DISEASES OF THE NEWBORN
 Colic is a condition generally described as abdominal pain or
Failure to Thrive (FTT)
 Growth failure is a sign of inadequate growth resulting from an
inability to obtain or use calories required for growth. One of the
more common criteria is weight that falls below the fifth
percentile for the child’s age. Another definition of FTT includes
a weight for age (height) z value of less than −2.0 (a z value is
a standard deviation value that represents anthropometric data
normalizing for sex and age with greater precision than growth
percentile curves [Markowitz, Watkins, and Duggan, 2008]).
According to Cole and Lanham (2011) FTT is a weight curve
that crosses more than 2 percentile lines on a standardized
growth chart after previous achievement of a stable growth
pattern. Weight for length is reported to be a better indicator of
acute undernutrition.
 FTT was classified before as organic FTT and nonorganic FTT
but later it was classified according to pathophysiology in the
following categories:
 Inadequate caloric intake – Incorrect formula preparation,
neglect, food fads, excessive juice consumption, poverty,
breastfeeding problems, behavioral problems affecting
eating or central nervous system problems affecting
intake.
 Inadequate absorption - Cystic fibrosis, celiac disease,
vitamin or mineral deficiencies, biliary atresia, or hepatic
disease.
 Increased metabolism - Hyperthyroidism, congenital heart
disease, hyperthyroidism, or chronic immunodeficiency.
 Defective utilization—Genetic anomaly such as trisomy 21
or 18, congenital infection, or metabolic storage diseases.
 The cause of growth failure is often multifactorial and involves a
combination of infant organic disease, dysfunctional parenting
behaviors, subtle neurologic or behavioral problems, and
disturbed parent–child interactions.
 Infants who are born preterm and with VLBW or ELBW, as well
as those with intrauterine growth restriction (IUGR), are often
referred for growth failure within the first 2 years of life because
they typically do not grow physically at the same rate as term
cohorts even after discharge from the acute care facility. Catch-
up growth has been shown to be much more difficult to achieve
in ELBW and VLBW infants.
 Diagnosis is initially made from evidence of growth failure. If
FTT is recent, the weight, but not the height, is below accepted
standards (usually the fifth percentile); if FTT is longstanding,
both weight and height are low, indicating chronic malnutrition.
Perhaps as important as anthropometric measurements are a
complete health and dietary history (including perinatal history),
physical examination for evidence of organic causes,
developmental assessment, and family assessment. A dietary
intake history, either a 24-hour food intake or a history of food
consumed over a 3- to 5-day period, is also essential. In
addition, explore the child’s activity level, parental height,
perceived food allergies, and dietary restrictions.
 The primary management of FTT is aimed at reversing the
cause of the growth failure. The goal is to provide sufficient
calories to support “catch-up” growth—a rate of growth greater
than the expected rate for age. In addition to adding caloric
density to feedings, the child may require multivitamin
supplements and dietary supplementation with high-calorie
foods and drinks. Any coexisting medical problems are treated.
Providing a positive feeding environment, teaching the parents
successful feeding strategies, and supporting the child and
family are essential components of care. Accurate assessment
of initial weight and height and daily weight, as well as
recording of all food intake, is mandatory.
 Four primary goals in the nutritional management of children
with FTT are to: correct nutritional deficiencies and achieve
ideal weight for height; allow for catch-up growth; restore
optimum body composition; and educate the parents or primary
caregivers regarding the child’s nutritional requirements and
appropriate feeding methods.
Abdominal Colic
cramping that is manifested by loud crying and drawing the legs
up to the abdomen. Other definitions include variables such as
duration of cry greater than 3 hours a day occurring more than
3 days a week and for more than 3 weeks and parental
dissatisfaction with the child’s behavior. Colic is more common
in infants younger than 3 months than in older infants, and
infants with difficult temperaments are more likely to be colicky.
Despite the obvious behavioral indications of pain, the infant
with colic gains weight and usually thrives. There is no
evidence of a residual effect of colic on older children. Colic is
self-limiting and in most cases resolves as infants mature,
generally around 12 to 16 weeks of age.
 Potential causes for colic are too rapid feeding, overeating,
swallowing excessive air, improper feeding technique
(especially in positioning and burping), and emotional stress or
tension between the parent and child. Although all of these may
occur, there is no evidence that one factor is consistently
present. Colic is multifactorial and that no single treatment for
every colicky infant will be effective in alleviating the symptoms.
