Failure to Thrive (FTT) in infants is a condition wherein the child is not gaining weight at an expected rate. It is identified as a very common problem usually encountered in the Pediatric practice.
Compared to other infants of the same age, children with FTT condition tend to be smaller and shorter. The two classifications of failure to thrive in infants are Organic and non-organic.
- Organic failure to thrive – described as the result of a disease condition
- Non-organic failure to thrive – has no known medical conditions involved
Both types of FTT relate to inadequate nutrition. The pathophysiology of FTT involves the deficiency of calories essential for the adequate growth of the child.
This can be a result of not taking enough calories, losing too many calories, or an increase in caloric demand. It is important to have an early recognition and treatment of Failure to Thrive to prevent possible developmental delays and other long-term effects on the child’s development.
Signs and Symptoms of Failure to Thrive in Infants
An infant with Failure to Thrive (FTT) may exhibit some of these symptoms:
- Height, weight, and head circumference smaller than the standard
- Poor sucking
- Delay in physical skills
- Delay in social and mental skills
- Immobility
- Stiff or “floppy” muscles
- Weak cry
- Unresponsiveness
- Irritability
- Delay in secondary sexual characteristics (during adolescence)
Causes of Failure to Thrive
Failure to thrive can be caused by medical issues or environmental factors. The following are the causes that contribute to the FTT condition:
- Medical Causes of Failure to thrive
- Chromosomal abnormalities
- Major organ system defects
- Congenital digestive system disorders
- Problems with the endocrine system and other hormone deficiencies
- Brain defects
- Food intolerance
- Heart and lung problems
- Metabolic Disorders
- Blood-related issues
- Chronic infections
- Complications during pregnancy
- Lack of digestive enzymes
- Cerebral palsy
2. Other causes
- Inadequate intake – due to economic problem, poverty or poor eating habit
- Physical abuse
- Neglect – not enough food is being offered to the infant; this may be due to breastfeeding problems, errors in milk formula measurements, financial constraints or problems with transitioning from strictly milk feedings to solid foods
- Loss of emotional bond between parent and infant
- Child-caregiver relationship issues such as abuse
- Mental trauma
- Parasitic disease, or exposure to other infections such as tuberculosis
Treatment of Failure to Thrive in Infants
Nutritional rehabilitation is the main concern of the treatment. It should be emphasized that immediate management of acute problems such as dehydration, shock, sepsis and others must first be addressed.
Seeking early help with FTT child’s nutritional needs is a vital move to avoid worsening the condition. Apart from immediate management of acute problems, the nursing care planning and goals for children with Failure to thrive are the following:
- Achievement of ideal weight for height and correction of nutritional deficiencies
- Allowance for catch up growth
- Optimum body composition restoration
- Parental awareness in child feeding and nutritional requirement.
Failure to Thrive Infant Nursing Diagnosis
Possible Infant Failure to Thrive Nursing Diagnosis
- Imbalanced Nutrition: Less than body requirements related to low calorie intake of the infant
- Deficient fluid volume related to inadequate oral intake of the infant
- Disturbed Sensory Perception
- Constipation related to dehydration
- Impaired Parenting related to the lack of knowledge and parenting skills
- Anxiety of the parent or caregiver related to situational crisis of FTT
- Risk for Dehydration
- Risk for Impaired Skin Integrity related to poor nutrition
- Ineffective Coping of the parent or caregiver
Assessment
| Infant Failure to Thrive Nursing Interventions | Rationale |
| Perform a full assessment of the infant:Assess the child for: Height and weight, and trends if there are anyMedical history Signs and symptoms of FTT through physical examAsk the mother/carer for the following:Whether breastfeeding or formula and the frequency/ amount of feedingBehavior of infant while feedingMedical and family history Parental concernsAssess the infant through laboratory tests as indicated by the physician. | To distinguish organic from non-organic FTT, it is essential to know the historic and physical evidence. If the history or physical examinations suggest that the cause of FTT is organic, the child must undergo appropriate diagnostic tests. Most of the recommended tests involve: Complete blood count with differentialErythrocyte sedimentation rateCreatinineElectrolyte levelsUrinalysisStool analysis The results of the initial screenings and laboratory tests will be the basis for a possible requirement of further extensive investigations. |
| Assess the patient’s awareness of his/her condition and reasons for seeking medical intervention. | Some patients seek consultation not just because of their signs and symptoms but also to escape from stressors that may be the reason they are failing to thrive. Identifying this early on will result in timely management. |
| Get the parent or caregiver’s consent for medical intervention and care and explain the reason for each. | Parents or caregivers become more cooperative with the treatment plans if they know about what’s going on. |
