Study Map for: Failure to Thrive in Children

Pathophysiology: Risk Factors Treatment Outcomes: (meds, surgical procedures, etc.)

Failure to thrive in children is - Sufficient nutrition
weight consistently below the 3rd Non-modifiable: - Treatment of underlying disorder
to 5th percentile for age and sex, - Poverty - Long term social support
progressive decrease in weight - Chronic illness
to below the 3rd to 5th percentile,
or a decrease in 2 major growth
percentiles in a short period of Modifiable: Actual/Potential Risks from treatments or procedures:
time. This may be a medical - Environmental neglect (lack of - Not following plan of care after discharge
condition or may be related to food) - Continued undernutrition
environmental factors. All types - Improperly prepared formula
of failure to throve relate to - Inadequate supply of breast milk
inadequate nutrition. Treatment - Poor understanding of feeding
is aimed at restoring proper techniques
nutrition. - Stimulus deprivation
- Acute illness
Organic FTT: growth failure is - Anorexia
due to an acute or chronic
disorder that interferes with
nutrient intake, absorption, Diagnosis
metabolism, or excretion or that
increases energy requirements. Diagnostic Tests:
Illness of any organ system can - Frequent weight monitoring
be a cause. - Height and head size
- Thorough medical, family, and
Nonorganic FTT: due to social history, dietary history
insufficient caloric intake. It - Testing for endocrine disorders
usually manifests first as failure
to gain weight. Most children with Laboratory Tests:
nonorganic FTT manifests - Electrolytes
growth failure before age 1 year - CBC
and many by ages 6 months. - BUN, creatinine
- Urinalysis
Mixed FTT: organic and - Stool for pH, reducing substance,
nonorganic causes can overlap. odor, color, consistency, fat
Children with organic disorders content
also have disturbed - Thyroxine
environments or dysfunctional - Thyroid stimulating hormone
parental interactions. Children
with severe undernutrition cause Consults: (to consider with this disease
by nonorganic FTT can develop process)
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 medical problems. - Dietician
Disease Complication(s): - Pediatrician
- Anemia - Social work
- Malabsorption - Psychiatrist NURSING MANAGEMENT:
- Refeeding syndrome - Psychologist Priority
- UTI - Inpatient or outpatient care System(s) Head to toe, psychosocial
- Sepsis
- Pneumonia Assess - Physical Exam: Skin turgor, anterior fontanel, signs of
- Decreased immune emancipation, weight, temperature, apical pulse,
response respirations, responsiveness, listlessness, irritability
- Anxiety - Interaction: when interviewing the family caregiver,
- Electrolyte imbalances carefully observe the interaction between the
- Delayed mental and caregiver and the child and note the caregivers
physical development responsiveness to the child’s needs and the child’s
- Reduced intellectual response to the caregiver.
capacity - History: take a careful history of feeding and sleeping
patterns or problems.
Presentation: (signs and
symptoms)
- Underweight Do - Provide sensory stimulation
- Reduced growth in head (prioritize) - Maintain adequate nutrition and fluid intake
circumference occurs late - Post feeding: burp child frequently during and at the
indicating very severe or end of each feeding
long standing - Document the intake
undernutrition (brain is - Monitor elimination patterns
preferentially spared in - Encourage caregiver to become involved in child’s
protein energy feedings
undernutrition) - Promote skin integrity
- Smaller and shorter than
peers
- Fussiness or crying
- Lethargy
- Sleepiness
- Constipation Teach - Proper feeding techniques
- Physical delays (walking, - Amount and timing
sitting) - Cueing
- Social delays (interacting, - Post feed instructions
learning) Evaluation - Improved alertness and responsiveness
- Delayed puberty - Increased caloric or oral fluid intake
- Maintained normal urinary and bowel elimination
- Maintained skin integrity
- Improved parenting skills and build parental
confidence
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 Growth and Development Impacts Psychosocial Implications and Concerns (Holistic)
Can develop mental and physical developmental delays Caregiver stress can be a cause. Financial insecurity can be a cause. Do
a thorough family assessment.

Additional Notes:

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