Failure to thrive

This page is for adult patients; see failure to thrive (peds) for pediatric patients.

Background

  • Usually multifactorial and seen in patients with chronic illnesses.
  • Defined as unintended weight loss >5% from baseline, decreased appetite, poor nutrition, inactivity, and often accompanied by dehydration, depressive symptoms, and impaired immune function.

Clinical Features

  • Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, insufficient caloric absorption, or excessive caloric demand.
  • Patients often have a combination of physical impairment, malnutrition, depression, and cognitive impairments.

Differential Diagnosis

  • Chronic or recurrent infections
  • Immunodeficiency
  • Endocrine disorder
  • Cancer
  • Chronic lung disease
  • Chronic renal insufficiency
  • Heart failure
  • Hepatic failure
  • Chronic wounds
  • Hip or other large bone fracture
  • Inflammatory bowel disease
  • Malabsorption or malnutrition
  • Rheumatologic diseases
  • Stroke
  • Depression
  • Dementia
  • Psychosis
  • Medication side effects or interactions
    • Anticholinergics, antiepileptics, benzodiazepines, beta blockers, central alpha antagonists, diuretics, steroids, neuroleptics, opioids, SSRIs, and TCAs are common culprits

Evaluation

Workup

Diagnosis

  • History and physical examination are often sufficient to make the diagnosis. Many elderly patients with failure to thrive will be unable to provide an accurate history, so family members or caregivers must be involved.
    • A thorough review of medications is necessary, as polypharmacy may contribute to failure to thrive.

Management

  • If a specific medical cause can be identified, treatment should be tailored to the etiology, taking into account the potential risks for already frail patients.
  • Oftentimes, treatment will involve nutritional supplementation, physical/occupational/speech therapy, modifications of living environment, and treatment of depression and/or dementia.

Disposition

  • Some patients can be discharged from the ER with PCP follow up.
  • Evaluate for ability to care for at home and possible need for placement
  • If failure to thrive is severe or refractory to treatment, conisder goals of care discussions and a hospice referral

See Also

External Links

References