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earlier in this chapter for definitions) Developmental delays—social, motor, adaptive, language Undernutrition Apathy Withdrawn behavior Feeding or eating disorders, such as vomiting, feeding resistance, anorexia, pica, rumination No fear of strangers (at age when stranger anxiety is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).