FAILURE TO THRIVE

• Often called pediatric undernutrition or protein- energy

malnutrition.
• Is a unique syndrome in which infants weight is less than
the norms for their gestation corrected age, sex, genetic
potential, and medical condition.
• Weight below the 5 the percentile for age and sex
• Weight for age curve falls across two major percentile
lines
• Inadequate physical growth diagnosed by observation of
growth over time using a standard growth chart
 TWO CATEGORIES
1. Syndromes that can be explained because of Organic
causes Which Occurs when there is an underlying medical
cause , such as cardiac disease.
2. Syndromes that can occur because of a Disturbance in
the parent-child relationship, Resulting in maternal role
insufficiency ( unorganic cause ).
3. Idiopathic failure to thrive -unknown cause
 ASSESSMENT

• Weigh all child at routine health assessments, and plot and

compare their weight with standard growth curves.
• Take a detailed pregnancy history because in many
instances a breakdown in the development of parenting
began in the prenatal period.
 SIGNS AND SYMPTOMS
• Lethargy with poor muscle tone, a loss of subcutaneous fat,
or skin breakdown.
• Lack of resistance to the examiners manipulation, unlike the
response of the average infant.
• Rocking on four excessively, as if seeking stimulation, if
emotionally deprived.
• Possibly a reluctance to reach for toys or initiate human
contact than is demonstrated by the average infant.
• Starring hungrily at people who approach them as if they are
starved for human contact. Some health care personnel have an
uneasy feeling when caring for these infants because the eye
contact is so intense.
• Little cuddling or conforming to being held by the second month
of life.
• Markedly delayed or absent speech because of lack of
interaction.
• Diminished or non existent crying
• Lack of appropriate weight gain
• Irritability
• Easily fatigued
• Excessive sleepiness
• Lack of age-appropriate social response (i.E.,Smile)
• Avoids eye contact
• Lack of molding to the mother's body
• Does not make vocal sounds
• Delayed motor development
 Child may contribute to the poor parenting
interaction by being
• Irritable
• Fussy
• Colicky
• Difficult child
POTENTIAL COMPLICATIONS
• Persistent short stature
• Secondary immune deficiency
• Increased susceptibility to infection, establishing an
infection-malnutrition cycle since illness decreases
appetite and nutrient intake, which leaves the child
vulnerable to severe or prolonged infections
• Permanent damage to various parts of the brain and
CNS
Normal growth in infants
• Average birth weight = 3.3kg
• Weight drops as much as 10% in first few days of
life (likely due to loss of excess fluid)
• Birth weight should be gained back by 10days of
age.
• Birthweight should be doubled by age 4months and
tripled by age 12 months.
ON AVERAGE, INFANTS GAIN:
• 26-31grams per day from 0-3 months
• 17-18 grams per day from 3-6 months
• 12-13 grams from 6-9 months
• 9-13 grams per day from 9-12 months
• 7-9 grams per day from 1- 3 years
LENGTH INCREASES BY:
• 25cm during the 1st year
• 12.5 cm in the 2nd year
• 5-6cm/year between 4 years old and puberty
• Up to 12cm/year around puberty
• Head circumference average at birth = 35cm
• Head circumference increases, on average, to:
• 47 cm by age 1 year
• 55 cm by age 6 years
DIAGNOSTIC AND EVALUATION
TEST
• Denver developmental screening test-Used to show any delays in
development.
• Growth chart
• The following tests may be done:
• Complete blood count (cbc)
• Electrolyte balance
• Hemoglobin electrophoresis to check for conditions such as sickle
cell disease
• Hormone studies, including thyroid function tests
• X-rays to determine bone age
• Urinalysis
 TREATMENT
• Treatment depends on the underlying cause
• High calorie diet for catch up growth
• 150% of recommended daily caloric intake based on expected weight
• +/- feeding behavior modification
• Psychosocial involvement/ intervention
• Close follow up
• Physical and cognitive delays
• Hospitalization when necessary
• Correct any vitamin or mineral deficiencies
• Identify and treat any other medical conditions
 NURSING INTERVENTION

• Monitor carefully intake and output

• Assess stool for ph and reducing substances (glucose) to be
certain that the child is absorbing nutrients.
• If a stool tests positive for glucose or has an acid ph (less than
7.0), it suggests that not even carbohydrates , the easiest food to
absorb, are being processed.
• Evaluate how the infant sucks or is able to take food from a spoon
and swallow.
• Record any symptoms, such as pulling up the legs or crying after
eating, that suggest gastrointestinal discomfort.
• Nurture the child
• support and encourage the parents
IMPAIRED PARENTING SKILLS
• Provide consistent care
• Involve parents in care
• Teach parents positive feeding techniques.
• Maintain face to face posture with the child
• Talk to child encouragingly during feeding
• Give positive feedback
• Demonstrate and reinforce responding To child’s Cues
PARENTAL BEHAVIOR
• May need reassurance to help with their own anxiety
• Encourage, but don’t force, child to eat
• Make meals pleasant, regular times, don’t Rush
• May need to schedule meals every 2-3 Hours
• Make the child comfortable
• Encourage some variety and cover the Basic food groups
• Snacks between meals
 PREVENTION

• REGULAR CHECK-UPS CAN

HELP DETECT FAILURE TO
THRIVE IN CHILDREN
 NEONATAL SEPSIS
• Neonatal sepsis is a blood
infection that occurs in an baby
younger than 90 days. Example :
bacterial blood stream infection
(BSI) (such as meningitis,
pneumonia, pyelonephritis, or
gastroenteritis) which results in
fever.
 CAUSES
Neonatal sepsis can be caused by a variety of bacteria, viruses and
pathogens. Infants can get sepsis by either vertical or horizontal
transmission:
 Vertical transmission: a maternal infection spreads to the baby
shortly before delivery, or during delivery.
 Horizontal transmission: the baby acquires an infection due to
contact with environmental contaminants, caregivers or healthcare
providers.
SIGNS & SYMPTOMS OF SEPSIS
➡️Fever or low temperature (newborns and infants may
have low temperature)
➡️Fast heart rate.
➡️Fast breathing.
➡️Feeling cold/cold hands and feet.
➡️Clammy and pale skin
➡️Shortness of breath.
➡️Extreme pain or discomfort.
• Diarrhea • Seizures
• Low blood sugar • Abdominal swelling
• Reduced movement • Jaundice
• Reduced
sucking/feeding
 RISK FACTORS FOR NEONATAL
SEPSIS
• Birth asphyxia
• Premature rupture of
the membranes (water • Meconium staining
breaking) • Urinary catheterization
• Premature birth • Mechanical ventilation
• Chorioamnionitis • Poor feeding
• Poor prenatal care advancement
 TREATMENT
• Infants younger than four weeks old who have signs of infection
and/or a fever will receive antibiotics (iv) immediately.
• If the mother had chorioamnionitis or other risk factors, the infant
will receive iv antibiotics, even if there are no symptoms present.
• If bacteria is found in the spinal fluid, the infant will receive
antibiotic treatment for up to three weeks.
• For infections related to the herpes simplex virus (hsv), infants may
receive acyclovir, an antiviral medication.
 PREVENTION OF NEONATAL
SEPSIS
🔴Avoiding unnecessary separation of the newborn from the
mother
🔴Hand-washing before delivering and handling the infant.
🔴Good basic hygiene and cleanliness during delivery
🔴Appropriate umbilical cord care.
🔴Appropriate eye care.