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Failure to Thrive Follow-up

  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Nov 04, 2015
 

Further Outpatient Care

Carefully monitor growth parameters and overall development. Continue weekly weight checks using the same clinic scale until sustained growth is documented for months.

Provide home visitation services either through public health resources or through a hospital/clinic program as the situation warrants.

Monitor support services aggressively in conjunction with the involved agencies, in particular, local child protection services.

Use the care team regularly and include the family and all involved specialists at team meetings.

Closely document the child’s clinical course.

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Further Inpatient Care

Failure to thrive (FTT) is considered a medical emergency in infants or toddlers who weigh less than 70% of the predicted weight for length.

Watch for refeeding syndrome.

Most infants and children younger than 1-2 years can be treated with a coordinated outpatient care plan. Far fewer patients are hospitalized as inpatients today because of the development of appropriate and focus-specific outpatient care clinics and poor reimbursement for inpatient care.

Patients with severe malnourishment who have had either no previous workup or for whom outpatient care has failed may require hospitalization.

Hospitalization may be required in cases of suspected abuse or neglect, as well as for patients who are perceived to be in an unsafe environment. Foster care placement may be a subsequent requirement.

Nasogastric and gastrostomy tubes should be reserved for the most severe cases.

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Deterrence/Prevention

Prevention of growth failure related to parental neglect and family and/or social dysfunction can be viewed on primary, secondary, and tertiary levels.

Primary prevention involves careful assessment and monitoring of all families in primary care practice for any risk factors as reviewed above.

Secondary prevention involves monitoring and intervention when these risk factors or situations are identified in a family or child. Consider early intervention as a mode of prevention in cases in which the goal is preventing the potential morbidity of growth failure.

Tertiary prevention involves cases that have been identified and where intervention has begun to address the growth failure. Prevent further growth failure, with the resultant developmental disability and poor outcome morbidity, by creating and implementing a care plan that involves detailed review (see Treatment).

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Prognosis

Early diagnosis is crucial. Growth, development and behavior can be affected.

Prognosis should be guarded for infants and children with severe malnutrition. If abuse and neglect are comorbid in a case of FTT, the degree of risk and risk factors for poor outcome increase in complexity and potential for poor outcome increases.

With early intervention and treatment, the overall outcome can be promising for infants and children who respond to the nutritional and environmental interventions needed. Nutritional and growth improvement alone does not mean that all problems are resolved.

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Patient Education

Patient education is one of the most crucial elements of the care plan for these patients. It involves education dealing with nutrition, feeding, and normal child behavior and development.

Also shared with caregivers are the interventions and therapy needed for the patient and those needed to address the family or caregiver pathology or dysfunction.

Consider such education a long-term requirement throughout the early years of the child's growth and, in some situations, for the entire childhood.

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Contributor Information and Disclosures
Author

Andrew P Sirotnak, MD Professor and Vice Chair of Faculty Affairs, Department of Pediatrics, University of Colorado School of Medicine; Department Head, Child Abuse and Neglect, Director, Child Protection Team, The Children's Hospital

Andrew P Sirotnak, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Antonia Chiesa, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine

Antonia Chiesa, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References
  1. Cole SZ, Lanham JS. Failure to thrive: an update. Am Fam Physician. 2011 Apr 1. 83(7):829-34. [Medline].

  2. Black MM, Dubowitz H, Casey PH, et al. Failure to thrive as distinct from child neglect. Pediatrics. 2006 Apr. 117(4):1456-8; author reply 1458-9. [Medline].

  3. Block RW, Krebs NF, American Academy of Pediatrics Committee on Child Abuse and Neglect, American Academy of Pediatrics Committee on Nutrition. Failure to thrive as a manifestation of child neglect. Pediatrics. 2005 Nov. 116(5):1234-7. [Medline].

  4. Brewster DR. Inpatient management of severe malnutrition: time for a change in protocol and practice. Ann Trop Paediatr. 2011. 31(2):97-107. [Medline].

  5. Wojcicki JM, Holbrook K, Lustig RH, Epel E, Caughey AB, Muñoz RF, et al. Chronic maternal depression is associated with reduced weight gain in latino infants from birth to 2 years of age. PLoS One. 2011 Feb 23. 6(2):e16737. [Medline]. [Full Text].

  6. Bambang S, Spencer NJ, Logan S, Gill L. Cause-specific perinatal death rates, birth weight and deprivation in the West Midlands, 1991-93. Child Care Health Dev. 2000 Jan. 26(1):73-82. [Medline].

  7. Frank D, et al. Failure To Thrive. Reece R, Christian C, eds. Child Abuse Medical Diagnosis and Management. 3rd ed. Chicago, Ill: American Academy of Pediatrics; 2009. 465-512.

  8. Gahagan S. Failure to thrive: a consequence of undernutrition. Pediatr Rev. 2006 Jan. 27(1):e1-11. [Medline].

  9. Lowen D. Failure to Thrive. Jenny C, ed. Child Abuse and Neglect Diagnosis, Treatment and Evidence. 1st ed. St. Louis, Mo: Elsevier Saunders; 2011. 547-62.

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This 6-month-old infant was admitted with marasmus. The infant was born to a mother who did not bond effectively because of postpartum depression. He has evidence of severe wasting and neglectful care as also evidenced by the diaper excoriation. Weight gain was achieved by placement in foster home.
 
 
 
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