Publication Date: March 2020 (Volume 17, Number 03)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 03/01/2023.
Although failure to thrive (FTT) is a relatively common presentation in the emergency department, many emergency clinicians are unsure of how to properly work up a pediatric patient with this condition. Obtaining a thorough history and physical examination will likely reveal the cause of FTT. Although most laboratory testing has low diagnostic yield, they may be indicated in certain circumstances. Radiologic testing is normally not indicated unless the history or physical examination point to a specific etiology. This issue reviews the etiology, pathophysiology, and management of patients with FTT, with the goal of improving outcomes while minimizing unnecessary testing, decreasing cost, and expediting emergency department care.
Excerpt From This Issue
Your first patient is a previously healthy, vaccinated 6-month-old boy who presents with poor weight gain. The child has been seen by his primary care provider multiple times within the last several weeks, and the mother is very concerned because he has not shown any improvement. The child was born at term via spontaneous vaginal delivery, did not spend any time in the NICU, and has been well. Despite this, in the past 2 months, the patient has gone from the fiftieth percentile on his growth curve to less than the thirtieth percentile. The patient has not had any vomiting or diarrhea and has been urinating and moving his bowels normally. On physical examination, he is smaller than expected, but otherwise his vital signs are unremarkable, as is the remainder of his physical examination. You inform the family you are going to review his chart, and as you leave the room, you wonder what is going on with this patient. Could it be a metabolic or cardiac abnormality? Is it a problem with the gastrointestinal or respiratory system? What if this is a manifestation of neglect? What tests should you order for the patient? Should you be starting him on IV fluids? Should this patient be admitted to the hospital or discharged home? Do you need to call social work?