Common Problems That

Develop During Infancy

Failure to Thrive
Failure to thrive refers to

children whose current

weight or rate of weight
gain is significantly lower
than that of other children
of similar age and gender.

Causes, incidence, and

risk factors
MEDICAL
CAUSES:
Chromosomeproblems such as Down syndrome andTurner syndrome
Organ problems
Thyroid hormone deficiency, growth hormone deficiency, or other

hormone deficiencies
Damage to the brain or central nervous system, which may cause
feeding difficulties in an infant
Heart or lung problems, which can affect how nutrients move through
the body
Anemia or other blood disorders
Gastrointestinal problems that make it hard to absorbe nurtients or
cause the body to have a lack of digestive enzymes
Long-term gastroenteritis and gastroesophageal reflux (usually
temporary)
Cerebral palsy
Long-term (chronic) infections
Metabolic disorders
Complications of pregnancy and low birth weight

Other factors :
Emotional deprivation as a result of

parental withdrawal, rejection, or hostility

Poverty
Problems with child-caregiver relationship
Parents do not understand the appropriate
diet needs for their the child
Exposure to infections, parasites, or toxins
Poor eating habits, such as eating in front of
the television and not having formal meal
times
Many times the cause cannot be
determined.

Assessment
Symptoms of failure to thrive include:
Height, weight, andhead circumferencedo

not match standard growth charts.

Weight is lower than 3rd percentile (as
outlined in standard growth charts) or 20%
below the ideal weight for their height.
Growth may have slowed or stopped after a
previously established growth curve.

Children who fail to thrive may have the following

delayed or slow to develop:
Physical skills such as rolling over, sitting, standing and
walking
Mental and social skills
Secondary sexual characteristics (delayed in
adolescents)
Babies who fail to gain weight or develop often have a
lack of interest in feeding or a problem receiving the
proper amount of nutrition. This is called "poor feeding."
Other symptoms that may be seen in a child that fails
to thrive include:
Constipation
Excessive crying
Excessive sleepiness (lethargy)
Irritability

Diagnostics
Physical exam - child's height, weight, and body

shape.
Denver Developmental Screening Test will be
used to show any delays in development. A
growth chart outlining all types of growth since
birth is created.
The following tests may be done:
Complete blood count (CBC)
Electrolyte balance
Hemoglobin electrophoresis to check for conditions

such as sickle cell disease

Hormone studies, including thyroid function tests
X-rays to determine bone age
Urinalysis

Management
Treatment depends on the cause of the delayed growth

and development.
Delayed growth due to nutritional factors can be helped
by showing the parents how to provide a well-balanced
diet.
Other treatment depends on the severity of the condition.
Increase the number of calories and amount of fluid the
infant receives
Correct any vitamin or mineral deficiencies
Identify and treat any other medical conditions
The child may need to stay in the hospital for a little
while.
Treatment may also involve improving the family
relationships and living conditions. Sometimes, the
parent's attitudes and behavior may contribute to a
child's failure to thrive.

Cleft Palate
A congenital failure of fusion between the

right & left palate process

NSG. GOALS
Prevent aspirations/ Infection
Place in Prone or side-lying position
Provide Nutrition - Feed with special nipple

that fills cleft & allow sucking

Clean mouth with water after feeding
Burp at each ounce
Thicken formula to provide extra calories
Provide parental support

ASSOCIATED PROBLEMS
1. Eating
2. Nasal Speech
3. Lack of Normal dental function or

appearance
4. Repeated bouts of otitis media with
subsequent hearing loss
COMPLICATIONS
1. Long term problems:
a. Speech impairment
b. Hearing impairment
c. Improper tooth placement
d. Recurring otitis media
2. Faulty social adjustment

CLINICAL MANIFESTATION
Physical appearance of cleft lip & palate
Incompletely formed lip
Opening in roof of mouth felt with the
examiners finger on palate
MANAGEMENT
Surgery to close the cleft lip CHEILOPLASTY
done as early as possible using rule of 10
at least 10 weeks old
weighs = 10 lbs
having at least 10 grams Hbg

Cleft Palate surgery

Is not done very early (not earlier than 10-12

months because it can harm tooth buds)

NOR;
Too late (because the palate can become too
rigid & the child may develop undesirable
speech patterns
Velopharyngeal flap operation
at 8-9 years old
to revise previous repair
correct nasal deformities

Intussusception
Telescoping of part of
intestine into an adjacent
distal portion.

