Nutritional Considerations in Failure to Thrive Differential Diagnoses

Author: Simon S Rabinowitz, MD, PhD; Chief Editor: Jatinder Bhatia, MBBS more...

Updated: May 4, 2010

What would you like to print?

Multimedia Library

Tables

References

Differential Diagnoses

Proceed to Workup

Contributor Information and Disclosures

Author

Simon S Rabinowitz, MD, PhD Professor of Clinical Pediatrics, New York Medical College; Chairman, Chief and Medical Administrator, Department of Pediatrics, Chief, Pediatric Gastroenterology and Nutrition, Richmond University Medical Center

Simon S Rabinowitz, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, New York Academy of Sciences, North American Society for Pediatric Gastroenterology and Nutrition, Phi Beta Kappa, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Madhavi Katturupalli, MD Resident Physician, Department of Pediatrics, New York Medical College, Richmond University Medical Center

Madhavi Katturupalli, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Genie Rogers, MA, CCC-SLP, BRS-S Speech-Language Pathologist, Infant and Child Learning Center, Neonatal Intensive Care Unit, Downstate University Hospital; Clinical Supervisor, Speech Therapy Services, Step by Step Infant Development Program

Genie Rogers, MA, CCC-SLP, BRS-S is a member of the following medical societies: American Speech-Language-Hearing Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Maria Rebello Mascarenhas, MBBS Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief Nutrition, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia

Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Jatinder Bhatia, MBBS Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia

Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, Society for Pediatric Research, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Merrily P M Poth, MD Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

