Pediatric Failure to Thrive

Posted by e-Medical PPT
Failure to Thrive (FTT):
 Weight below the 5th percentile for age and sex
 Weight for age curve falls across two major percentile lines
 A sign that describes a problem rather than a diagnosis
 Usually describes failure to gain wt
 In more severe cases length and head circumference can be affected
 Underlying cause is insufficient usable nutrition to meet the demands for growth
 Approximately 25% of normal children will have a shift down in their wt curve of up to 25%, then follow a normal curve -- this is not failure to thrive

Etiology
Inadequate Caloric Intake
Incorrect preparation of formula
Poor feeding habits (ex: too much juice)
Poverty
Mechanical feeding difficulties (reflux, cleft palate, oromotor dysfunction)
Neglect
 Physicians are strongly encouraged to consider child abuse and neglect in cases of FTT that don’t respond to appropriate interventions

Inadequate absorption
Celiac disease
Cystic fibrosis
Milk allergy
Vitamin deficiency
Biliary Atresia
Necrotizing enterocolitis

Increased metabolism
Hyperthyroidism
Chronic infection
Congenital heart disease
Chronic lung disease

Other considerations
Genetic abnormalities, congenital infections, metabolic disorders (storage diseases, amino acid disorders)

Lab Evaluation
Unless suggested by History and Examination, no routine lab tests recommended initially*
One study of hospitalized pts resulted in only 1.4% of tests being of diagnostic assistance in FTT
If problem persists, could consider:
CBC, U/A, Electrolytes, TSH, ESR, Lead, HIV, Tb
If not improving with adequate diet, consider:
Stool for fat, reducing substances, pathogens 
Celiac antibody testing
CF testing

Management
Goal is “catch-up” weight gain
Most cases can be managed with nutrition intervention and/or feeding behavior modification
General principles:
High Calorie Diet
Close Follow-up
Keep a prospective feeding diary-72 hour
Assure access to WIC, food programs, other community resources...

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