2. • Failure to thrive (FTT) is a common term to
describe a lack of adequate weight gain in
pediatric-aged patients.
• Current consensus defines FTT as a weight for age
less than 5TH percentile on standardized age-
based growth charts, a decrease in weight
percentile of more than 2 major percentile lines
on the growth chart, or less than the 80th
percent of median weight for height/length ratio.
3.
4. • FTT/weight faltering is a significant risk factor
for malnutrition.
• Left untreated, FTT can lead to stunted growth
and has been associated with developmental
delays and other significant long-term effects
in the developing child.
5. Etiology
• FTT/weight faltering represents a red flag that
warrants further evaluation to determine the
underlying etiology of the patient's poor
weight gain.
• related to an underlying organic medical
condition, decreased caloric intake from an
inorganic cause, or both.
6. • Inadequate caloric intake to support weight
gain from inorganic causes is the most common
etiology of FTT and is often multifactorial
• Examples might include improper mixing of
infant formulas, inadequate breast milk supply or
difficulty with milk transfer at the breast, lack of
parental knowledge of appropriate feeding
volumes, patient feeding refusal or other
maladaptive feeding behaviors, food insecurity,
and less commonly parental abuse or neglect.
7. • A thorough patient history, including a
detailed feeding history as well as a
psychosocial and behavioral history, can be
invaluable
8. Inadequate Caloric Intake
• Organic etiologies include oral-motor
dysfunction or craniofacial abnormalities that
prevent the patient from consuming enough
calories by mouth.
• Patients with esophageal abnormalities,
gastroesophageal reflux, or pyloric stenosis
can all experience difficulties maintaining
adequate caloric intake.
9. Increased Caloric
Losses/Malabsorption
• Examples include inflammatory bowel disease,
celiac disease, milk-protein allergy, exocrine
pancreatic insufficiency such as cystic fibrosis,
and other protein-losing enteropathies.
10. Increased Systemic Caloric Demand
• Underlying conditions in this category tend to
be organic etiologies resulting from chronic
diseases such as congenital heart disease,
kidney or liver disease, anemia, malignancy,
and chronic infectious diseases.
• In these conditions, the patient's caloric
demand is much higher than average, making
it challenging to consume enough calories to
meet this demand.
11. History and Physical
• Feeding History
• Obtain a detailed feeding history, including types of food,
amounts, and frequency in which foods are consumed.
• For infants, determine if the baby is feeding overnight or
only during the daytime.
• If the infant is breastfed, determine the duration of feeds,
maternal estimates of milk supply and infant's ability to
transfer milk at the breast, breast pumping history, and
volumes of expressed breast milk if applicable.
• If the infant is formula-fed, identify the type of formula and
mixing technique the family uses. For bottle-fed infants,
consider asking about the type of bottle and nipple flow
rate.
12. Elimination History
• Stool frequency and consistency
• Red flags include blood or mucus in the stool,
large bulky/foul-smelling stools, and, in older
children, waking at night with stool urgency or
new episodes of stool incontinence when
previously potty trained.
• Urine output as an overall marker of hydration
and any unusual smells or symptoms of infection,
such as frequency, urgency, or dysuria, should be
documented.
13. Birth, Past Medical, and
Developmental History
• Any history of prematurity, birth complications
such as small for gestational age, neonatal
hypoglycemia, or jaundice should be noted.
• Maternal prenatal history focusing on any
known toxin/drug or infectious exposures
should also be considered.
• Developmental milestones should be
assessed, and any delays documented.
14. Physical Examination
• A head-to-toe physical exam carefully assessing
for any abnormalities for the patient's poor
weight gain.
• Specific findings that should be noted are any
dysmorphic features, oral motor dysfunction,
thyroid nodules or goiter, presence of a heart
murmur
• Assessing the patient's general affect may also be
helpful, noting fussiness or irritability and
interpersonal interactions with parents or other
family members in the exam room.
