Failure to thrive (peds)

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

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

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

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).

See Also

External Links

References