References

Bauchner H. Failure to Thrive. In: Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, PA: WB Saunders; 2007:37;184-7.
Frank DA, Zeisel SH. Failure to thrive. Pediatr Clin North Am. Dec 1988;35(6):1187-206. [Medline].
Porter B, Skuse D. When does slow weight gain become 'failure to thrive'?. Arch Dis Child. Jul 1991;66(7):905-6. [Medline].
Zenel JA Jr. Failure to thrive: a general pediatrician's perspective. Pediatr Rev. Nov 1997;18(11):371-8. [Medline].
Hoare KJ. A baby presenting with failure to thrive in primary care: a case report. Cases J. 2009;2(1):137. [Medline].
Leung DH, Chung CT. Cases in pediatric gastroenterology from The Children's Hospital of Philadelphia: a 2-year-old boy with diarrhea, failure to thrive, and hepatomegaly. Medscape J Med. 2009;11(1):13. [Medline].
Rudolf MC, Logan S. What is the long term outcome for children who fail to thrive? A systematic review. Arch Dis Child. Sep 2005;90(9):925-31. [Medline].
Olsen EM, Petersen J, Skovgaard AM, et al. Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population. Arch Dis Child. Feb 2007;92(2):109-14. [Medline].
Reilly SM, Skuse DH, Wolke D, Stevenson J. Oral-motor dysfunction in children who fail to thrive: organic or non-organic?. Dev Med Child Neurol. Feb 1999;41(2):115-22. [Medline].
Olsen EM, Skovgaard AM. [Psychosomatic failure-to-thrive in infants and toddlers]. Ugeskr Laeger. Nov 25 2002;164(48):5631-5. [Medline].
Skuse DH. Non-organic failure to thrive: a reappraisal. Arch Dis Child. Feb 1985;60(2):173-8. [Medline].
Manikam R, Perman JA. Pediatric feeding disorders. J Clin Gastroenterol. Jan 2000;30(1):34-46. [Medline].
[Guideline] Centers for Disease Control and Prevention. CDC Growth Charts. August 4, 2009;[Full Text].
[Guideline] Cronk C, Crocker AC, Pueschel SM, et al. Growth charts for children with Down syndrome: 1 month to 18 years of age. Pediatrics. Jan 1988;81(1):102-10. [Medline].
[Guideline] Lyon AJ, Preece MA, Grant DB. Growth curve for girls with Turner syndrome. Arch Dis Child. Oct 1985;60(10):932-5. [Medline].
[Guideline] Horton WA, Rotter JI, Rimoin DL, Scott CI, Hall JG. Standard growth curves for achondroplasia. J Pediatr. Sep 1978;93(3):435-8. [Medline].
Drewett RF, Corbett SS, Wright CM. Cognitive and educational attainments at school age of children who failed to thrive in infancy: a population-based study. J Child Psychol Psychiatry. May 1999;40(4):551-61. [Medline].
Prazuck T, Tall F, Nacro B, et al. HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso. AIDS. Jan 1993;7(1):103-8. [Medline].
Lechner-Gruskay D, Honig PJ, Pereira G, McKinney S. Nutritional and metabolic profile of children with epidermolysis bullosa. Pediatr Dermatol. Feb 1988;5(1):22-7. [Medline].
Berwick DM, Levy JC, Kleinerman R. Failure to thrive: diagnostic yield of hospitalisation. Arch Dis Child. May 1982;57(5):347-51. [Medline].
Genero A, Moretti C, Fait P, Guariso G. [Non-organic failure to thrive: retrospective study in hospitalized children]. Pediatr Med Chir. Sep-Oct 1996;18(5):501-6. [Medline].
Homer C, Ludwig S. Categorization of etiology of failure to thrive. Am J Dis Child. Sep 1981;135(9):848-51. [Medline].
Daniel M, Kleis L, Cemeroglu AP. Etiology of failure to thrive in infants and toddlers referred to a pediatric endocrinology outpatient clinic. Clin Pediatr (Phila). Oct 2008;47(8):762-5. [Medline].
Oates RK. Similarities and differences between nonorganic failure to thrive and deprivation dwarfism. Child Abuse Negl. 1984;8(4):439-45. [Medline].
Skuse DH. Non-organic failure to thrive: a reappraisal. Arch Dis Child. Feb 1985;60(2):173-8. [Medline].
Schwarz SM, Corredor J, Fisher-Medina J, Cohen J, Rabinowitz S. Diagnosis and treatment of feeding disorders in children with developmental disabilities. Pediatrics. Sep 2001;108(3):671-6. [Medline].
Tannenbaum GS, Ramsay M, Martel C, Samia M, Zygmuntowicz C, Porporino M. Elevated circulating acylated and total ghrelin concentrations along with reduced appetite scores in infants with failure to thrive. Pediatr Res. May 2009;65(5):569-73. [Medline].
Sills RH. Failure to thrive. The role of clinical and laboratory evaluation. Am J Dis Child. Oct 1978;132(10):967-9. [Medline].
Maggioni A, Lifshitz F. Nutritional management of failure to thrive. Pediatr Clin North Am. Aug 1995;42(4):791-810. [Medline].
Black MM, Dubowitz H, Krishnakumar A, Starr RH Jr. Early intervention and recovery among children with failure to thrive: follow-up at age 8. Pediatrics. Jul 2007;120(1):59-69. [Medline].
Black MM, Dubowitz H, Hutcheson J, Berenson-Howard J, Starr RH Jr. A randomized clinical trial of home intervention for children with failure to thrive. Pediatrics. Jun 1995;95(6):807-14. [Medline].
Reif S, Beler B, Villa Y, Spirer Z. Long-term follow-up and outcome of infants with non-organic failure to thrive. Isr J Med Sci. Aug 1995;31(8):483-9. [Medline].
Corbett SS, Drewett RF. To what extent is failure to thrive in infancy associated with poorer cognitive development? A review and meta-analysis. J Child Psychol Psychiatry. Mar 2004;45(3):641-54. [Medline].
Emond AM, Blair PS, Emmett PM, Drewett RF. Weight faltering in infancy and IQ levels at 8 years in the Avon Longitudinal Study of Parents and Children. Pediatrics. Oct 2007;120(4):e1051-8. [Medline].
Mackner LM, Starr RH Jr, Black MM. The cumulative effect of neglect and failure to thrive on cognitive functioning. Child Abuse Negl. Jul 1997;21(7):691-700. [Medline].

