Failure to thrive (peds): Difference between revisions
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{{Peds top}} [[failure to thrive]] | |||
==Background== | ==Background== | ||
* Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, insufficient caloric absorption, or excessive caloric demand. | * Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, insufficient caloric absorption, or excessive caloric demand. | ||
* Defined as weighing <5th | * Defined as weighing <5th%ile for age and sex, or weight deceleration crossing two major growth lines on a growth chart. | ||
* Does not imply a defect in social, intellectual, or emotional development, but if untreated may lead to any combination of those. | * Does not imply a defect in social, intellectual, or emotional development, but if untreated may lead to any combination of those. | ||
* Classically divided into endogenous (medical) and exogenous (psychosocial or environmental) causes | * Classically divided into endogenous (medical) and exogenous (psychosocial or environmental) causes | ||
==Clinical Features== | ==Clinical Features== | ||
*Weight <5th percentile or weight deceleration crossing two major growth lines | |||
*+/- signs/symptoms of [[malnutrition]] | |||
*+/- signs/symptoms of underlying pathology | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
====Endogenous Causes==== | ====Endogenous Causes==== | ||
* GERD | * [[GERD]] | ||
* IBS | * [[IBS]] | ||
* Food allergy | * Food allergy | ||
* Malabsorption | * Malabsorption | ||
* Pyloric stenosis | * [[Pyloric stenosis]] | ||
* Gastrointestinal atresia or malformation | * Gastrointestinal atresia or malformation | ||
* Inborn | * [[Inborn errors of metabolism]] | ||
* Thyroid | * [[Thyroid disease]] | ||
* Chronic infection or immunodeficiency | * Chronic infection or immunodeficiency | ||
* Chronic pulmonary disease | * Chronic pulmonary disease | ||
* Congenital heart disease or heart failure | * [[Congenital heart disease]] or heart failure | ||
* Malignancy | * Malignancy | ||
* Celiac disease | * Celiac disease | ||
* Inflammatory bowel disease | * [[Inflammatory bowel disease]] | ||
====Exogenous Causes==== | ====Exogenous Causes==== | ||
* Breastfeeding problem (latching, suckling, or swallowing) | * Breastfeeding problem (latching, suckling, or swallowing) | ||
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* Mood disorder | * Mood disorder | ||
* Eating disorder | * Eating disorder | ||
* Child neglect or abuse | * Child neglect or [[child abuse]] | ||
==Evaluation== | ==Evaluation== | ||
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==Management== | ==Management== | ||
*Treat underlying cause | |||
*Treat [[malnutrition]] | |||
==Disposition== | ==Disposition== | ||
* Most cases can be discharged with PCP follow up. PCPs can make appropriate referrals for nutritional counseling, lactation coaching, or formula supplementation. | * Most cases can be discharged with PCP follow up. PCPs can make appropriate referrals for nutritional counseling, lactation coaching, or formula supplementation. | ||
* Indications for hospitalization include failure of outpatient management, suspicion of endogenous cause requiring urgent management, suspicion of abuse or neglect, signs of traumatic injury, severe psychosocial impairment of the caregiver, or evidence of serious malnutrition (<70th | * Indications for hospitalization include failure of outpatient management, suspicion of endogenous cause requiring urgent management, suspicion of abuse or neglect, signs of traumatic injury, severe psychosocial impairment of the caregiver, or evidence of serious malnutrition (<70th% of predicted weight for length). | ||
==See Also== | ==See Also== | ||
Latest revision as of 23:05, 28 November 2019
This page is for pediatric patients. For adult patients, see: failure to thrive
Background
- Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, insufficient caloric absorption, or excessive caloric demand.
- Defined as weighing <5th%ile for age and sex, or weight deceleration crossing two major growth lines on a growth chart.
- Does not imply a defect in social, intellectual, or emotional development, but if untreated may lead to any combination of those.
- Classically divided into endogenous (medical) and exogenous (psychosocial or environmental) causes
Clinical Features
- Weight <5th percentile or weight deceleration crossing two major growth lines
- +/- signs/symptoms of malnutrition
- +/- signs/symptoms of underlying pathology
Differential Diagnosis
Endogenous Causes
- GERD
- IBS
- Food allergy
- Malabsorption
- Pyloric stenosis
- Gastrointestinal atresia or malformation
- Inborn errors of metabolism
- Thyroid disease
- Chronic infection or immunodeficiency
- Chronic pulmonary disease
- Congenital heart disease or heart failure
- Malignancy
- Celiac disease
- Inflammatory bowel disease
Exogenous Causes
- Breastfeeding problem (latching, suckling, or swallowing)
- Improper formula preparation
- Caregiver depression
- Lack of food availability
- Cleft lip/palate
- Mood disorder
- Eating disorder
- Child neglect or child abuse
Evaluation
- A detailed history and physical examination (including accurate height and weight) are usually sufficient to establish a cause. Over 80% of cases are due to insufficient caloric intake from exogenous causes.
- History should focus on breastfeeding technique, frequency, and duration, or amount of formula and method of preparation.
- Observed feeds can often be useful to identify problems.
- If an endogenous cause is suspected, specific lab tests or imaging studies may be helpful to evaluate for metabolic abnormalities, the presence of infections, malignancy, or anatomic malformations. Additional testing should be ordered on a case by case basis and is only recommended if a specific etiology is suspected.
Management
- Treat underlying cause
- Treat malnutrition
Disposition
- Most cases can be discharged with PCP follow up. PCPs can make appropriate referrals for nutritional counseling, lactation coaching, or formula supplementation.
- Indications for hospitalization include failure of outpatient management, suspicion of endogenous cause requiring urgent management, suspicion of abuse or neglect, signs of traumatic injury, severe psychosocial impairment of the caregiver, or evidence of serious malnutrition (<70th% of predicted weight for length).