eMedicine Specialties > Pediatrics: General Medicine > Nutrition
Failure to Thrive: Treatment & Medication
Updated: May 4, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Most children with failure to thrive (FTT) can be treated as outpatients; home visits and close clinical follow-ups often help determine the underlying reason for the failure to thrive. However, hospitalization sometimes is necessary for diagnostic and therapeutic reasons. Diagnostic benefits of admission may include observation of feeding, parental-child interaction, and dietary habits, as well as the ability to perform specific tests and consult subspecialists.
Therapeutic benefits may result from hospitalization. Acute needs, such as dehydration, infection, anemia, or electrolyte imbalance, can be addressed and managed within the hospital. For instance, intravenous fluids, systemic antibiotic therapy, transfusion, and, possibly, parenteral nutrition often are in-hospital procedures. Of course, if an organic etiology is found for the failure to thrive in a particular child, specific therapy can be initiated during the hospitalization.
Another benefit of hospitalization may be the observation of parent-child interaction. In addition to observation of the feeding techniques of the parents, other interactions can be observed more easily in the hospital. For instance, the degrees to which parents bond, speak, and even interact with their children all can be observed during the hospital stay. If children gain weight easily during a hospitalization, the cause of the failure to thrive is most likely nonorganic.
Consultations
When treating children with failure to thrive, an interdisciplinary team approach combining pediatric, nutritional, mental health, and social work expertise often is helpful. An interdisciplinary approach ensures that programs such as women, infants, and children (WIC); food stamps; and Medicaid can be accessed. Using an interdisciplinary approach is also helpful if appropriate home-based intervention needs to be arranged.
Other advantages of using an interdisciplinary team include the fact that the family's psychosocial situation can be addressed and intervention can be provided. For example, an older child with a chronic illness and failure to thrive may benefit from referral to a psychologist. If neglect is suspected, child protective services can become involved as a result of this multidisciplinary approach.
Subspecialists should be involved for the treatment of organic illness when identified.
Diet
The long-term goal for every child with failure to thrive is to provide adequate energy intake for growth. Therefore, even if no etiology is found for a child with failure to thrive, aggressive dietary management is the cornerstone of therapy. Proper feeding can be achieved through infant formulas that are adjusted to meet the child's specific nutrient needs. For instance, some children are given formulas that have as much as 30 kcal/oz, whereas other children may receive regular 20 kcal/oz formulas supplemented with high-calorie food fortifiers, which can be lipids, protein, or carbohydrates (CHO).
Infants may be given concentrated formulas, assuming renal function is normal. If this option is chosen, renal function must be normal because the osmolar load of the resultant formula is high. In cases in which this is a problem because of renal insufficiency, increasing the fat content of the formula may be useful as a way of delivering additional calories.
Supplements for older children may include adding cheese, sour cream, butter, margarine, or peanut butter to meals. Also, high-energy (approximately 1 kcal/mL) shakes, which are available in different flavors, provide a good supplement (eg, Pedia Sure, Kindercal, Boost). Multivitamin and mineral supplements, including iron and zinc, usually are recommended to all undernourished children. Tube feeding rarely is indicated except for severe malnutrition and debilitation. In children with organic failure to thrive, continuous nighttime tube feeding also may be used to increase their energy intake.
Whether the child with failure to thrive is an inpatient or an outpatient, increasing energy intake is necessary. In younger children, energy intake is increased by increasing the amount of formula or caloric concentration of formula, using 24 or 27 kcal/oz, or adding calorie fortifiers. In toddlers, supplemental high-energy formulas as much as 30 kcal/oz are used. Sometimes these can be administered through tube feedings.
Table 2. Examples of High-Calorie FortifiersOpen table in new window
Table
| 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 |
| 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 |
Open table in new window
Table
| 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) |
| 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) |
More on Failure to Thrive |
| Overview: Failure to Thrive |
| Differential Diagnoses & Workup: Failure to Thrive |
 Treatment & Medication: Failure to Thrive |
| Follow-up: Failure to Thrive |
| Multimedia: Failure to Thrive |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
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Further Reading
- The following are relevant clinical guidelines:
- The following are relevant clinical trials:
- Related eMedicine topics include the following:
Keywords
failure to thrive, FTT, growth failure, failure of growth, malnutrition, delayed growth, growth charts, infant growth, normal growth, growth in infants, normal weight in infants, normal height in infants, head circumference in infants, Down syndrome, Turner syndrome, malnutrition, diarrhea, cerebral palsy, seizure, hepatomegaly, marasmus, maternal eating disorders, anorexia, bulimia, psychosocial deprivation, neglect, emotional deprivation syndrome, prematurity, placental insufficiency, alcohol ingestion, hypertension, preeclampsia, heart disease, diabetes mellitus, short stature, Prader-Willi syndrome, craniofacial abnormalities, congestive heart failure, chronic lung disease, bronchopulmonary dysplasia, gastroesophageal reflux, esophagitis, cystic fibrosis, CF, hyperthyroidism, milk protein allergy, Celiac disease, protein-losing enteropathies, Shwachman-Diamond syndrome, renal failure, renal tubular acidosis, hypothyroidism, systemic lupus erythematosus, treatment, diagnosis
