In this section
Failure to thrive
Updated by: Dr. Praveen Goday
Updated on: 3/9/2017
Diagnosis/symptom
Signs and symptoms
- Weight-for-length (or BMI) < 3rd percentile (CDC growth chart) or 2nd percentile (WHO growth chart)
- Poor or no weight gain
- Over a period of time that varies according to the age of the child. In general, the younger the child, the shorter the interval where there is little or no weight gain
- Significant downtrend in weight percentiles
- These should be done along with:
- Assessment of parental size / growth
- Correction for prematurity (where applicable)
Causes
Most commonly is due to inadequate calorie intake; Other causes: malabsorption, etc. account for <5% of FTT cases.
Referring provider's initial evaluation and management:
Diagnosis:
*See gestational age chart and guide to high-calorie beverages below
Initial interventions in a child with failure to thrive
- Establish Mealtime Routine
- Meals and snacks offered every 3 hourly
- Ideally, all meals and snacks should be offered in a high chair/at the table
- Minimize distractions
- Avoid force feeding
- Grazing in between meal and snack times should be eliminated
- NO JUICE
- Limit meals to 30 minutes
*Additional resources below
When to initiate referral/ consider refer to GI Clinic:
- ↓ weight, ↓ height - Malnutrition
- Normal weight, ↓ height - Endocrine
- Normal weight, ↓ height, dysmorphism - Genetics/Endocrine
- SGA patients without catch-up growth can be referred to endocrine clinic for possible growth hormone treatment
- Nutrition Clinic: Contact Dr Praveen Goday at pgoday@mcw.edu for FTT patients who are not progressing according to plan.
What can referring provider send to GI Clinic?
1. Using Epic
- Please complete the external referral order
In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:
- Urgency of the referral
- What is the key question you would like answered?
Note: Our office will call to schedule the appointment with the patient.
2. Not using Epic external referral order:
- In order to help triage our patients maximize the visit time, please fax the above information to (414) 607-5288
- It would also be helpful to include:
- Chief complaint, onset, frequency
- Recent progress notes
- Labs and imaging results
- Other Diagnoses
- Office notes with medications tried/failed in the past and any lab work that may have been obtained regarding this patient's problems.
Specialist's workup will likely include:
After referral to GI Clinic:
*Most children with FTT do not need labs
Labs:
- Significant FTT
- FTT not due to inadequate calorie intake
Common labs
- :CBC, ESR
- Metabolic panel, electrolytes
- Anti-TTG IgA, serum IgA level
- Fecal elastase
- Urinalysis

If a child is <10th percentile for gestational age then child is SGA
Female | 10th %ile | Male | 10th %ile | ||
GA | Grams | Pounds/ounces | GA | Grams | Pounds/ounces |
23 | 477 | 1 lb 0.8 oz | 23 |
509 |
1 lb 2.0 oz |
24 | 524 | 1 lb 2.5 oz | 24 | 561 | 1 lb 3.8 oz |
25 | 584 | 1 lb 4.6 oz | 25 | 626 | 1 lb 6.1 oz |
26 | 645 | 1 lb 6.8 oz | 26 | 704 | 1 lb 8.8 oz |
27 | 719 | 1 lb 9.4 oz | 27 | 789 | 1 lb 11.8 oz |
28 | 807 | 1 lb 12.5 oz | 28 | 884 | 1 lb 15.2 oz |
29 | 915 | 2 lb 0.3 oz | 29 | 988 | 2 lb 2.9 oz |
30 | 1052 | 2 lb 5.1 oz | 30 | 1114 | 2 lb 7.3 oz |
31 | 1196 | 2 lb 10.2 oz | 31 | 1267 | 2 lb 12.7 oz |
32 | 1352 | 2 lb 15.7 oz | 32 | 1433 | 3 lb 2.5 oz |
33 | 1545 | 3 lb 6.5 oz | 33 | 1625 | 3 lb 9.3 oz |
34 | 1730 | 3 lb 13 oz | 34 | 1810 | 3 lb 15.8 oz |
35 | 1869 | 4 lb 1.9 oz | 35 | 1980 | 4 lb 5.8 oz |
36 | 2028 | 4 lb 7.5 oz | 36 | 2170 | 4 lb. 12.5 oz |
37 | 2260 | 4 lb 15.7 oz | 37 | 2401 | 5 lb 4.7 oz |
38 | 2526 | 5 lb 9.1 oz | 38 | 2652 | 5 lb 13.5 oz |
39 | 2724 | 6 lb 0.1 oz | 39 | 2833 | 6 lb 3.9 oz |
40 | 2855 | 6 lb 4.7 oz | 40 | 2950 | 6 lb 8.1 oz |
41 | 2933 | 6 lb 7.5 oz | 41 | 3039 | 6 lb 11.2 oz |
Mid-parental height
|
Guide to high-calorie beverages
Fortifying breast milk
- 24-26 calorie/ounce breast milk:
- Add 1 tsp infant formula + 2.5 oz expressed breast milk
- (Calorie level varies with type of formula used)
Fortifying infant formulas
- 24 calorie/ounce recipe:
- *For infant formulas EXCEPT premature formulas (Neosure, Enfacare), Neocate, and Neocate Jr.
- 3 scoops powder + 5 ounces water (Add water to bottle first, and then add powder)
- 27 calorie/ounce recipe:
- *For infant formulas EXCEPT premature formulas (Neosure, Enfacare), Neocate, and Neocate Jr.
- 5 scoops powder + 7 ounces water (Add water to bottle first, and then add powder)
- 30 calorie/ounce recipe:
- *For infant formulas EXCEPT premature formulas (Neosure, Enfacare), Neocate, and Neocate Jr.
- 4 scoops powder + 5 ounces water (Add water to bottle first, and then add powder)
Toddler beverages
- Pediasure ®, Boost ®, Nutren Jr. ®
- 30 calories/ounce
- Carnation Instant Breakfast ® w/ whole milk
- 30 calories/ounce
- Cheaper than Pediasure ($0.50 / packet)
- 7 oz Whole milk with 1 oz heavy whipping cream
- 30 calories/ounce and cheapest