Childhood obesity and failure to thrive Flashcards
comorbid with obesity
- Diabetes
- Hypertension
- Liver disease
- Sleep apnea
- Orthopedic problems (joints, muscle strain)
etiology
causes are multifactorial with both genetic and environmental factors influencing a person’s caloric intake and energy expenditure. Clinically, we measure weight appropriateness through body mass index (BMI)
interventions for obesity
1) prevention through encouraging healthy eating habits
2) establishing healthy eating habits early
3) lifestyle interventions (ie. decreasing sedentary activities such as TV watching and promoting regular exercise/play)
4) pharmacologic (as a supplement to behavioral and lifestyle changes)
5) surgery (only for children over 13 years with BMITs of 40 or greater) the 2 offered to pediatric clients include gastric bypass and gastric banding.
failure to thrive
diagnosis given to infants or children who fail to grow or gain weight. The first 2 years of life are crucial for brain growth and infants diagnosed with FTT are at high risk for lasting deficits in growth, cognition, language, and socio-emotional functioning.
FTT - organic
arising from a diagnosable physical cause
a. Perinatal- refers to infants that were born very low birth weight
b. Toxic and immunologic- arise from significant nutritional and immunologic deficiency, which has the potential to increase vulnerability to infection and increase susceptibility to lead toxicity.
c. Neurodevelopmental-results from inadequate nutrition on the developing nervous system.
FTT - nonorganic
impaired growth without apparent physical cause, most likely due to psychological factors.
a. Disturbances in child-parent interactions
b. Difficult infant temperament and behavior
c. Financial difficulties within the family
d. Child/domestic abuse
f. Disturbed attachment to parent
g. Caregiver mental or physical illness
h. Neglect of child
j. Caregiver health beliefs
Experts differentiate between FTT in infants versus children with behavior related food preferences
2 years of age
children around 2 who fail to thrive may be the result of
behavioral issues and/or nonorganic factor
infant vs older children assessment
Infant assessment emphasizes interactional issues with caregivers while the assessment of older children focuses more on behaviors in feeding situations. Focus is on determining if the child is not eating due to 1) environmental factors/psychosocial factors or 2) neuromuscular difficulties (known disability) which may affect feeding (ie. poor mastication/chewing skills in a child with cerebral palsy making eating slow and labor intensive).
role of OT working with a child with FTT
- Improving oral motor and feeding skills
- Promoting positive parent interactions (understanding your child’s feeding cues)
- Engaging the child in positive, developmentally appropriate feeding situations
Increasing Calories for Weight Gain
Many times children that have difficulty gaining weight can benefit from a supplemental diet to add calories, NOT bulk to diet. Every ounce of food counts! A high calorie diet could be beneficial for:
• Children with poor oral motor skills and difficulty taking in high volumes of food
• Children with small stomach and limited space for food
• Children that take a long time to eat (or be fed by caregiver) and may become tired before finishing a meal
ideas on how to add extra protein calories to meals
- Add ¼ cup of powdered nonfat milk to regular milk, mashed potatoes, uncooked cereal, juice drinks.
- Use carnation instant breakfast
- Serve beans or peas in sauces made with cheese or milk
- Mix tuna fish with cream cheese. Oil-packed tuna has more calories per ounce than water-packed tuna.
- Add extra whole egg to raw foods that are cooked – macaroni and cheese, ground meats, pancakes
- Sprinkle parmesan cheese on meats and vegetables
adding fat to meals
- Add margarine, butter, or oil to meats, vegetables, hot cereals, and cooked desserts.
- Mayonnaise, sour cream, and salad dressings can be served on vegetables, meats, sandwiches, and fruit salads
- Peanut butter and other nut butters are high in oil
- Cream and ice cream have high fat content
- Avocados are high in fat and calories; they work well in softer diets.
pharmacology considerations
medications that can reduce desire to eat
pharmacology examples
• Seizure medications
Dilantin – causes hypertrophy of the gums with accompanying discomfort in the mouth
• Mineral oil
Often recommended for constipation, but can reduce the body’s ability to absorb Vitamins A, E, and D leaving the child more vulnerable to infection
• Antibiotics
Tetracyclin, cortinsone medications and diuretics all contribute to decrease zinc absorption or increase it excretion from the body. Deficiencies of Zinc can contribute to a reduced appetite and hypersensitivity OR hyposensitivity to food taste.
