Weight is affected first, then height, then head circumference as malnutrition worsens.
Before you read
Test yourself first: 4 questions
Question 1 of 4
A nurse is teaching a client with chronic heart failure about daily self-monitoring. The nurse instructs the client to report which weight change to the provider?
Answer: B. A weight gain of 2 to 3 pounds (about 1 to 1.5 kg) in 24 hours, or about 5 pounds (2.3 kg) in a week, signals fluid retention and should be reported because it often precedes worsening heart failure. Daily weighing at the same time, on the same scale, in similar clothing, after voiding, is correct technique.
Question 2 of 4
A nurse teaches a client with heart failure about a fluid and sodium restriction. Which statement indicates the teaching was effective?
Answer: A. Correct understanding includes weighing daily and reporting a gain of 2-3 pounds in a day, reading labels for sodium, avoiding the salt shaker, and staying within the prescribed fluid limit. Doubling fluids or adding salt for flavor would be unsafe in heart failure.
Question 3 of 4
A nurse is teaching a client with HIV about the importance of adherence to antiretroviral therapy. Which statement by the client indicates correct understanding?
Answer: A. Antiretroviral therapy must be taken consistently and exactly as prescribed; missed or inconsistent doses allow the virus to replicate and develop drug resistance, reducing future treatment options. Stopping when feeling well, skipping doses to save medication, and taking it only during illness all promote resistance and treatment failure.
Question 4 of 4
A school-age child is learning new skills and comparing themselves to peers. Per Erikson, the task is:
Answer: B. School age (6–12) is industry vs. inferiority — developing competence and accomplishment. Success builds confidence; repeated failure fosters inferiority.
Keep the streak going with more questions like these, each with a full rationale.
What is failure to thrive?
Causes are organic (a medical condition), nonorganic (psychosocial/feeding issues), or mixed. Key principle: most cases are nonorganic and relate to feeding technique, calorie intake, or the caregiver-infant relationship.
Key points to remember
- Weight is affected first, then height, then head circumference as malnutrition worsens.
- Nonorganic FTT is linked to feeding problems, poverty, neglect, maternal depression, or disturbed bonding.
- Organic causes include malabsorption, congenital heart disease, GERD, cleft palate, and metabolic disorders.
- A standardized weight gain during structured feeding in the hospital points toward a nonorganic cause.
- Affected infants may be apathetic, avoid eye contact, be difficult to console, or show developmental delays.
- Catch-up growth requires extra calories, often 150 percent or more of normal daily requirements.
Common causes
- Organic: illness, malabsorption
- Nonorganic: neglect, poor bonding
Nursing priorities
- Obtain accurate serial weights on the same scale, at the same time, with the infant undressed, and plot on growth charts.
- Document a detailed feeding history, intake, and direct observation of a feeding session.
- Provide a calm, unhurried, consistent feeding environment and caregiver during meals.
- Calculate and deliver high-calorie nutrition as prescribed and record intake meticulously.
- Observe and support caregiver-infant interaction and model responsive feeding.
Labs & values
Patient teaching
- Feed on a consistent schedule, hold the infant during feeds, and minimize distractions.
- Use prescribed high-calorie formula or fortification and avoid filling up on water or juice.
- Recognize and respond promptly to the infant's hunger and satiety cues.
- Keep all follow-up weight checks and feeding-support appointments.
Red flags: report now
- Signs of severe dehydration or malnutrition (lethargy, sunken fontanel, poor turgor) require prompt intervention.
- Suspected neglect or abuse contributing to FTT is a mandated report.
- Refeeding too aggressively can cause refeeding syndrome (low phosphate, potassium, magnesium); advance calories carefully.
References
Clinical references for this topic