Failure of growth in weight, length, and head circumference starting at birth, suggesting an organic etiology that occurred in utero.

Growth failure in length and weight with a normal head circumference in an infant with growth hormone deficiency.

Acquired hypothyroidism.

Constitutional delay of growth.

Failure to thrive secondary to caloric deprivation.

Table 1. Summary of Organic Causes of Failure to Thrive

Prenatal causes	Prematurity with complications Maternal malnutrition Toxic exposure in utero Alcohol, smoking, medications, infections IUGR Chromosomal abnormalities
Postnatal causes	Inadequate intake Lack of appetite (chronic illness) Inability to suck or swallow Vomiting Therapy used to treat primary illness (eg, chemotherapy) Developmental delay GI pain or dysmotility Poor absorption and/or use of nutrients Malabsorption Anatomical GI problems Pancreatic and cholestatic conditions Inborn errors of metabolism Chronic GI infections Increased metabolic demand HIV infection Malignancy Cardiopulmonary diseases and inflammatory conditions Renal failure Hyperthyroidism

Prenatal causes

Prematurity with complications
Maternal malnutrition
Toxic exposure in utero
Alcohol, smoking, medications, infections
IUGR
Chromosomal abnormalities

Postnatal causes

Inadequate intake

Lack of appetite (chronic illness)
Inability to suck or swallow
Vomiting
Therapy used to treat primary illness (eg, chemotherapy)
Developmental delay
GI pain or dysmotility

Poor absorption and/or use of nutrients

Malabsorption
Anatomical GI problems
Pancreatic and cholestatic conditions
Inborn errors of metabolism
Chronic GI infections

Increased metabolic demand

HIV infection
Malignancy
Cardiopulmonary diseases and inflammatory conditions
Renal failure
Hyperthyroidism

Table 2. Examples of High-Calorie Fortifiers

Product	Calories	Source
Medium-chain triglyceride (MCT) oil	7.7 kcal/mL	Fractionated coconut oil
Microlipid	4.5 kcal/mL	Safflower oil
Corn oil	8.4 kcal/mL	Corn
ProMod (protein powder)	28 kcal/scoop (4.2 kcal/g) 5 g/scoop	Whey protein with lecithin
Polycose (powder or liquid)	Powder - 23 kcal/tbsp Liquid - 30 kcal/tbsp	Powder - Hydrolyzed cornstarch Liquid - Glucose polymers derived from hydrolyzed cornstarch
Rice cereal (powder)	15 kcal/tbsp	Rice flour
Nonfat dry milk powder	15 kcal/T (1.5 g protein)	Cow's milk
Powder infant formula	40 kcal/tbsp	Cow's milk
Liquid concentrated infant formula	40 kcal/oz	Cow's milk

Table 3. Examples of High-Calorie Nutritional Products

Product, 30 kcal/oz	CHO, g/100 mL	Protein, g/100 mL	Fat, g/100 mL	Osmolality	Nutrient Sources
Nutren Junior (Clintec)	12.8	3	4.2	350	CHO - Maltodextrin, sucrose Protein - Casein, whey Fat - Soy, MCT, and canola oils (Vanilla, also available with fiber)
Kindercal (Mead Johnson)	13.5	3.4	4.4	310	CHO - Maltodextrin, sucrose Protein - Caseinates, milk protein concentrate Fat - Canola, MCT, and high-oleic sunflower oils Contains soy fiber 6.3 g/L (Vanilla)
PediaSure (Ross)	11	3	5	310	CHO - Corn syrup solids, sucrose Protein - Caseinate, whey protein concentrate Fat - High-oleic safflower, soy, and MCT oils (Vanilla, also available with fiber)
Boost (Mead Johnson)	17.4	4.3	1.7	590-620	CHO - Sucrose, corn syrup solids Protein - Milk protein concentrate Fat - Canola, sunflower, corn oils (Chocolate, chocolate mocha, strawberry, vanilla)

View Table List

Read more about Nutritional Considerations in Failure to Thrive on Medscape