failure to thrive

Question 1

what is failure to thrive?

Answer 1

• inadequate growth
• deceleration in wt gain
• low wt to height ratio
• standard growth chart abnormal
• malnutrition

Question 2

how is FTT classified?

Answer 2

according to its pathophysiology
- inadequate caloric intake
- inadaquate absorption
- increased metabolism
defective utilization

Question 3

what are the 3 categories/causes of FTT?

Answer 3

1) non-organic
2) organic
3) combined

Question 4

what environmental and psychosocial factors contribute to non-organic causes of FTT?

Answer 4

pre natal:
- lack of nurturance in parents own childhood
- unwanted pregnancy/teen pregancy
- family crisis
- single parent (isolation)
- mental/physical illness (maternal eating disorder)
- malnourished mom
- lack of bonding w unborn bb
- low ses
- multiple gestations
post natal
- Post partum depression
- poor feeding skills
- dysfnx family interactions
- lack of support
- child neglect

Question 5

what are organic causes of FTT?

Answer 5

• reduced availability of nutrients
• increased nut req/ increased metabolic demands
• exposure to toxins
• pathophysiological cause (GERD, pyloric stenosis, malabsorption syndrome)

Question 6

what are combined (non organic + organic) factors that contribute to FTT?

Answer 6

• illness in children = family stress, depression, alcohol and drug abuse
• resistance or non-compliance

Question 7

what are your assessment?

Answer 7

• family interaction
• physical
• assess contributing factors
• assess facial expressions
• psychosocial hx
• response to child cues
• child’s activity lvl
• parental height
• food allergies
• dietary restrictions
• growth pattern of parents and siblings
• family rituals at mealtime

Question 8

what are the clinical manifestation of FTT?

Answer 8

• growth failure
• malnutrition
• dev delays
• apathy
• poor hygiene
• feeding/eating disorders
• withdrawn behavior
• no fear of stranger
• minimal smilling
• avoidance of eye contact
• scan the environment
• avoid face to face contact
• intense interest in inanimate objects
• dislikes being touched

Question 9

what are long term effects of FTT?

Answer 9

poor growth
cognitive delays
poor academic performance

Question 10

what is used to diagnose FTT?

Answer 10

• if recent: wt falls below 5th percentile for age, height remains normal
• if longstanding: wt and height below 5th percentile for age
• dietary hx: 24h food intake or hx 3-5 day intake
• mom’s prenatal dietary hx
• other test to r/o organic problems

Question 11

what are the indications for hospitalization in FTT children?

Answer 11

• child abuse/neglect
• severe acute malnutrition
• significant dehydration
• caretaker substance abuse/psychosis
• serious recurrent infections

Question 12

what is the management of FTT?

Answer 12

• primary = reverse the cause
• if severe malnutrition -> reverse malnutrition without going into a refeeding syndrome, then treat the cause
• high cal diet + vit and mineral supplements
• reduce stress on family (clsc, supplemental food program, therapy, temporary foster home)
• teaching: diease process, cause and tx + feeding strategies

Question 13

what are the nursing goals of FTT?

Answer 13

1) correct nut deficiencies and achieve ideal wt for height
2) provide adequate cal for catch up growth
3) restore optimum bosy composition
4) educate parents abt nutritional req and appropriate feeding methods