This document defines failure to thrive and outlines its causes and evaluation process. Failure to thrive is defined as weight or growth below major percentiles. Causes include inadequate intake due to issues with appetite, ingestion, or food availability; altered growth regulation from prenatal or genetic factors; calorie wasting from vomiting or malabsorption; and increased caloric needs. Evaluation involves assessing growth data, medical history, nutrition, development, a feeding observation, and labs if indicated. Hospitalization may be needed if abuse is suspected or for severe cases.
8. Other definitionOther definition
Change of growth that has crossed twoChange of growth that has crossed two
major growth percentiles (i.e. from abovemajor growth percentiles (i.e. from above
the 75th percentile to below the 25th).the 75th percentile to below the 25th).
9. Attained growthAttained growth
Weight <3rd percentile on NCHS growthWeight <3rd percentile on NCHS growth
chartchart
Weight for height <5th percentile on NCHSWeight for height <5th percentile on NCHS
growth chartgrowth chart
Weight 20% or more below ideal weight forWeight 20% or more below ideal weight for
heightheight
Triceps skinfold thickness < 5 mmTriceps skinfold thickness < 5 mm
10. Rate of growthRate of growth
Depressed rate of weight gainDepressed rate of weight gain
<20 g/d from 0 to 3 months of age<20 g/d from 0 to 3 months of age
<15 g/d from 3 to 6 months of age<15 g/d from 3 to 6 months of age
Falloff from previously established growth curveFalloff from previously established growth curve
Downward crossing of >2 major percentiles onDownward crossing of >2 major percentiles on
NCHS growth chartNCHS growth chart
Documented weight lossDocumented weight loss
18. c)Unavailability of foodc)Unavailability of food
Inappropriate feeding techniqueInappropriate feeding technique
Insufficient/inadequate volume of foodInsufficient/inadequate volume of food
Inappropriate food for ageInappropriate food for age
Withholding of food (abuse, neglect)Withholding of food (abuse, neglect)
34. COMPONENTS OF EVALUATIONCOMPONENTS OF EVALUATION
Growth dataGrowth data
HistoryHistory: : Problem contextProblem context , , MedicalMedical , ,
NutritionalNutritional , , PsychosocialPsychosocial , ,
Developmental/behavioralDevelopmental/behavioral
Physical examinationPhysical examination
Developmental/behavioral assessmentDevelopmental/behavioral assessment
Observation of a feedingObservation of a feeding
Laboratory studiesLaboratory studies
HospitalizationHospitalization
35. Growth dataGrowth data
Current growth parametersCurrent growth parameters
Growth curves over timeGrowth curves over time
Relationship of growth parameters to eachRelationship of growth parameters to each
otherother
36. HistoryHistory
Problem contextProblem context
When growth problem first became a When growth problem first became a
concernconcern
Previous interventions attemptedPrevious interventions attempted
37. Medical historyMedical history
Prenatal care and complications (infection, Prenatal care and complications (infection,
maternal nutrition, drug exposure)maternal nutrition, drug exposure)
Gestational age and growth parameters at birth Gestational age and growth parameters at birth
(SGA, prematurity)(SGA, prematurity)
Perinatal complications (infections, CNS Perinatal complications (infections, CNS
insults, anomalies)insults, anomalies)
40. Schedule and length of feedingsSchedule and length of feedings
Daily feeding/mealtime environmentDaily feeding/mealtime environment
Location/positioning during feedingsLocation/positioning during feedings
Perceptions of suck, swallow, and grasp of nipplePerceptions of suck, swallow, and grasp of nipple
Caregivers involved with feedingsCaregivers involved with feedings
41. Amount and type of mealtimeAmount and type of mealtime
supervisionsupervision
Behavior during feedingBehavior during feeding
History of progression to solid/table foods History of progression to solid/table foods
Favorite/disliked foods Favorite/disliked foods
Parental knowledge/beliefs regarding Parental knowledge/beliefs regarding
child/infant feedingchild/infant feeding
Family eating practices and beliefs Family eating practices and beliefs
Financial constraints affecting food Financial constraints affecting food
45. Physical examinationPhysical examination
Physician and child interactionPhysician and child interaction
Skinfold measurementsSkinfold measurements
Complete physical examinationComplete physical examination
46. Observation of a feedingObservation of a feeding
Feeding environment (home observation)Feeding environment (home observation)
Type and amount of food offeredType and amount of food offered
Duration of feedingDuration of feeding
Child's oromotor and fine motor skillsChild's oromotor and fine motor skills
48. Hospitalize if:Hospitalize if:
Evidence of physical abuse and/or severe Evidence of physical abuse and/or severe
neglectneglect
High risk for abuse and neglect, very disturbed High risk for abuse and neglect, very disturbed
parent & child interaction, poor parent functioning, parent & child interaction, poor parent functioning,
and/or an extremely stressful environmentand/or an extremely stressful environment
Severe malnutrition and/or medically unstableSevere malnutrition and/or medically unstable
Outpatient management failure Outpatient management failure