• Malnourished/Dehydrated (growth failure)
• Developmental delays
• Apathy/Withdrawn/Avoid Eye Contact/FLAT AFFECT
• Feeding/Eating Disorders (excessive vomiting, refusal, PICA)
• No fear of strangers when stranger anxiety is normal
• Radar Gaze (blank stare)

Question 4

Nursing Management FTT

Answer 4

Goals
- Correct nutritional deficiencies
- Achieve ideal weight by providing sufficient calories
- Restore optimal body composition
- Educate caregiver of nutrition and feeding methods.

Interdisciplinary team - Dieticians, pediatricians, social work, nursing, occupational therapist.

• When hospitalized, we try to assign very consistent caregivers (primary nursing team) and provide structure to environment to know how this patient eats best and unique eating methods. This is to understand how to address nutritional concerns of the patient and family dynamics.

Education
- Queues to look for when child is hungry
- Set up routine and rituals around eating to promote healthy eating behaviors
- Sometimes we can give high calorie formulas or supplement nutrition

Treatment
- Highly individualized based on patient