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Failure to Thrive Evaluation
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Failure to Thrive Evaluation
See Also
Delayed Growth
Failure to Thrive
Failure to Thrive Causes
Failure to Thrive Diagnosis
Failure to Thrive Red Flags
Failure to Thrive Management
Evaluation
Step 1 - Review Growth Patterns
See
Growth Assessment
See
Height Measurement in Children
See
Weight Measurement in Children
Head Circumference
Expected Weight gain (g/day)
Age 0 to 3 months: 26-31 grams weight gained per day
Age 3 to 9 months: 13-18 grams weight gained per day
Age 9 to 14 months: 10-11 grams weight per day
Age 15 to 24 months: 7-9 grams weight per day
Plot weight, height and
Head Circumference
Correct
Premature Infant
Gestational age
(<24 months)
35% of
Small for Gestational Age
infants <5% at age 4
Evaluation
Step 2- Determine if
Failure to Thrive
is present and to what degree
See
Failure to Thrive Diagnosis
See
Failure to Thrive Red Flags
Evaluation below is in light of distinguishing
Failure to Thrive Causes
History
Nutrition
Dietary intake
Consider detailed 1-3 day diary of dietary intake
Quality and Quantity of food
Does the child feed themself (e.g. spoon, cup)
Psychosocial events around feeding time
Is the child distracted or not supervised?
Are there food battles or food refusal?
Discuss food preparation (e.g. formula too dilute)
Beverages
Milk amounts (excessive?)
Nonnutritive drinks such as juice soda
Stool
habits (e.g. frequency and consistency)
Consider dietary or nutrition
Consultation
Pica
history
Nursing or
Breast Feeding
history
Infequent brief feedings
Maternal ingestion of milk suppressant
Alcohol
Diuretic
s
Inadequate milk supply
Nipple problems
Inadequate milk let down
Poor suck
Maternal
Malnutrition
Maternal exhaustion or
Major Depression
History
Social
Interference with adequate caretaking
Risk factors
Economic stress
Disorganized family
Social isolation
Parental depression
History of parent loss
Overworked parent
Parental
Alcohol Abuse
or
Drug Abuse
Intimate Partner Violence
or other abuse
Consider physical, psychological or marital problems
Restricted home diet due to health, cultural, religious or nutritional beliefs
History
Past Medical
Birth
Gestational age
<37 weeks
Low birth weight (<2500 g or <5 lb 8 oz)
Complications
Congenital anomalies
Autism
Developmental Delay
Cerebral Palsy
Trisomy 21
Chronic medical conditions
Anemia
Asthma
Gastroesophageal Reflux
disease
Poor
Oral Health
or
Dentition
Acute illness
Otitis Media
Gastroenteritis
History
Family
Short Stature
Failure to Thrive
in siblings
Mental illness
Exam
Observe interaction between parent and child
Feeding and non-feeding times
Decreased, inconsistent, or nonmutual interactions
Maladaptive parent-child feeding interactions
Consider observation in hospital with multispecialty evaluation
Exam
Assess for
Developmental Delay
Gross Motor function from neuromuscular weakness
Social skills and Expressive Language
Gaze avoidance
Minimal smiling
Non-responsive to people
Inappropriately friendly to strangers
Bizarre behavior
Apathy
Poor hygiene
Exam
Complete Physical
Decrease in skin fold thickness and Subcutaneous fat
Suggests
Malnutrition
Dysmorphic features in Congenital Dysorders
Identify findings suggestive of physical abuse or neglect
Observe for parent-child interactions
Focus on evaluation for
Failure to Thrive Red Flags
Cacchexia
Malignancy
Type I Diabetes
Cognitive deficits
Developmental Delay
Heart Murmur
Congenital Heart Disease
Hepatomegaly
Chronic illness, infection or
Malnutrition
Edema
Renal or hepatic disease
Labs
Indications
Failure to Thrive Red Flags
are present
Refractory course despite adequate caloric replacement
Efficacy
Normal in 98% of
Failure to Thrive
Consider obtaining only if no improvement
Sills (1978) Am J Dis Child 132:967-9 [PubMed]
Initial labs
Urinalysis
and
Urine Culture
Serum Comprehensive Metabolic Panel (
Electrolyte
s,
Renal Function
tests,
Liver Function Test
s)
Complete Blood Count
Thyroid Function Test
s
Erythrocyte Sedimentation Rate
(ESR) or
C-Reactive Protein
(
C-RP
)
Specific Labs if indicated by history and physical
Stool
for fat content
Stool
for
Ova and Parasite
s
Serum complement levels
Immunoglobulin
levels
Serum Calcium
Seum Phosphate
Serum Albumin
Beta Carotene
Echocardiogram
HIV Test
Hepatitis B Surface Antigen
PPD or Tb Quantiferon
Cystic Fibrosis
testing (if not done with
Newborn Screen
)
Imaging
Skeletal XRay of hands and wrist for
Bone Age
References
Homan (2016) Am Fam Physician 94(4): 295-9 [PubMed]
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