Nutrition Interventions for Children with Special Health Care Needs

The Cause of Growth Failure
Section 3 - Condition-Specific Nutrition Interventions
Historically, the origins of early age growth failure have been dichotomized as
organic or non-organic FTT (1,2). Although this view has evolved into the complex
understanding of mixed etiology, practitioners tend to oversimplify issues of cause as
static rather than interrelated and evolving (1). It is important to recognize that the
majority of children who fail to thrive do so because of multiple, interrelated factors
that may result from the child, the parent, the parent-child relationship, and the
many influences of extended family, culture, and community (1,2,7-10).
As the development of feeding and growth problems is better understood, the
integral relationship between feeding and emotional development becomes clear.
Early on, most infants positively connect internal feelings of hunger with the
satisfying outcome of eating (8-10). Similarly, young infants begin to positively
connect their desire for socialization and comfort with reciprocated parental gestures,
eye contact, and soothing verbal praise. The infant who repeatedly looks into the
blank, expressionless face of a detached, depressed parent may, over time, make
fewer, less sustained bids for her parent’s attention even at feeding.
As the infant’s ability to communicate different needs improves, parents are better
able to read and respond to their child’s cues. Both the parent and the child come
to trust the positive outcome of having the infant’s needs met and the parent’s
satisfaction in doing so. The benefits of such attunement reach beyond early infancy
to the time when the child begins her own struggle for autonomy. Success in this
early relationship lays the foundation for ongoing healthy interactions between a
parent and child as they navigate future developmental stages (2,8-10).
There are numerous factors within both a parent and child’s life that may negatively
impact early associations with food and a child’s desire to express hunger and need
for comfort (2,7). Examples of factors pertaining to the child include prematurity,
developmental delays, or various illnesses. Infants born prematurely often have
immature lungs, compromised gastrointestinal absorption, and/or weak oral motor
skills. Infants with these complications fatigue easily during feedings and are often
unable to take in an adequate volume of food or absorb all nutrients required for
growth without nutritional support. Other infants with low tone or developmental
delays may be unable to communicate hunger discomfort in order to elicit a
consistent parental response and establish a positive connection to feeding tasks or
food. Parents of such children often report a history of a baby who seldom cries and
does not express hunger or discomfort for other reasons.
Other common conditions include cardiac anomalies that can cause a child to fatigue
easily during feedings and/or require restriction of fluid intake in order to avoid
Nutrition Interventions for Children With Special Health Care Needs 151