NCMA 219 CU7

• FAILURE TO THRIVE - Growth failure due to inadequate intake of calorie that is essential for growth.
• FAILURE TO THRIVE - Less than expected growth for 3 years.
• FAILURE TO THRIVE - Peak incidence of FTT at the age of 9-24 months.
• FAILURE TO THRIVE - Uncommon at the age of 5 years old.
• FAILURE TO THRIVE - Majority of children who is affected is less than or equal 18 months old.
• FAILURE TO THRIVE - Gender is not a basis to acquire FTT.
• FAILURE TO THRIVE - Weight for length is reported to be a better - indicator of acute under nutrition.

   
• FAILURE TO THRIVE

  • According to waterlow criteria, severe FTT is <70% median.
  • According to Cole and Lanham (2011), FTT is a weight curve that crosses more than 2 percentile lines on a standardized growth chart after previous achievement of a stable growth pattern.
• FAILURE TO THRIVE

  1. Infants who are born: Preterm, VLBW or ELBW, IUGR.

  • Are referred for growth failure within the first 2 years of life, they do not grow physically at the same rate as term.
  • Catch-up growth is much more difficult to achieve in ELBW and VLBW infants.

   
• EXAMPLE OF FTT:

  A child under 6 months who has not grown for 2 months.

  A child over 6 months who has not grown for 3 months.
• ORGANIC FTT - Secondary to underlying illness.
• NON-ORGANIC FTT - Psychosocial FTT, no known medical condition that causes poor growth, inadequate food or  nutrition.
• MIXED FTT - Organic and non organic causes coexist.
• CATEGORIES OF FTT ACCORDING TO PATHOPHYSIOLOGY:

  INADEQUATE CALORIE INTAKE - Caused by environmental and financial factors.

  INADEQUATE ABSORPTION - Caused by underlying disease.

  INCREASED METABOLISM - Caused by underlying disease.

  DEFECTIVE UTILIZATION - Caused by genetic or chromosomal abnormalities.
• CAUSES OF FTT:

  • Multifactorial

  Underfeeding is the most common cause.

   
• RISK FACTORS: FTT

  • Low-socio economic stress

  Increase psycho-social stress

   
• SIGNS AND SYMPTOMS: FTT

  • Weight < 5th percentile
  • Developmental delays
  • Withdrawn behavior
  • Feeding or eating disorder
  • No fear of strangers
  • Avoidance of eye contact
  • Stiff, unresponsive and minimal smiling.
  • Decreased prealbumin with blood work.
• DIAGNOSIS: FTT

  1. Identify underlying diseases such as:

  • Cystic fibrosis
  • Hyperthyroidism

   
• NUTRITIONAL MANAGEMENT: FTT

  • Correct nutritional deficiencies.  
  • Allow for catch up growth.
  • Increase calorie intake.
  • Concentrate the milk formula.
  • Replace whole milk for high calorie milk for toddlers.
• If FTT is severe - Tube feeding and TPN is necessary.

   
• CONTRAINDICATION: FTT

  • Avoid juice and no calorie food.

   
• SUDDEN INFANT DEATH SYNDROME (SIDS)

  • Sudden unexpected death of any infant.
  • Death usually occurs during sleep.
  • Death is unexplained by post mortem examination.
• SIDS - Most common cause of death in children ages as 1 month to 1 year.
• SIDS - Peak: 2-4 months, 95%-6th months.
• ETIOLOGY: SIDS

  • Usual cause is unknown.
  • Hypoxemia
  • Apnea
  • Immature nervous system
  • Brain stem abnormality in neuro regulation of cardio-respiratory control.

   
• APPERANCE WHEN FOUND: SIDS

  • Blue, apneic & lifeless.
  • Frothy blood tinged fluid in nose and mouth.
  • Blanket over head, huddled in a corner with dishevel bed.
  • Diaper is filled with stool & urine.
  • Mother is horrified.

   
• NURSING MANAGEMENT: SIDS

  • Evaluate family coping and grieving patterns.
  • Provide anticipatory guidance for typical  feelings.
  • Allow the parent to verbalize; listen and validate feelings.
  • Refer for counselling if needed.
  • Monitor infants at risk for apnea.
  • Teach parents how to minimize the risk for SIDS.

   
• AVOID THE FOLLOWING: SIDS

  • Co-sleeping
  • Soft, moldable matress
  • Use of pillows/blankets
  • Overheating during sleep
  • Smoking
  • Baby sleeping in supine or side-lying position.
• Colic - is a paroxysmal abdominal pain that generally occurs in infants under 3 months of age.
• Colic is identified using the “Rule of Three” - inconsolable crying that lasts more than three hours a day and occurs more than three days a week for at least three weeks.
• COLIC - Often the crying occurs late in the day, around the same time — some doctors call it “the witching hour” — though crying can occur at other times (nytimes.com, 2020)
• CAUSES OF COLIC:

  • The cause is unclear
  • Overfeeding,
  • Swallowing too much air while feeding.
• COLIC - Formula milk too high in carbohydrate.

  • Formula-fed infants are more likely to have colic than breastfed infants.
• OTHER MANIFESTATIONS: COLIC

  • Vigorous sucking then stopping when another wave of intestinal pain occurs.
  • Bowel movement are normal.
  • Infants with colic still thrive
• Colic interferes with parental sleeping and may interfere with the formation of the parent-child relationship.

   
• • Colic usually disappears at 3 months when digestion becomes easier, and the child can maintain a more upright position, allowing less gas to form.
• CRYING RELATED TO COLIC IS DIFFERENT IN THE FOLLOWING WAYS:

  • The infant may have been happy, fussy, feeding, or even sleeping.
  • The crying episode begins suddenly and often occurs in the evening hours.
  • Colic episodes are more intense, louder, and higher pitched than "normal" crying. Infants with colic may sound as if they are in pain or are screaming.
• Infants with colic are difficult or impossible to soothe, no matter what the parents do. There may be periods of quiet, but infants often remain fussy. Crying may end after the infant passes gas or a bowel movement.
• INFANTS WITH COLIC MAY HAVE PHYSICAL SYMPTOMS OF INCREASED MUSCLE TONES IN BABIES:

  • The baby's face is red, and the skin around the mouth is pale.
  • The belly is bulging and hard.
  • The legs are drawn into the belly, and the feet are cold. (The legs can also be straight out when the baby cries especially hard.)
  • The fingers are clenched shut.
  • The arms are stiff, tight, and straight. (The elbows can also be bent.)
  • The back is arched.
• OTHER CAUSES OF EXCESSIVE CRYING: COLIC

  1. A parent should first check for manageable causes of crying:

  • HUNGER – Try feeding the baby to see whether hunger is the problem.
  • PAIN – illness, physical injury, tight clothing, hair tourniquet.