Failure to thrive

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Updated by: Dr. Praveen Goday
Updated on: October 2020

Causes

Most commonly is due to inadequate calorie intake; Other causes: malabsorption, etc account for <5% of FTT cases

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
• These should be done along with:
  • Assessment of parental size / growth
  • Correction for prematurity (where applicable)

Referring provider's initial evaluation and management:

Diagnosis: Initial interventions in a child with failure to thrive

Establish mealtime routine

• Add calories
• Meals and snacks offered every 3 hourly
• 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

Most children with FTT do not need labs:

Labs are needed if:

• Significant FTT, FTT not due to inadequate calorie intake

Common labs:

• CBC, ESR
• Metabolic panel
• Anti-TTG IgA, serum IgA level
• If less than 2 years old: DPG

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 referral form, please complete:
• What is the patient's chief complaint
• Describe details
• Pertinent past medical history
• Abnormal imaging findings
• What is the key question you want addressed
• Please ensure we have growth charts
• If you have obtained labs make sure that we have access to them
2. Not using Epic referral form:
• Please fax 414-266-4966 the above information and include:
• Chief complaint, onset, frequency
• Recent progress notes
• Labs and imaging results
• Other Diagnoses

Office Number: (414) 607-5280

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

Guide to high-calorie beverages

Resources for increasing calories:

Provider resources

• https://childrenswi.org/nutritionhandbook
• Indications for use of pediatric formulas and oral supplements
• Recipes for fortifying breast milk
• Infant and pediatric powder formula recipes
• Weight velocity charts

Patient resources

• https://childrenswi.org/publications/teaching-sheets
• High calorie drinks
• High calorie diet
• ABCs of boosting calories
• High calorie infant diet

3 scoops powder + 5 ounces water (Add water to bottle first, and then add powder)