HOLY FAMILY COLLEGE OF NURSING

EVALUATION PERFORMA FOR CLINICAL PRESENTATION

Name-
S.NO. CRITERIA ALLOTED MARKS OBTAINED MARKS
1. Lesson plan (organization and adequacy of content, 20
submission, planning)
2. Preparation of class 5
3. Introduction 5
4. Subject matter and depth of knowledge 5
5. A.V aids 30
6. Confidence 10
7. Language and voice 10
8. Grooming 5
9. Summary & conclusion 5
10. Punctuality 5

Total 100

Remarks:

Signature of the Supervisor:

HOLY FAMILY COLLEGE OF NURSING
NEW DELHI.

CLINICAL TEACHING
ON
FAILURE TO THRIVE.
IDENTIFICATION DATA

NAME :

CLASS :

SUBJECT : CHILD HEALTH NURSING

TOPIC : CLINICAL TEACHING ON FAILURE TO THRIVE

DATE OF PRESENTATION :

PLACE : CLINICALS

DURATION : 15 MINS.

METHOD OF TEACHING : LECTURE CUM DISCUSSION

SUPERVISOR :

AV AIDS : CHARTS, FLASH CARDS

PREVIOUS KNOWLWDGE OF THE STUDENTS:
Students may have some knowledge about the normal growth and development of the child.

GENERAL OBJECTIVES:

Group point of view:

At the end of the teaching session the group will be able to

 Gain knowledge about the topic failure to thrive
 Able to assess the condition in the clinical areas.

Student teacher point of view:

 Teach the group effectively.

 Realize the cognitive functions.
 Develop and improve professional efficiency.

SPECIFIC OBJECTIVES:

- Introduce the topic.

- Define failure to thrive.
- Explain the types of causes of failure to thrive.
- Explain the pathophysiology of failure to thrive.
- Enlist the clinical manifestations of FTT.
- Enlist the possible complications of FTT.
- List the diagnostic tests for FTT.
- Explain the management and nursing management of FTT.
Time Specific Content Teaching and Evaluation
Objective Learning Activity

1 min Introduce the Introduction:

topic
Failure to Thrive is a
common problem of
children from usually
poor socio-economic
group. This term as
Emotional
Deprivation and as
Maternal Deprivation
syndrome. Failure to
thrive is not a disease,
but a sign of
inadequate nutrition.
Inadequate physical
growth diagnosed by
observation of growth
over time using a
standard growth chart.
Time Specific Objective Content Teaching and Evaluation
Learning Activity

2min Define the topic Definition: Student teacher Define FTT.

s defines about FTT
Failure to thrive can be defined as a chronic potentially lifethreatening disorder of
infant and children who fail to gain weight and even lose weight. The children with
FTT show failure of expected growth and noticeable lack of wellbeing. It indicates
psychosomatic growth failure.
Or

It may be defined as inadequate physical growth diagnosed by observation of growth

over time using a standard growth chart where weight fall below the 5th percentile for
age and sex.

Explain the causes Causes: Student teacher What are the

5min for FTT explains about types of causes of
s The causes of FTT have been divided into endogenous(organic) and exogenous (non- types of causes FTT?
organic) causes and mixed causes. FTT
But experts now days suggest that FTT be classified accordingly to pathophysiology in
the following categories:

- Inadequate caloric intake

- Malabsorption/caloric retention defect
- Increased metabolic demands.
- Defective utilization
Tim Specific Objective Content Teaching and Evaluation
e Learning Activity
The cause of growth failure is often multifactorial and involves a combination of infant
organic disease, dysfunctional parenting behaviours, subltle neurological problems and
disturbed-child interactions.

