Pediatric Nutrition

Case Study- Failure to Thrive (FTT)

Article: Failure to Thrive
Nutrition Care Manual

Baby boy, 2 month old Date of Birth (DOB): 4/3/15

Chief Complaint​: Apnea
History of Present Illness:
- History of central and mixed apneas
- Recently discharged from the hospital after having apnea and cyanosis episodes.
- Discharged with caffeine as well as apnea and bradycardia monitor and oxygen via nasal canula.
- Saw the Pulmonary Service in the outpatient. A bronchoscopy and pH probe was scheduled by
them.
- Presented on this admission to the ED secondary to a prolonged episode of apnea at home.
Past Medical History: ​36 wk GA, Central and Mixed Apneas, FTT
Diet: ​Similac Advance ad lib
Social History: ​Lives at home with mother, grandparents, two siblings and aunt
Medications: ​Caffeine, Solumedrol, Zantac
Labs: ​Caffeine- 3.0 Vit D- 33
Testing during Admission:
- Bronchoscopy- findings of nasopharyngeal/laryngeal malacia and airway inflammation
- Swallow Study- (+) for aspiration and reflux
- Findings will make necessary for patient to get a G-tube/Nissen, a trach, and might need
mechanical ventilation
Anthropometrics:
​Weight:
​5/11/15 1 mo 8 days 3.63 kg 34% ile -0.4 z score
6/5/15 2 mo 2 days (admission) 3.65 kg <2%ile -2.9 z score
Height:
5/11/15 51 cm < 2%ile -2.47 z score
6/5/15 52 cm <2%ile -3.37 z score
Weight for Length:
5/11/15 58 %ile 0.22 z score
6/5/15 33 %ile -0.42 z score

Answer the following questions:

1. What is the corrected age for this patient on admission?
1 month
2. Did the patient gain an appropriate amount of weight between one and two months of age?
No, should have gained 20-30g/day within 32 days. He only gained 20 g across the entire time frame
when he should have gained 640-960g. He is at 2.5% of expected weight gain.
 3. Is his failure to thrive related to medical factors or environmental factors?
This child failure to thrive is related to medical factors such as apnea, reflux, neuro
pharyngeal/laryngomalacia and airway inflammation. He cannot breath which may be preventing him
from eating.

4. Why is caffeine being given to this patient?

- reduces the need for the ventilator

- excites respiratory neural output

5. Why is the patient getting Solumedrol and Zantac?

The Zantac is for reflux (antacid).
The Solumedrol is for inflamed airways

6. After conversing with the mother, the baby takes between 15-20 ounces of Similac Advance 20
kcal/oz. each day.
4 out of 7 days he takes 15 ounces
3 out of 7 days he takes 20 ounces

a. What is the average intake of calories, protein, and volume that the patient consumes?
Expressed it as: Kcal kcal/kg
Protein Protein/kg
Volume ml/kg
*expressed as an average
96 kcal/kg
1.85 g protein/kg
143.8ml/kg

b. Is the patient meeting RDA for kcals? Is he meeting RDA for protein?
No, he is not meeting the RDA.
110-120 kcal/kg
3.4-4.5g/kg protein
7. Once the patient gets a g-tube and feeds are initiated via the tube, formulate and initial plan on
how much and potential schedule of his feeds? Refer to page 9 of the Pediatric Formulary Card.

Assume all feeds with the g-tube for aspiration risk.

Provide 3 feeds of 2 oz of 22 kcal/oz

8. Using the malnutrition criteria, does the patient classifies as malnourished? If yes, what degree
of malnutrition?
Meets criteria for severe malnutrition because less than 25% of expected weight gain, weight decline
of 2.5 z-score, and only meeting 80% and 46% of kcal and protein needs respectively.