(Newswire.net — June 6, 2022) — “Failure to thrive” (FTT) is a term that is widely used today, but it does not have a precise definition. FTT is also known as malnutrition and undernutrition. FTT is often multifactorial and involves complex interactions between social, medical, nutritional, emotional, as well as social factors. This wide range of factors can present a challenge for diagnostics, but providers from all disciplines can evaluate and coordinate a management plan to treat FTT.
What is FTT
Classically, failure to thrive is when a child’s body weight falls below the standardized curve and/or to a greater degree than their height This recognition relies on reliable serial growth measurements. The data collectors must be well-trained and use a standard method.
The Centres for Disease Control and Prevention recommends that children younger than 2 years old use the World Health Organisation’s weight for length growth chart and the CDC body Mass Index (BMI) growth charts for older children.
Diagnostic evaluation
The key to determining the cause of FTT and how to manage it is diagnostic evaluation. The diagnostic evaluation of FTT should be initiated by a paediatric dietician. This involves taking a detailed eating history and performing a social, clinical, and developmental assessment to determine if there are any issues that could lead to undernutrition. These causes can be classified as inadequate caloric intake or inadequate caloric usage and/or higher metabolic demands. If you think of a healthy diet for your children, you can contact pediatric dieticians from Offspring Health.
History and physical examination
The parent/caregiver may provide a 24-hour recall to obtain a dietary history. Providers should seek the assistance of a dietitian to conduct a more detailed assessment, including counting calories.
It is important to record the patient’s diet and calories, as well as when they eat and how often. The history should also include questions about the child’s eating habits, meal times, and parent reactions to nutrition. Insufficient calories can be caused by excessive consumption of juice and other drinks that are low in nutrition and restrict appetite, as well as improper formula preparation. Breastfeeding mothers should discuss their diet, use of medication, alcohol, and other substances that could affect milk production and down.
Accurate history can also help to identify the underlying cause of FTT. This includes symptoms such as vomiting, diarrhea, blood in the stool, bloody stool, or constipation. It is also possible to ask about respiratory signs like breathing difficulties, chronic cough, or snoring. Detailed family history is necessary to determine the growth patterns of siblings, parents, and grandparents, and to identify illnesses like food allergies, inflammatory bowel diseases, celiac disease, and asthma. The physical exam should also include observation of parent-child interactions, including during feeding.
Management
FTT management includes the creation of a nutrition plan and the identification of causes. Multifactorial management is ideal. It includes a multidisciplinary team that includes a pediatrician, dietitian, and social worker as well as other services, if necessary.
The nutritional plan aims to provide sufficient calories, protein, as well as micronutrients such iron and zinc. To determine the daily caloric requirement (kcal/kg), for catch-up growth, you can use this formula:
Strategies to achieve the target weight will depend on the child’s age and the underlying FTT. This may include supplementation with energy-dense formulas for formula-fed babies and lactation support for the mothers; dietary fortification using energy-dense foods and nutritional supplements for toddlers and older kids.
If the child cannot get the nutrition they need orally, tube feeding may be an option. A nasogastric tube will be preferred to a gastrostomy tube unless the child cannot tolerate tube feedings after a trial or it is expected that the tube feedings will last more than 6 months. Individual decisions about whether to provide continuous or bolus feeds are made.
If a child is severely malnourished, it is important to increase caloric intake gradually. This can prevent refeeding syndrome from occurring, which is a serious problem related to fluid and electrolyte shifts. Refeeding syndrome is possible in children with severe FTT/malnutrition. These children should be admitted to the hospital for careful clinical monitoring.
Follow-up
Parents should be asked to keep a log and bring their child in for weight checks to monitor the child’s progress. It is reasonable to assume that FTT early intervention will reduce long-term malnutrition. However, there is not enough longitudinal data and the findings from existing studies are inconsistent. Follow-up for children with FTT should include an examination of their mental and emotional development, and referrals to appropriate resources to optimize their outcomes.
Children admitted to the hospital may be released after their consultations and diagnostic testing are completed and consistent weight gain is observed. Parents must understand the management recommendations and must also have a plan in place for continued care and follow-up.
Summary
For the care and monitoring of FTT children, the role of an outpatient pediatrician is crucial. Routine growth assessments enable providers to diagnose FTT. Providers can also use their history-taking skills and physical examination skills to often identify the etiology of FTT in a cost-effective and timely manner.
Specific diagnostic findings can guide further evaluation and management. Multidisciplinary treatment is often required as FTT tends to be multifactorial. Pediatricians would be able to provide the best care possible for children with FTT if they had a standardized approach.