Failure to Thrive: A Practical Guide

 


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Am Fam Physician. 2016 Aug 15;94(4):295-299.

  Patient information: See related handout on failure to thrive, written by the author of this article.

Author disclosure: No relevant financial affiliations.

Children with very low weight for age or height and those who do not maintain an appropriate growth pattern may have failure to thrive (FTT), also known as weight faltering. If confirmed by repeated valid measurements, FTT should prompt a search for causes of undernutrition, including neglect, family food insecurity, and underlying medical conditions. Inadequate caloric intake is the most common cause of FTT, but inadequate nutrient absorption or increased metabolism is also possible. Difficulty attaining or maintaining appropriate weight is the first indication of FTT, and sustained undernutrition can impede appropriate height, head circumference, and the development of cognitive skills or immune function in extreme cases. Early identification and management of the issues causing undernutrition are critical. In most cases, an appropriate growth velocity can be established with outpatient management based on proper nutrition and family support. Primary care physicians can effectively treat most children with FTT, and subspecialist consultation or hospitalization is rarely indicated.

Failure to thrive (FTT) is an abnormal pattern of weight gain defined by the lack of sufficient usable nutrition and documented by inadequate weight gain over time. The decrease in the velocity of weight gain results in the child steadily falling off the expected weight curve on growth charts.13 The term weight faltering has been proposed to more appropriately emphasize that problems with appropriate weight gain are the initial and most reliable clinical finding of undernutrition. The term weight faltering is also perceived to be less negative or alarming, and less potentially critical of parents or caretakers.2,4,5

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferencesComments

Valid weight measurements over time, rather than at a single point, are required for the recognition of failure to thrive.

C

46, 8, 9

World Health Organization growth charts are recommended for children up to two years of age. Centers for Disease Control and Prevention growth charts are recommended for patients two to 20 years of age.

C

1012

Specialized growth charts can be used in addition to the standard charts for supplemental data collection in children born prematurely or with specific diagnoses, such as Turner syndrome or trisomy 21.

Routine laboratory testing and hospitalization are rarely indicated in the assessment of failure to thrive.

C

5, 22, 27

Testing should generally be targeted at specific underlying diagnoses that are suspected.


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferencesComments

Valid weight measurements over time, rather than at a single point, are required for the recognition of failure to thrive.

C

46, 8, 9

World Health Organization growth charts are recommended for children up to two years of age. Centers for Disease Control and Prevention growth charts are recommended for patients two to 20 years of age.

C

1012

Specialized growth charts can be used in addition to the standard charts for supplemental data collection in children born prematurely or with specific diagnoses, such as Turner syndrome or trisomy 21.

Routine laboratory testing and hospitalization are rarely indicated in the assessment of failure to thrive.

C

5, 22, 27

Testing should generally be targeted at specific underlying diagnoses that are suspected.


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Although problems achieving or sustaining appropriate weight are the predominant manifestations of FTT, ongoing severe malnutrition impairs overall growth, impacting weight first, then length and head circumference. In extreme cases, the development of cognitive skills and appropriate immune function can be impaired, resulting in failure to achieve developmental milestones and normal health.2,5,6

Diagnosis

The term FTT should be used as a clinical finding and not as a diagnosis.4,7 Recognition depends on reliable and valid measurements over time; therefore, serial measurements of weight and height must be accurately obtained and charted on an appropriate reference scale (growth chart).46,8,9 The World Health Organization (WHO) growth charts are recommended for patients up to two years of age

The Author

GRETCHEN J. HOMAN, MD, is a board-certified pediatrician and an assistant professor at the University of Kansas School of Medicine in Wichita.

Author disclosure: No relevant financial affiliations.

Address correspondence to Gretchen J. Homan, MD, University of Kansas Medical Center, 620 N. Carriage Parkway, Wichita, KS 67208 (e-mail: ghoman@kumc.edu). Reprints are not available from the author.

REFERENCES

show all references

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