a. Organic or Endogenous

- Causes are due to physical or mental issues with the child itself. It can include
various inborn errors of metabolism. Problems with the gastrointestinal system
such as excessive gas and acid reflux are painful conditions which may make
the child unwilling to take in sufficient nutrition.
- Cystic fibrosis, diarrhoea, liver disease, anaemia or iron deficiency, Crohn's
disease, and coeliac disease make it more difficult for the body to absorb
nutrition.
- Other causes include physical deformities such as cleft palate and tongue tie.
- Milk allergies can cause endogenous FTT.FAS (Fetal alcohol syndrome) has
also been associated with failure to thrive.
- Also the metabolism may be raised by parasites, asthma, urinary tract
infections, and other fever-inducing infections, hyperthyroidism or congenital
heart disease, so that it becomes difficult to get in sufficient calories to meet the
higher caloric demands.
Tim Specific Objective Content Teaching and Evaluation
e Learning Activity

b. Inorganic or Exogenous

- Caused by caregiver's actions. Examples include physical inability to produce

enough breastmilk, using only babies' cues to regulate breastfeeding so as to
not offer a sufficient number of feeds (sleepy baby syndrome).
- Difficulties with sensory processing are more commonly observed in toddlers
who have a history of growth deficiency and feeding problems; however,
further research is required in order to determine a causal relationship between
sensory processing problems and nonorganic FTT.

c. Mixed
- In the terms as dichotomous can be misleading, since both endogenous and
exogenous factors may co-exist.

- For instance, a child who is not getting sufficient nutrition may act content so
that caregivers do not offer feedings of sufficient frequency or volume, and a
child with severe acid reflux who appears to be in pain while eating may make
a caregiver hesitant to offer sufficient feedings.
Tim Specific Objective Content Teaching and Evaluation
e Learning Activity

Other subtypes include:

1. Inadequate caloric intake

- Poverty/inadequate food supply – number one risk factor for failure to thrive
globally.
- Improper mixing of formula.
- Postpartum depression/maternal depression – studies have shown that mothers
with postpartum depression are at increased risk for experiencing breastfeeding
difficulties.
- Cleft lip and cleft palate – impaired oral motor coordination/poor suck.
- Cerebral palsy/hypotonia.
- Gastroesophageal reflux disease – symptoms of irritability, fussiness, and
spitting up that occur shortly after feeding. Typically resolves by 1–2 years of
age.
- Malrotation
- Pyloric stenosis - Most commonly presents at 1–2 months of age with forceful,
projectile vomiting immediately after feeds. More common in first-born males.
Tim Specific Objective Content Teaching and Evaluation
e Learning Activity
 2. Malabsorption/caloric retention defect

- Lactose intolerance/cow's milk protein allergy – affects 2–3% of infants during

the first year of life
- Coeliac disease
- Short bowel syndrome – necrotizing enterocolitis is the most common cause.
- Cystic fibrosis
- Biliary atresia.

3. Increased metabolic demand

- Hyperthyroidism
- Chronic infections – tuberculosis
- TORCH infections – toxoplasmosis, other (syphilis, varicella zoster, parvovirus
B19), rubella, cytomegalovirus, herpes
- Inflammatory bowel disease
- Diabetes mellitus
- Congenital heart defects
- Chronic lung disease – bronchopulmonary dysplasia, bronchiectasis
- Inborn disorders of metabolism – galactosemia, glycogen storage diseases.

4. Defective utilization

Genetic anomaly such as trisomy 21 or 18, congenital infection, or metabolic storage

diseases.
Time Specific Objective Content Teaching and Evaluation
Learning Activity

5min Explain the Pathophysiology Student teacher What is the

s pathophysiology of Precipitating factor (Medical,
explains about the pathophysiology
FTT Predisposing factor (Age, pathophysiology of of FTT?
Sex, Genetics, Race)Psychosocial, Behavioural)
FTT