Bowden Text

Intussusception
Common cause of intestinal obstruction in

children ages 3 to 25 months

Proximal segment of bowel prolapses or
telescopes into the lumen of an immediately
distal segment of bowel.
The prolapse results in vascular compromise,
edema and mechanical obstruction.
Bleeding results in the passage of blood and
mucous in the stool.

Assessment
Child appears with intermittent pain which is

colicky, severe
Child will often draw legs up
Episodes occur 2-3 times / hour
Vomiting is prominent feature bile stained
vomiting a late sign
Bowel movements bloody / mucous
Classic current jelly stool is a late sign

Clinical Manifestation
Mucous + blood =
classic currant jelly
stool

Diagnostic X-ray

Diagnostics
Contrast enema using air, barium,

or water-soluble contrast may be

used for diagnosis or a therapeutic
treatment tool. This test typically
follows nasogastric decompression
and the administration of IV fluids.
Electrolyte studies will reveal
electrolyte loss relative to symptoms

Reduction of Intussusception

Management
Reduce the obstruction before the bowel

becomes necrotic.
Contrast Enema is diagnostic in 95% of cases

and therapeutic curative in most cases.

Surgical reduction is radiologic reduction is not
achieved.

Surgical Intervention
IV fluids + antibiotics pre-operatively.
Manual reduction is attempted.
If bowel perforation is noted during operative

procedure a temporary colostomy may be

needed.

Nursing management
Promote adequate hydration: monitor

NGT drainage, clear liquids after

surgery
Promote adequate nutrition according
to childs age and nutritional
requirements
Monitor bowel elimination: stool
amount and characteristics, abdominal
distension, bowel sounds
Monitor for infection : wound redness,
swelling, and drainage, temperature

Hirschsprung Disease

Hirschsprung Disease
Congenital megacolon is a congenital absence

of ganglio cells (ganglia).

This results in obstructed passage of stools
causing the normal bowel to distend.

Assessment
In the newborn
No meconium in the first 24 hours
Bilious vomiting
Abdominal distention
Fever

Older infants / children

History of chronic constipation or fecal mass
Abdominal distention
Failure to thrive

Diagnosis and Treatment

Rectal biopsy
Removal of the aganglionic portion of the

colon.
1st stage surgery is often a colostomy
2nd stage is pull-through surgery to connect
the working colon to a point near the anus.

Typical X-ray

Colostomy at Birth

Goal is to close colostomy and do pull through surgery at 6 to 12

Long Term Complications

Anal stricture
Incontinence of stool
Short bowel syndrome

Spina Bifida Cystica

Incomplete fusion of one or more vertebral

laminae, resulting in an external protrusion of

the spinal tissue.

5 per 10,000 births

Other anomalies

Focused History
Poor maternal nutrition
Maternal age
Pregnancy history
Birth order
Socioeconomic status

Diagnosis
Ultrasound
Elevated AFP
95% survival rate

Meningomyelocele /
Meningocele

Bowden & Greenberg

Myelomeningocele
A protruding saclike structure

containing meninges, spinal fluid and

neural tissue.

Myelomeningocele

Assessment at Birth
Size, level, nature of tissue covering
Nerve involvement
Lower limbs / bowel and bladder function

Monitor for signs of hydrocephalus

Head circumference
Leakage of CSF
Cranial sutures

Immediate Interventions
Protect from injury and infection
Rupture of the sac can lead to death
Sterile moist dressing on sac until surgery
Position to prevent pressure on back

Goals of Surgery
Provide a normal anatomic barrier
Control Infection
Control hydrocephaly

Community Care
Bladder and bowel problems
Latex allergies: due to in and out

catheterization
Problems with self-esteem
Orthopedic management
Schooling based on IQ

Hydrocephalus
Greek meaning water on the brain
Dilation of the ventricles
Two primary causes:
Congenital .5 to 1%
Acquired:
Lesion, tumors, infection, intracranial bleed,

myelomeningocele

Hydrocephalus

Head Circumference

Hydrocephalus
Bulging anterior fontanelle
Eyes deviated downward
Setting Sun sign

Bates: Physical Assessment

Transillumination of Skull
Advanced cases of
Hydrocephaly produces
a glow of light over
the entire cranium.

Bates: Physical Assessment

Severe Hydrocephalus

Assessment
Bulging fontanels
Split sutures
Increasing head circumference
Prominent scalp veins
Sunset eyes
Irritability high pitched cry
Poor feed
The older child will complain of headache

Interventions
Placement of shunt to
drain CSF from the
ventricles to another
part of the body.

Assessment of Shunt
Vomiting
Headache
Irritability
Fever
Redness along shunt line
Fluid around shunt valve