PEM Playbook – Failure to Thrive

Originally published at Pediatric Emergency Playbook on July 1, 2019 – Reposted with permission

Follow Dr. Tim Horeczko on twitter @EMTogether


Failure to Thrive (FTT) is not just for the clinics. We need to be on the lookout, because if we find it, there is already a big problem.

Definitions of Failure to Thrive may quibble on the details, but for us in the ED:

  1. Consistently under 2nd percentile in weight over time
  2. “Falling off” the growth curve over 2 or more points

We can get around the longitudinal requirement by looking at weight as a “spot check” — if grossly below weight without any other chronic condition, be alarmed.

Failure to thrive results from inadequate calories. This may be due to:

  1. Not enough offered
  2. Not enough taken
  3. Not enough absorbed

Any concern should trigger a more complete H&P (in audio).

Classic instructional video on the mother-infant dyad (scan through for various types).

After a focused H&P, you may need to admit the child for further workup, or to show that he can/cannot gain weight with routine care.

Remember, if you are the first one to bring this up, there is a real problem. By definition, an outpatient plan has failed. We will not be able to distinguish among the various possibilities of organic and non-organic causes (or mix thereof); our job is to be ready to catch it and act on it. The child’s development, future intelligence, and welfare are at risk.

References

Birth to 24 months: Boys Weight-for-length percentiles and Head circumference-for-age percentiles

Birth to 24 months: Boys Length-for-age percentiles and Weight-for-age percentiles

Birth to 24 months: Girls Weight-for-length percentiles and Head circumference-for-age percentiles

Birth to 24 months: Girls Length-for-age percentiles and Weight-for-age percentiles

Jaffe AC. Failure to Thrive. Pediatrics in Review. 2011; 32(3)

Prutsky GJ et al. When Developmental Delay and Failure to Thrive Are Not Psychosocial. Hospital Pediatrics. 2016; (1):6

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