| Obtain vital signs of the infant such as blood pressure, temperature, heart rate, respiratory rate, oxygen saturation. Check the current height, weight, and head circumference. | These vital signs are the basic indicators of underlying pathologic processes. Any derangement will show up as abnormal values and point to the possible etiology of the condition. |
Planning and Intervention
| Infant Failure to Thrive Nursing Interventions | Rationale |
| Observe and evaluate the patient’s condition through food chart, growth chart, and daily weight chart. | Since the child is below the ideal weight, regular checking of weights must be one of the interventions. Signs and symptoms continuing imbalanced nutrition must also be assessed and addressed. It is important to consider that appropriate and prompt treatment must be given once organic cause is detected. Parents and caregivers play an important role for the intervention. They can start out with keeping a food diary so an analysis can be made to correlate the food intake with the weight gain. From this information, a diet can be set up for the parents to follow. |
| Perform the actual patient care through the following interventions:Provide sensory stimulationMaintain adequate nutrition and fluid intakeRefer the infant to dietitian and visiting/community nurses | Enlisting dieticians or visiting nurses may also prevent the worsening of the FTTof the child. Furthermore, they can provide psychosocial and educational support for the children’s families. |
| Educate the parent and/or caregiver about nutrient deficiency and how to address it. Identify the poor feeding patterns to be eliminated. | Individualization to the specific needs of the child and family is the strategy to manage the child with psychosocial problems. To address the psychosocial needs of the family, providing specific feeding guidelines and correcting misinformation can help. |
| Set a series of meetings with the parent/ caregiver to discuss concerns and feelings about the infant’s condition. Provide all the necessary institutions and their contact information to the parent/ caregiver. | Since caregivers should be included in the treatment, the perspective of the parents pertaining to their child’s health should not be set aside. It is important to guide the parents in diffusing their emotions and focus their concerns for the health and improvement of the patient. It will be helpful if they will be educated to develop positive goal of enhancing parent-child relationship. The treatment of Failure to Thrive will be more successful if there is a positive and caring partnership between the parent/caregiver and the infant. |
Monitoring
To determine the efficacy of the intervention, the following must be obtained:
- Achievement of ideal weight for height
- Nutritional deficiencies corrected
- Catch up growth allowance achieved
- Optimum body composition restored
- Improved parental awareness in child feeding and nutritional requirement
| Infant Failure to Thrive Nursing Interventions | Rationale |
| Assess the parent or caregiver’s willingness to follow dietary guidelines as prescribed by the nutritionist. | Consistency is the key to successful treatment outcomes. Diligently following the management plan is of vital importance to maintain the patient’s recovering state. |
| Assess for new-onset symptoms. | Some illnesses may masquerade as another illness and may only be diagnosed upon the emergence of other associated symptoms. |
| Assess for the severity of existing symptoms such using standardized scales. | Any change in the intensity, frequency, and location of existing symptoms could imply an ongoing pathologic process that needs immediate attention. |
| Monitor the vital signs, pain status, and patient’s general well-being. | To assess the response to treatment and monitor for side effects brought about by medications, procedures, and other interventions. |
| Assess the parent or caregiver’s adherence to treatment and supportive management. | Continuous compliance to treatment and management indicates good insight on the patient while poor compliance might need additional intervention. |
| Monitor for signs of recent harm, neglect, or abuse of the infant | Parents or caregivers may hide their harmful tendencies in the infant with FTT from health workers and tend to give alibis. It is important to detect if such activities are still ongoing. |
Documentation
One of the most important steps for caring FTT is documentation. It provides insights that will serve as guidance to make formative decisions. Additionally, it will give information if there are improvements of patient’s condition. Documentation of the following information must be taken into consideration:
- Taking notes of the symptoms and perception of the patient
- Daily food diary
- Intake of calorie
- Fluid intake
- Results of laboratory examinations
- Fluid balance
- Changes in weight
- Presence of edema
- Vital signs
- Urine specific gravity
- Financial status of the family
- Parenting skill level
- Religious and cultural restrictions
- Developmental stages
- Plan of care
- Teaching plan
- Actions performed
- Intervention responsiveness
- Outcome progress
- Plan of care modifications
All young children who are diagnosed with FTT, whether primarily organic or psychosocial in origin, suffer from serious malnutrition and are at high risk to develop long term physical and psychological developmental problems.
It is not enough to know the FTT classification type of the patient. The approach must also involve nutritional, developmental and psychosocial influences.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
