Nutrition Interventions for Children with Special Health Care Needs

Chapter 14 - Nutrition Interventions for Failure to Thrive
descriptions which often steer practitioners toward an oversimplified and ineffective
treatment approach. Until there are more useful diagnostic criteria, early age
undernutrition and growth failure can be more accurately conceptualized as a clinical
syndrome related to dynamic multifactorial issues within a child/family’s functioning
that require interdisciplinary treatment. In this way early age growth failure is similar
to eating disorders of older age groups (1,3).
In contrast to the confusion around definitions and diagnostic criteria for FTT,
physiologic risk factors associated with pediatric undernutrition and the benefits
of early intervention are clear. When a child’s nutritional intake is compromised,
slowed weight gain is the first notable growth problem. Generally this is followed
by a decline in the rate of linear growth and head circumference if the degree
of malnutrition is significant or prolonged (4). The potential long-term effects
of these delays include short stature, developmental delays, and/or suppressed
immune function (1). Despite normal variations among children’s growth, the risk of
undernutrition and the benefit of early intervention warrant further evaluation when
one of the following is noted in a child’s growth pattern (1,2,4):
• failure to maintain previously established growth curve
• weight for length or height persistently below the 5th percentile.
A special situation to consider when evaluating early age growth patterns is a child
born prematurely with a weight or length below the 5th percentile that persists
beyond two years of age. Although a premature infant’s weight or length may remain
significantly low for a long period of time, growth velocity may be accelerated,
and the child’s nutrient intake may be adequate (2). Some children born small for
gestational age (SGA) also may remain below the 5th percentile for weight or length.
Catch-up growth potential will vary and, in part, is dependent upon the duration and
cause of the growth retardation.
Caution is warranted when predicting a child’s growth outcome by using specific
ethnic group charts. Data used to formulate growth charts for various ethnic
populations can be misleading, particularly when used for children who have
immigrated to the United States. Research has shown that immigrant children raised
in the United States with increased access to food, grow taller than family members
brought up in their country of origin (5). This phenomenon is also true for American
children whose parents may have short stature in response to nutritional deprivation
during their childhood (6). Thus, it is important to use the CDC growth charts when
assessing the growth of children in the US.
150 Nutrition Interventions for Children With Special Health Care Needs