Failure to Thrive (Growth failure)

  • Failure to Thrive (Growth failure)
    • Pathophysiologic causes of failure to thrive
      • Inadequate caloric intake: 
        • Incorrect formula preparation, neglect, food fads, excessive juice consumption, lack of food availability, breastfeeding problems, behavioral problems affecting eating, or central nervous system problems affecting intake
      • Inadequate absorption: 
        • Food allergy, malabsorption, pyloric stenosis, GI atresia, inborn errors of metabolism
      • Excessive caloric expenditure: 
        • Hyperthyroidism, malignancy, congenital heart disease, chronic pulmonary disease, or chronic immunodeficiency
    • Clinical manifestations of failure to thrive
      • Growth failure (see earlier in this chapter for definitions)
      • Developmental delays—social, motor, adaptive, language
      • Undernutrition
      • Apathy
      • Withdrawn behavior
      • Feeding or eating disorders, such as vomiting, feeding resistance, anorexia, pica, rumination
      • No fear of strangers (at age when stranger anxiety is normal)
      • Avoidance of eye contact
      • Wide-eyed gaze and continual scan of the environment (“radar gaze”)
      • Stiff and unyielding or flaccid and unresponsive
      • Minimal smiling
        • Some parents are at increased risk for attachment problems because of
          • Isolation and social crisis
          • Inadequate support systems
            • Teenage and single mothers
          • Poor parenting role models as a child
          • Lack of education
          • Physical and mental health problems
            • Physical and sexual abuse
          • Depression
          • Drug dependence
          • Immaturity
            • Especially in adolescent parents
          • Lack of commitment to parenting
            • Giving priority to entertainment or employment
      • Feeding the child with failure to thrive
        • Provide a primary core of staff to feed the child. 
          • The same nurses are able to learn the child’s cues and respond consistently.
        • Provide a quiet, unstimulating atmosphere. 
          • A number of children with failure to thrive (FTT) are very distractible, and their attention is diverted with minimal stimuli. 
          • Older children do well at a feeding table; bottle-fed infants and children should always be held.
        • Maintain a calm, even temperament throughout the meal.
          • Negative outbursts may be commonplace in this child’s habit formation. 
          • Limits on eating behavior definitely need to be provided, but they should be stated in a firm, calm tone. 
          • If the nurse is hurried or anxious, the feeding process will not be optimized.
        • Talk to the child by giving directions about eating. 
          • “Take a bite, Lisa” is appropriate and directive. 
          • The more distractible the child, the more directive the nurse should be to refocus attention on feeding. 
          • Positive comments about feeding are actively given.
        • Be persistent. 
          • This is perhaps one of the most important guidelines. 
          • Parents often give up when the child begins negative feeding behavior. 
          • Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. 
          • Although forced feeding is avoided, “strictly encouraged” feeding is essential.
        • Maintain a face-to-face posture with the child when possible.
          • Encourage eye contact, and remain with the child throughout the meal.
        • Introduce new foods slowly. 
          • Often these children have been exclusively bottle-fed. If acceptance of solid foods is a problem, begin with pureed food and, after it is accepted, advance to junior and regular solid foods.
        • Follow the child’s rhythm of feeding. 
          • The child will set a rhythm when the previous conditions are met.
        • Develop a structured routine. 
          • Disruption in other activities of daily living has great impact on feeding responses, so bathing, sleeping, dressing, playing, and feeding are structured. 
          • The nurse should feed the child in the same way and place as often as possible. The length of the feeding should also be established (usually 30 minutes).