Organic cause Inorganic cause

Inadequate calorie- protein intake

Calorie- protein deficiency

Depletion of adipose tissue or fat tissue Adequate response of adrenal cortex

Loss of lean body tissue Optimal Increase in plasma cortisol

Weight loss, decreased energy, Growth hormone response inhibited

reduced body movement and
weaknesses.
Growth retardation

Failure to thrive
Time Specific Objective Content Teaching and Evaluation
Learning Activity
5min Enlist the clinical Clinical Manifestations: Student teacher What are the
s manifestations of Lethargy with poor muscle tone, a loss of subcutaneous fat, or skin breakdown. explains about the clinical
FTT  Lack of resistance to the examiner’s manipulation, unlike the response of the clinical manifestations of
average infant. manifestation of FTT?
 Possibly a reluctance to reach for toys or initiate human contact than is FTT
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.
 A child may contribute to the poor parenting interaction by being
- Irritable
- Fussy
- Colicky
- Difficult child
Other symptoms:
 lack of appropriate weight gain
 irritability
 easily fatigued
 excessive sleepiness
 lack of age-appropriate social response (i.e., smile)
Time Specific Objective Content Teaching and Evaluation
Learning Activity

 avoids eye contact

 lack of molding to the mother's body
 does not make vocal sounds
 delayed motor development
Student teacher What can be the
2min Enlist the possible Potential complications enlists the possible possible
s complications of complications of complications of
FTT.  Persistent short stature FTT. FTT if not
 Secondary immune deficiency treated?
 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.

Diagnostic and Evaluation test

List the diagnostic
5min tests for FTT  Denver Developmental Screening Test- used to show any delays in Student teacher What are the
s development. lists down the diagnostic tests
diagnostic tests for for FTT?
 Growth chart
FTT.
 Dietary intake history either a 24- hour intake or a history of food consumed
over 3 to 5-day period.
Tim Specific Objective Content Teaching and Evaluation
e Learning Activity

The following tests may be done:

o Complete blood count (CBC)

o Electrolyte balance
o Hemoglobin electrophoresis to check for conditions such as sickle cell
disease
o Hormone studies, including thyroid function tests
o X-rays to determine bone age
o Urinalysis
o
 If indicated, anti-TTG IgA antibodies can be used to assess for Celiac's disease,
and a sweat chloride test is used to screen for cystic fibrosis.
 If no cause is discovered, a stool examination could be indicated to look for fat
or reducing substances.
 C-reactive protein and erythrocyte sedimentation rate (ESR) can also be used to
look for signs of inflammation.
Time Specific Objective Content Teaching and Evaluation
Learning Activity
7min Explain the Management Student teacher What is
s management and explains about the management for
nursing Treatment depends on the underlying cause management and FTT?
management of • High calorie diet for catch up growth: The child may require multivitamin nursing
FTT supplements and dietary supplementations with high calorie foods and drinks. Co- management of
existing medical problems are treated. FTT
• Psychosocial involvement/ intervention
• Close follow up
• Physical and cognitive delays
• Hospitalization admission is indicated for:
- Evidence(anthropometric) of severe acute malnutrition,
- Child abuse or neglect
- Significant dehydration
- Caretaker substance or psychosis.
• Correct any vitamin or mineral deficiencies

Nursing care management:

 Caring for the child with FTT presents many nursing challenges, whether
treatment takes place in the hospital or home.

 Providing a positive feeding environment, teaching parents successful feeding

strategies and supporting the children.
Tim Specific Objective Content Teaching and Evaluation
e Learning Activity

 Parental involvement in treatment plan and care is vital.

 Emotional support to the parents and necessary instructions are essential for
improvement of parent-child relationship and resolution of emotional conflict
of the child.

 Regular follow-up should be done for effective management.

Summary:

At the end of the topic I summarize it and I have discussed about introduction,
definition, causes, types, subtypes, pathophysiology, possible complications, diagnostic
evaluation, management and nursing management.

Conclusion:

I hope all have understood my topic. Thank you all for your cooperation.
Bibliography:
Dutta Parul, “Paediatric Nursing”, Second edition, Jaypee Publishers.
Wong’s, “Essential Of Paediatric Nursing”, First South Asian Edition, Elsevier.
www.wikipedia.com