Morning ReportMarch 10, 2011

Failure to Thrive Final Common Pathway

◦ Medical◦ Psychosocial◦ Environmental

Interaction between◦ Environment◦ Health◦ Development ◦ Behavior

Definition◦ Failing to grow at a rate consistent with expected

standard for infants and toddlers younger than 3 years of age

Wasting◦ Decreased weight for height◦ Signals acute malnutrition◦ Decreased subcutatneous fat

Stunting◦ Decreased height for age◦ Sign of chronic undernutrition

Failure to Thrive

Organic

◦ Medical disorder interfering with growth

Malabsorptive disorders

Genetic syndromes

Endocrine disorders

Neurologic dysfunction

Failure to Thrive

Nonorganic◦ Diagnosis of exclusion◦ Environmental conditions◦ Specific examples

Oromotor dyspraxia Sensory-motor disorder Feeding disorder of infancy Family relationship problem Child neglect Mental disorder of parent

Multifactorial◦ Combination of multiple factors

Failure to Thrive

Prevalence◦ Low weight for age

4.1%◦ Low weight for height

2.5%

Risks◦ Poverty◦ Food insecurity◦ Larger family size◦ History of child abuse

Failure to Thrive

Pathogenesis◦ Loss of calories through malabsorption

◦ Increased caloric expenditure Hyperthyroidism, CHD, chronic pulmonary disease

◦ Inadequate intake of calories Most common

Failure to Thrive

Presentation

◦ Family is concerned that their child is not growing as well as other children of the same age

◦ Family reports that the child is feeding poorly

◦ Physician notices on PE or growth charts

Failure to Thrive

Evaluation◦ Complete History

Including complete review of systems Nutritional history Feeding behavior history Documentation of parent-child patterns FH SH History of height and weight trajectories of parents and

siblings

Failure to Thrive

Growth chart◦ Most important◦ Growth velocity

Physical exam◦ Neurodevelopmental status

Failure to Thrive

Failure to Thrive Lab tests

◦ Few tests are recommended◦ Based on positive findings from history and

physical exam◦ Non-response to dietary therapy◦ Routine

Iron deficiency Lead poisoning TB Chronic UTI

Failure to Thrive Address nonmedical problems

◦ Mental health disorders◦ Child maltreatment◦ Feeding disorders◦ Positive reinforcement and pediatrician support are

key

Address medical problems

Severe issues◦ Intense therapy◦ G-tube feedings

Prognosis◦ Most show improvement with dietary intervention

Some will show improvement without intervention as development progresses

◦ “Picky eaters” in childhood Some may have anxiety disorders or autistic

spectrum disorders◦ Cognitive and school outcomes are worse

May be influenced by other environmental factors as well

Failure to Thrive