Ricci, p. 1172

 AKA growth failure, pediatric undernutrition
 Wt below 5 th percentile or decline in previously stable pattern by 2 %ile lines
 If both ht and wt are low, malnutrition has been going on for a long time
 May be developmental delays or retardation
(may be caused from malnutrition)

 Combination of parental and infant behaviors and conditions
 May be organic (physical cause) or inorganic (psychosocial)

 Systemic disease such as cardiac, pulmonary, GI
 Sensory or motor delays
 Prolonged mechanical ventilation and/or prolonged tube feedings leading to sucking and swallowing problems or food refusal



Neglect and/or abuse
Parental mental illness/MR
 Poor bonding and interaction
 Lack of maternal response to infant needs; inability to recognize cues
 Family stress
 Parental drug abuse
 Poor parental role models
 Infant temperament
 Poverty

 Growth failure
 Malnutrition
 Delays


Poor hygiene
Withdrawn, apathetic, poor eye contact, “radar gaze”, minimal smiling, no stranger anxiety
 Feeding resistance, vomiting, anorexia
 Stiff and resistant body posture or flaccid & unresponsive

 Goal is to determine cause
 Anthropometric measurements
 Health history
 Dietary history and dietary rituals
 Behaviors and interactions
 Observe feeding if possible
 Developmental assessment
 Social history
 Labs to rule out organic causes

 Need interdisciplinary team
 Reverse malnutrition—may require oral or tube feedings or TPN
 Relieve stressors (family may just need to find food source)
 Behavior modification at mealtime
 Family therapy
 Child may need temporary placement
 If organic, treat disease process in addition to correcting nutritional deficits

 120 kcal/kg/day needed for proper wt gain
 Formula or other liquid nutritional supplement
 Rice cereal
 Vegetable oil
 Vitamins and minerals
 Daily weights
 Strict I & O

 Measurements indicate severe malnutrition and/or there is significant dehydration
 Child abuse or neglect
 Caretaker substance abuse or psychosis
 Presence of serious infection or disease process that needs attention
 Tx not responsive to previous outpatient mgmt

 Early onset of FTT
 Young or uncooperative parent
 Low income
 Low parental educational level
 Severe feeding resistance from child
 Quality of follow-up—child needs home visits with observations and measurements
 Whether parents get therapy

 Foster + eating environment—calm, quiet
 Core of same nurses
 Teach successful eating strategies—persistence, eye contact, give child directions, create structure
 Teach parent infant caloric needs
 Teach parent to recognize cues
 Teach parent to hold, rock, stroke, talk to child
 Developmental stimulation for child
 Give positive reinforcement to parent