Concept: Development
Objectives

By the end of this module students should
be able to:
1. Describe the clinical manifestations
and therapeutic management of the child
with Failure to Thrive (FTT).
2. Develop a nursing care plan to meet
the emotional and physical needs of the
child with growth failure.
Definition
 FTT
Describes a syndrome in which
an infant falls below the 5th
percentile in height and weight on
growth chart
 Can be organic- r/t organic cause
such as AIDS, PKU, Congenital
Heart Disease, Cystic Fibrosis or
other physical cause
Definition (cont.)
 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
Pre-term and small-for-gestational-age
babies
 Parents suffering from depression, belownormal 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

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
Child with Failure
to Thrive
(feeding disorder
of infancy or
childhood)
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 (cont.)
 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
Diagnostic Findings
 Negative
nitrogen balance
indicates inadequate intake of
protein or calories
 Other tests to rule out organic
cause i.e. Upper GI series, stool
test for malabsorption
 Most other laboratory testing not
helpful in diagnosing FTT
Medical 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
Child with FTT before and
after intervention
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 (cont.)
 Assess
parent/child interaction
especially during feedings; Child
Assessment Satellite Training
(NCAST) Feeding Scale
Assesses feeding interaction of
infants up to 12 months of age
 Child should have consistent
nurse(s) caring for them
Nursing Interventions (cont.)





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
Review Questions
1. 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.
b.
c.
d.
Celiac disease
Imperforate anus
Failure to thrive
Hirschsprung’s disease
2. Which nursing diagnosis would
be most appropriate for the
infant admitted with inorganic
failure to thrive?
a.
b.
c.
d.
Impaired social interaction
Risk for infection
Alteration in bowel elimination
Impaired parenting
3. 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
c. Assign same nurses to care for
infant each shift
d. Measure vital signs every hour for
changes in status
ANSWER KEY
 1.
C
 2. A
 3. C