Failure to thrive (FTT) is a relatively common presentation in the emergency department. Up to 90% of cases of FTT have no identifiable cause and are categorized as nonorganic. Before deciding that FTT is nonorganic, it is imperative to consider and rule out organic causes. Identifying the underlying issues surrounding FTT is essential, as it will likely impact the treatment the patient receives.
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Points from the Emergency Department Management of Patients With Failure to Thrive:
- The following criteria can be used to identify patients with failure to thrive (FTT): weight deceleration crossing more than 2 percentile lines, weight for chronological age below the fifth percentile, and length for chronological age below the fifth percentile.
- Organic causes of FTT should be ruled out before deciding the cause is nonorganic. Examples of organic causes of FTT include congenital heart disease, gastrointestinal etiologies (eg, chronic malnutrition, pyloric stenosis, reflux, food insensitivities, celiac disease, cystic fibrosis, cow?s milk protein intolerance), hyperthyroidism, congenital nephrogenic diabetes insipidus, renal tubular acidosis, asthma, choanal atresia, malignancy, and anatomic/genetic abnormalities (eg, cleft lip/palate, trisomy 21).
- Clinicians must have a high index of suspicion for nonaccidental trauma and/or neglect, as they can also result in FTT.
- Inquire about difficulty with feeding, types of feeds, frequency of feeds, and feeding technique.
- Improper formula mixing can lead to diluted formula, hyponatremia, and poor growth.