Failure to Thrive (FTT) in infants is a condition characterized by insufficient weight gain or physical growth significantly below expected standards for age and gender. This nursing diagnosis focuses on identifying underlying causes, implementing interventions, and promoting optimal growth and development.
Causes (Related to)
Failure to thrive can result from various factors affecting an infant’s growth and development:
- Inadequate Nutrition:
- Poor feeding techniques
- Incorrect formula preparation
- Breastfeeding difficulties
- Feeding aversion
- Medical Conditions:
- Gastroesophageal reflux disease (GERD)
- Malabsorption disorders
- Congenital heart defects
- Metabolic disorders
- Neurological conditions
- Psychosocial Factors:
- Parental knowledge deficit
- Economic constraints
- Inadequate caregiver-infant bonding
- Environmental stressors
- Parental mental health issues
Signs and Symptoms (As evidenced by)
Subjective: (Caregiver reports)
- Poor feeding
- Irritability during feeds
- Decreased appetite
- Sleep disturbances
- Developmental delays
- Frequent crying
Objective: (Nurse assesses)
- Weight below 3rd percentile for age
- Declining growth curve trajectory
- Loss of subcutaneous fat
- Muscle wasting
- Delayed developmental milestones
- Poor muscle tone
- Lethargy
Expected Outcomes
- The infant will demonstrate consistent weight gain
- The infant will achieve appropriate developmental milestones
- The caregiver will demonstrate proper feeding techniques
- The infant will maintain adequate hydration
- The caregiver will verbalize understanding of nutritional needs
- Growth parameters will improve toward normal percentiles
Nursing Assessment
Monitor Growth Parameters
- Plot weight, length, and head circumference
- Calculate weight-for-length percentiles
- Document growth velocity
- Compare with standard growth charts
Evaluate Feeding Patterns
- Assess feeding frequency and duration
- Monitor intake volume
- Observe feeding techniques
- Document feeding behaviors
- Evaluate breast/bottle feeding efficacy
Assess Development
- Monitor developmental milestones
- Evaluate muscle tone and strength
- Assess social interaction
- Document play behaviors
- Evaluate cognitive development
Review Environmental Factors
- Assess home environment
- Evaluate caregiver knowledge
- Document social support systems
- Screen for barriers to care
- Assess economic resources
Nursing Care Plans
Nursing Care Plan 1: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than body requirements related to inadequate intake/absorption of nutrients as evidenced by weight below 3rd percentile and poor growth velocity.
Related Factors:
- Feeding difficulties
- Poor sucking reflex
- Inadequate caloric intake
- Malabsorption issues
- Limited caregiver knowledge
Nursing Interventions and Rationales:
- Monitor weight daily
Rationale: Tracks nutritional status and intervention effectiveness - Assess feeding patterns
Rationale: Identifies barriers to adequate nutrition - Teach proper feeding techniques
Rationale: Ensures optimal nutrient delivery
Desired Outcomes:
- The infant will demonstrate steady weight gain
- The infant will maintain adequate nutritional intake
- Caregiver will demonstrate proper feeding methods
Nursing Care Plan 2: Risk for Developmental Delay
Nursing Diagnosis Statement:
Risk for Developmental Delay related to nutritional deficits and inadequate stimulation as evidenced by delayed milestone achievement.
Related Factors:
- Malnutrition
- Limited environmental stimulation
- Decreased energy levels
- Poor muscle strength
- Inadequate caregiver knowledge
Nursing Interventions and Rationales:
- Assess developmental milestones
Rationale: Identifies areas needing intervention - Provide age-appropriate stimulation
Rationale: Promotes development and learning - Teach caregivers developmental activities
Rationale: Ensures continued stimulation at home
Desired Outcomes:
- The infant will show progress in developmental milestones
- The infant will demonstrate improved muscle strength
- Caregiver will engage in developmental activities
Nursing Care Plan 3: Caregiver Knowledge Deficit
Nursing Diagnosis Statement:
Deficient Knowledge related to infant feeding and growth requirements as evidenced by improper feeding techniques and inadequate caloric provision.
Related Factors:
- Limited access to information
- Language barriers
- Cultural beliefs
- Lack of previous experience
- Overwhelming responsibilities
Nursing Interventions and Rationales:
- Provide feeding education
Rationale: Ensures understanding of nutritional needs - Demonstrate proper techniques
Rationale: Promotes skill development - Offer culturally appropriate resources
Rationale: Enhances learning and compliance
Desired Outcomes:
- The caregiver will demonstrate proper feeding techniques.
- Caregiver will verbalize understanding of nutritional needs
- Caregiver will identify appropriate growth expectations
Nursing Care Plan 4: Interrupted Family Processes
Nursing Diagnosis Statement:
Interrupted Family Processes related to chronic health conditions as evidenced by difficulty coping with infant’s needs.
Related Factors:
- The stress of chronic condition
- Financial strain
- Time demands
- Limited support system
- Emotional burden
Nursing Interventions and Rationales:
- Assess family coping mechanisms
Rationale: Identifies areas needing support - Provide resource referrals
Rationale: Ensures access to necessary support services - Facilitate support group connections
Rationale: Promotes sharing of experiences and coping strategies
Desired Outcomes:
- The family will demonstrate improved coping skills
- The family will utilize available support services
- The family will report decreased stress levels
Nursing Care Plan 5: Risk for Impaired Attachment
Nursing Diagnosis Statement:
Risk for Impaired Parent-Infant Attachment related to feeding difficulties and chronic health concerns.
Related Factors:
- Feeding challenges
- Infant irritability
- Parental frustration
- Limited bonding opportunities
- Parental anxiety
Nursing Interventions and Rationales:
- Promote skin-to-skin contact
Rationale: Enhances bonding and attachment - Teach infant cues
Rationale: Improves parent-infant communication - Support positive interactions
Rationale: Builds confidence and relationship
Desired Outcomes:
- The parent will demonstrate positive interactions with the infant
- The parent will respond appropriately to infant cues
- The parent will express positive feelings about the relationship
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.
- Franceschi R, Rizzardi C, Maines E, Liguori A, Soffiati M, Tornese G. Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting. Ital J Pediatr. 2021 Mar 10;47(1):62. doi: 10.1186/s13052-021-01017-4. PMID: 33691756; PMCID: PMC7945305.
- Goh LH, How CH, Ng KH. Failure to thrive in babies and toddlers. Singapore Med J. 2016 Jun;57(6):287-91. doi: 10.11622/smedj.2016102. PMID: 27353148; PMCID: PMC4971446.
- Homan GJ. Failure to Thrive: A Practical Guide. Am Fam Physician. 2016 Aug 15;94(4):295-9. PMID: 27548594.
- Ma, Y., Jiang, Q., & Wang, Z. (2019). Clues From Ultrasound for an Infant With Failure to Thrive. Gastroenterology, 157(5), e12-e13. https://doi.org/10.1053/j.gastro.2019.06.015
- Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
