1. Interventions/Treatment Modalities: depending on cause of FTT and Childs response to treat nt, most cases are treated on an outpatient basis.
1.1. should receive 2 to 3 times the caloric intake for their normal age for "catch-up" growth
1.2. treat any coexisting medical problems
1.3. family therapy if needed
1.4. behavior modification: mealtime rituals, family social time
1.5. Add caloric density to food and give multivitamin supplements
1.6. primary goal: reverse cause of growth failure
2. Clinical Manifestations
2.1. When was the onset of problem? Right after solids introduced? Medications introduced? Eating disorder with adolescent girls?
2.2. Key assessment findings: fat stores in thighs and butt? Does the child have any extra intestinal manifestations suggestive of inflammatory bowel disease?
2.3. growth failure, developmental delays, undernutrition, apathy, withdrawn behavior, feeding or eating disorders, avoidance of eye contact, minimal smiling.
3. Definition: Inability to obtain enough calories or use calories resulting in inadequate growth. Defined in these categories:
3.1. Not enough calories in: less than the normal requirements of; infant = 100 Kcal/kg/day with a range of 80 – 140 Kcal/kg/day. Child 40-90 Kcal/kg/day, adolescent 30-50 Kcal/kg/day. Regular breast milk and formula contain 20 kCal/30mL = 0.67kCal/mL = 120-210mL/kg/day
3.2. Too much output: vomits or refluxes too much, too much stool or urine output, high insensible losses.
3.3. Too high metabolic demand/inadequate absorption: cerebral palsy, congenital heart disease, hypothyroidism, crohnes, renal diseases, malignancies.
3.4. Defective Utilization: genetic anomalies like trisomy 21 or 18, congenital infection, or metabolic storage diseases.
4. Diagnostics:
4.1. Acute: weight but not length/height is below accepted standards
4.2. Chronic: both weight and height/length are low, which indicates malnutrition
5.2. lead toxicity, anemia, stool-reducing substances, occult blood, ova and parasites, alkaline phosphatase, zinc levels.
6. Four Goals
6.1. Correct nutritional deficiencies and achieve ideal weight for height
6.2. provide adequate calories for "catch-up" growth
6.3. restore optimum body composition
6.4. educate primary caregivers on Childs nutritional requirements and feeding schedule
7. Nursing implications
7.1. plot on appropriate growth chart
7.2. assessment of child and family interactions
7.3. appropriate heigh, length/weight, head circumference.
7.4. keeping record of all food intake
7.5. structure an environment that promotes healthful eating for the child
7.6. monitor for signs of intolerance to formulas
7.7. planned program of play based on childs developmental age
8. Education
8.1. educate caregivers on nutritional requirements of child and age appropriate feeding methods
8.2. educate caregivers on formula preparations and feeding schedules
8.3. NO fruit juice until adequate weight gain is achieved with milk sources - at that time, no more than 4oz a day
9. Etiology/Risks
9.1. Not enough calories: improper mixing of formula, difficulty feeding, neglect, swallowing difficulties, baby with cardiac or occult respiratory issues because they tire out easily, increased metabolic demands.
9.2. living in poverty, infant organic disease, dysfunctional parenting behaviors, subtle neurological or behavior problems, disturbed parent child interactions.
9.3. primary etiology is inadequate caloric intake - whatever the cause.