 Management of colic should begin with an investigation of
possible organic causes (intussusception, cow’s milk allergy, or
other GI problems). One important nursing intervention (before
or after an organic cause has been eliminated) is reassuring
both parents that they are not doing anything wrong and that
the infant is not experiencing any physical or emotional harm.
The initial step in managing colic is to take a thorough, detailed
history of the usual daily events. Areas that should be stressed
include (1) the infant’s diet; (2) the diet of the breastfeeding
mother; (3) the time of day when crying occurs; (4) the
relationship of crying to feeding time; (5) the presence of
specific family members during crying and habits of family
members, such as smoking; (6) activity of the mother or usual
caregiver before, during, and after crying; (7) characteristics of
the cry (duration, intensity); (8) measures used to relieve crying
and their effectiveness; and (9) the infant’s stooling, voiding,
and sleeping patterns. Of special emphasis is a careful
assessment of the feeding process via demonstration by the
parent.
 Colic disappears spontaneously, usually by 3 to 4 months of
age, although guarantees should never be given, since it may
continue for much longer. Other support persons and extended
family members may be enlisted to help the parents during this
difficult time.
Sudden Infant Death Syndrome (SIDS)
 Sudden infant death syndrome is defined as the sudden death
of an infant younger than 1 year of age that remains
unexplained after a complete postmortem examination. There
are numerous theories regarding the etiology of SIDS; however,
the cause remains unknown. One hypothesis is that SIDS is
related to a brainstem abnormality in the neurologic regulation
of cardiorespiratory control. This maldevelopment affects
arousal and physiologic responses to a life-threatening
challenge during sleep (AAP, Task Force on Sudden Infant
Death Syndrome, 2005). Abnormalities include prolonged sleep
apnea, increased frequency of brief inspiratory pauses,
excessive periodic breathing, and impaired arousal
responsiveness to increased carbon dioxide or decreased
oxygen.
 Maternal smoking during pregnancy emerged as a major factor
in SIDS, and tobacco smoke in the infant’s environment after
birth has also been said to have possible relationship with
SIDS. Co-sleeping or an infant sharing bed with an adult or
older sibling on a non-infant bed has also been associated with
SIDS. Prone sleeping may cause oropharyngeal obstruction or
affect thermal balance or arousal state. Rebreathing of carbon
dioxide by infants in the prone position is also a possible cause
of SIDS. Infants sleeping prone and on soft bedding may not be
able to move their heads to the side, thus increasing the risk of
suffocation and lethal rebreathing. Soft bedding should be
avoided for infant sleeping surfaces. Bedding items such as
stuffed animals and toys should be removed from the crib while
the infant is asleep. Head covering by a blanket has also been
found to be a risk factor for SIDS. A subsequent meta-analysis
confirmed that exclusive breastfeeding for any period of time
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 decreased the overall risk of SIDS (Hauck, Thompson, Tanabe,
and others, 2011). Some studies have found pacifier use in
infants to be a protective factor against the occurrence of SIDS;
the data for pacifier use in infants in the first year of life are said
to be more compelling than data linking pacifier use to the
development of dental complications. All infants must be placed
on a supine position as they sleep with the head position
alternated from one side to the other to prevent plagiocephaly.
 Certain groups of infants are at increased risk for SIDS: Low
birth weight, Low Apgar scores, Recent viral illness, Siblings of
two or more SIDS victims, Male sex, and Infants of American
Indian or African American ethnicity. No diagnostic tests exist to
predict which infants will survive. Nursing care management
involves preventing SIDS by educating families about the risk of
prone sleeping position in infants from birth to 6 months of age,
the use of appropriate bedding surfaces, the association with
maternal smoking, and the dangers of co-sleeping on noninfant
surfaces with adults or other children. Another management is
to help promote modeling behaviors for parents to foster
practices that decrease the risk of SIDS, including placing
infants in a supine sleeping position in the hospital.
TERMINOLOGIES
 Failure to Thrive – a term used to describe a child whose
weight falls below the 5th percentile on a standardized growth
chart; growth measurements in addition to a persistent
deviation from an established growth curve is generally a cause
for concern.
 Sudden infant death syndrome - defined as the sudden death
of an infant younger than 1 year of age that remains
unexplained after a complete postmortem examination.

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