Failure to thrive
Background
- Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, caloric absorption, or excessive caloric demand.
- Separated into pediatric and adult (often seen in geriatric populations or in those with chronic illnesses).
Pediatric
- Defined as weighing <5th percentile for age and sex, or weight deceleration crossing two major growth lines on a growth chart.
- Does not imply a defect in social, intellectual, or emotional development, but if untreated may lead to any combination of those.
- Classically divided into endogenous (medical) and exogenous (psychosocial or environmental) causes
Evaluation
- A detailed history and physical examination are usually sufficient to establish a cause.
- History should focus on breastfeeding technique, frequency, and duration, or amount of formula and method of preparation.
- Observed feeds can often be useful to identify problems.
- Over 80% of cases are due to insufficient caloric intake from exogenous causes.
Differential Diagnosis
Endogenous Causes
- GERD
- IBS
- Food allergy
- Malabsorption
- Pyloric stenosis
- Gastrointestinal atresia or malformation
- Inborn error of metabolism
- Thyroid disorder
- Chronic infection or immunodeficiency
- Chronic pulmonary disease
- Congenital heart disease or heart failure
- Malignancy
- Celiac disease
- Inflammatory bowel disease
Exogenous Causes
- Breastfeeding problem (latching, suckling, or swallowing)
- Improper formula preparation
- Caregiver depression
- Lack of food availability
- Cleft lip/palate
- Mood disorder
- Eating disorder
- Child neglect or abuse