Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting

Abstract

Background: Failure to thrive is a common reason for referral to paediatric services. Malnutrition or inadequate caloric intake is the most common cause, while organic form is unlikely in children who are asymptomatic and healthy on examination. By this study we evaluate the application of a cost-effective flow chart that helps the clinician in a hospital setting discern accurately organic and non-organic failure to thrive.

Methods: Conduct a prospective single-center study in children up to 2 years of age with growth faltering. The pediatricians used a practical flow chart, took the medical history, created a growth chart, performed clinical examinations, and requested blood test and consultations in a step by step approach.

Results: Among the 74 subjects included in the study, the diagnosis of organic failure to thrive was reached by 42%. Gastrointestinal and genetic diagnoses were the most frequent. Patients with organic failure to thrive had significantly lower gestational age and birth weight. Age at diagnosis and Z-score weight were lower in organic than in non-organic forms. Most patients with non-organic forms (88%) did not undergo in-depth blood test or specialist advice.

Conclusion: The flow chart we presented was accurate for diagnosing children with failure to thrive in a hospital setting and distinct organic and non-organic forms. It was cost-effective to avoid unnecessary blood test or consultations in most non-organic diagnoses.

Keywords: Failure to thrive; Flow chart; Hospital setting.

Fig. 1

failure to thrive starting approach. IUGR: intrauterine growth restriction. SGA: small for gestational age. WT: weight, LT: length, HC: head circumference. BW: birth weight

Fig. 2

approach to first weight (WT) faltering. GERD: gastroesophageal reflux disease. E/E: entry/exit balance. CMPI: intolerance to cow’s milk proteins

Fig. 3

approach to weight (WT) faltering concomitant with length (LT) and/or head circumference (HC) faltering; approach to first HC faltering or first LT faltering

Fig. 4

box plot of weight (WT) z-score in non-organic failure to thrive (NOFTT) and organic failure to thrive (OFTT). The box’s centerline denotes the median value, the box’s extremes, the interquartile range, and the bars, the upper and lower limits of 95% of the data, p value by chi-square test