Failure to Thrive (FTT) is a condition in which a child fails to gain weight or grow as expected. This term typically refers to children whose growth and development are significantly below the norm for their age and sex.
It can manifest as weight below the 5th percentile for age or a significant drop in growth percentile over time.
Causes
1.Nutritional Factors:
- Inadequate Caloric Intake: Insufficient intake of calories or nutrients due to poor feeding practices, poverty, or lack of access to appropriate foods.
- Malabsorption: Conditions that impair nutrient absorption, such as celiac disease or lactose intolerance.
2. Medical Conditions:
- Chronic Illnesses: Conditions such as congenital heart disease, cystic fibrosis, or chronic kidney disease that increase metabolic demands or affect appetite and nutrient absorption.
- Gastrointestinal Disorders: Conditions like gastroesophageal reflux disease (GERD), chronic diarrhea, or chronic constipation.
3. Psychosocial Factors:
- Neglect or Abuse: Environmental factors such as neglect or abuse can impact a child’s nutritional intake and overall growth.
- Family Dynamics: Issues such as parental substance abuse, mental health problems, or inadequate parenting skills.
4. Developmental or Behavioral Issues:
- Feeding Difficulties: Conditions such as oral-motor dysfunction or sensory aversions that make feeding challenging.
- Failure to Bond: Lack of bonding or secure attachment between the child and caregiver, affecting feeding behaviors.
Pathophysiology
1. Inadequate Nutritional Intake: If the child does not consume enough calories or nutrients, the body’s growth processes are compromised. This results in decreased growth rates and weight gain.
2. Increased Metabolic Demand: Chronic illnesses or conditions that increase metabolic demand can outpace nutritional intake, leading to weight loss or failure to gain weight.
3. Impaired Nutrient Absorption: Conditions that affect the gastrointestinal tract can lead to poor nutrient absorption, contributing to malnutrition and poor growth.
4. Altered Growth Patterns: Persistent inadequate intake or chronic illness alters normal growth patterns, resulting in stunted growth and developmental delays.
Diagnostic Tests
1.Clinical Evaluation:
- Obtain a comprehensive history of feeding practices, growth patterns, and any underlying medical conditions.
- Assess growth parameters, including weight, height, and head circumference, and evaluate for signs of underlying medical conditions.
2.Laboratory Tests:
- Complete Blood Count (CBC): To check for anemia or other hematological abnormalities.
- Basic Metabolic Panel (BMP): To assess electrolyte levels and kidney function.
- Thyroid Function Tests: To rule out thyroid disorders.
- Stool Studies: To check for malabsorption or gastrointestinal infections.
3. Imaging and Specialized Tests:
- Abdominal Ultrasound or X-rays: To evaluate for gastrointestinal abnormalities or structural issues.
- Genetic Testing: If a genetic syndrome is suspected.
- Endoscopy: To assess for gastrointestinal pathology if indicated.
Medical Management
1. Nutritional Intervention:
- Adjust feeding practices to increase caloric density of foods, possibly using high-calorie supplements or fortified formulas.
- Use nutritional supplements such as vitamins, minerals, and specialized formulas if needed.
2. Treatment of Underlying Conditions:
- Manage any underlying medical conditions contributing to FTT (e.g., treating infections, managing chronic diseases).
- For children with feeding difficulties, involve a speech therapist or occupational therapist to address oral-motor issues.
3. Social and Environmental Interventions:
- Provide counseling and support to address psychosocial factors, including parenting education and family therapy.
- Connect families with resources for food assistance, financial support, or social services if needed.
Nursing Implications
Assessment
- Gather detailed information about the child’s growth patterns, feeding history, medical history, and family dynamics.
- Monitor growth parameters (weight, height, head circumference), assess for signs of illness, and evaluate the child’s nutritional status.
- Evaluate the child’s current diet, feeding habits, and any feeding difficulties.
Diagnosis
- Imbalanced nutrition less than body requirements related to inadequate intake or absorption.
- Risk for compromised family coping related to the stress of managing a child with FTT and possible social factors.
Planning
- Develop an Individualized Care Plan: Focus on increasing caloric intake, addressing any underlying medical or developmental issues, and providing family support.
- Plan educational sessions for caregivers on appropriate feeding practices, recognizing signs of nutritional deficiencies, and understanding the management plan.
Implementation
- Assist with meal planning, monitor the child’s intake, and administer nutritional supplements as prescribed.
- Coordinate care with other healthcare providers to address underlying medical conditions or developmental issues.
- Provide emotional support to the family, connect them with resources, and address any psychosocial factors affecting the child’s well-being.
Evaluation
- Assess the child’s response to nutritional interventions and track changes in growth parameters.
- Ensure caregivers understand the care plan, feeding strategies, and follow-up needs.
- Adjust the care plan based on the child’s progress, any new findings, or changes in the family situation.