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Nutritional Assessment- Failure to Thrive Eileen Cress, MS, RD, LDN August 9, 2012. Failure to Thrive. Inadequate physical growth or the inability to maintain the expected rate of growth over time. Undernutrition. Early Detection. First checkups key to early detection
Failure to Thrive
Eileen Cress, MS, RD, LDN
August 9, 2012
Inadequate physical growth or the inability to maintain the expected rate of growth over time.
First checkups key to early detection
Calculate weight gain and compare to minimum recommended infant gain of 15 to 30 g per day after 2 weeks of age, allowing for regain of birth weight (1)
Evaluate Meal Environment
Seated at a highchair or table?
Infants properly held?
Evaluate Meal Patterns/Intake-infants
Infant feeding- amount of breastmilkor formula, other ( juice, water, cereal)
Presence of reflux /vomiting/diarrhea
Frequency of feedings
Evaluate Meal Patterns / Intake
Infant Feeding Guidelines:
Birth–1 month: 2-4 oz, 6 or more times/d
1-3 months: 4-6 oz, 5-7 times/d
3-6 months: 6-7 oz, 4-6 times/d
6-9 months: 6-8 oz, 4-6 times/d
10-12 months: 7-8oz, 3 times /d
Feeding behavior and feeding skill development-infants
Transition to solids 4-6 months
Transition to diced and finger foods 9-12 months, including all food groups
Use of cup 10-12 months
Eliminate bottle at 12 months
Evaluate Meal Patterns/Intake-toddlers
Toddlers- grazing, portions of food items, frequency of meals/snacks.
Food Intake Diary- 3-day including one weekend day
Formula over- dilution
Large amount of baby cereal in bottle
Excess juice or other beverage
No feeding schedule
No high chairs/ Infants not held to bottle feed
Estimating nutrient needs
Energy and protein needs determined by using Dietary Reference Intakes of the Food and Nutrition Board, National Academy of Sciences.
Catch up growth
Kcal/kg age x IBW for ht (kg) = kcal/kg actual wt
Gm/kg for age x IBW for ht (kg) = gm/kg actual wt
actual wt (kg)
Develop feeding schedule
Food additives to puree foods
Food Additives to Enhance Calories (4)
http://abbottnutrition.com(Abbott Nutrition/ Similac products)
http://www.gerber.com( Gerber/Nestle Good Start products)
http://www.mjn.com(Mead Johnson/Enfamil products)
1. Gahagan S., Holmes R. A Stepwise Approach to Evaluation of Undernutrition and Failure to Thrive.
PediatrClin North Am. 1998 Feb; 45(1): 169-87.
2. A.S.P.E.N. Board of Directors. Nutrition Assessment: Pediatrics . J Parenter Enteral NutrJanuary 2002 26:
3. Mascarenhas, M R., Zemwl, B, Stallings, V.A. Nutritional Assessment in Pediatrics. Nutrition 1998. 14(1):105-
4.Samour, P.Q., King, K. Pediatric Nutrition. 2012, 4th ed. Jones and Bartlett., Sudbury, MA..