Emergency Department Management of Patients With Failure to Thrive

Points & Pearls Excerpt

• 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.

Most Important References

• Blair PS, Drewett RF, Emmett PM, et al. Family, socioeconomic and prenatal factors associated with failure to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC). Int J Epidemiol. 2004;33(4):839-847. (Population cohort study; 11,718 patients) 
• Olsen EM. Failure to thrive: still a problem of definition. Clin Pediatr (Phila). 2006;45(1):1-6. (Cross-sectional review, 2003- 2004) 
• Stephens MB, Gentry BC, Michener MD, et al. Clinical inquiries. What is the clinical workup for failure to thrive? J Fam Pract. 2008;57(4):264-266. (Review article) 
• Levy Y, Levy A, Zangen T, et al. Diagnostic clues for identification of nonorganic vs organic causes of food refusal and poor feeding. J Pediatr Gastroenterol Nutr. 2009;48(3):355-362. (Retrospective study; 226 patients) 
• Hannaway PJ. Failure to thrive: a study of 100 infants and children. Clin Pediatr (Phila). 1970;9(2):96-99. (Retrospective review; 100 patients)