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High Risk Nutrition Care Plan Guidelines 1

Risk 134 Failure to Thrive (Infants, Children)

Failure to Thrive (FTT) describes an inadequate growth pattern where growth is significantly lower than what is expected for age and sex. Typically, a sign of undernutrition, the cause of FTT is often complex and includes many factors. Growth should be assessed over time, rather than using a single measurement.

Assessment, counseling, and referral guidelines: • Complete nutritional assessment according to WIC protocol. • Assess diet. • Assess/discuss feeding techniques/dietary practices. • Assess/discuss formula preparation/concerns (formula kind/type, how made or mixed, number of feedings per day, amount per feeding, infant responses to feeding, etc.). • Assess for any family/socioeconomic issues that may impact the medical condition or feeding issues. • Counsel based on assessment findings. • Make referrals according to Section 3.5 of the WIC Procedure Manual.

Documentation: • Check “High Risk Education” on the Nutrition Education screen under Nutrition Education Topics and enter “FTT” under Topic Status. • Document the specific details regarding the nutritional assessment and nutrition care plan in the Nutrition Assessment field on the Care Plan Summary in Crossroads.

Recommendations for the WIC CPA: • Learn about and reinforce the health care team’s plan of care and encourage caregivers to keep all appointments. • Offer breastfeeding support to breastfeeding dyads. Refer to the WIC Designated Breastfeeding Expert (DBE), if available. • Suggestions following the nutrition assessment may include: o Increasing the child’s intake of calorically dense food o Correctly preparing infant formula o Reducing volume of fluids consumed, if excessive, to appropriate amounts (other than breastmilk or formula for infants) o Allowing children to choose how much and which foods to eat (from what is offered) o Feeding children at consistent times and not allowing child to graze on foods and beverages throughout the day o Feeding in a supportive setting (such as a table or highchair) and in a distraction free environment

Risk 201 Low Hematocrit/Low Hemoglobin