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Failure to thrive (FTT) is a sign of inadequate nutrition for optimal growth and development. FTT has multiple definitions, which include the following: weight-forage below the third percentile; a rate of weight gain that is disproportionate to the rate of length gain; weight-for-length less than 10th percentile (in children <24 months); and a decrease in 2 or more major growth percentile curves. 1,2 FTT more commonly presents in children less than 18 months of age. 2 In the United States, children with FTT account for 5% to 10% of primary care pediatric patients and 3% to 5% of pediatric hospital admissions. 2 Previous studies have described patient characteristics of children with failure to thrive. 3-8 These studies often made a distinction between "organic" (with an underlying medical pathology) and "nonorganic" (underlying behavioral and psychological) causes. 4,8-10 However, some researchers have advocated to abandon the use of the dichotomous "organic" versus "nonorganic" description of FTT. 1,11,12 The dichotomous division is thought to be too simplistic for clinical and research purposes and does not capture the complexity of patients presetting with FTT. Several researchers make the case that FTT is explained by multiple biopsychosocial factors and arises from the interaction between these factors. 9,11 Feeding difficulties are common in children with FTT. 13 The term "feeding difficulties" is commonly used as an umbrella term that refers to a "feeding problem of some sort." 14(p345) These problems can include 858526G PHXXX10.

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Introduction The field of Paediatric Medicine has grown tremendously over the last two decades. Several niche areas of practice have emerged, and opportunities for focused training in these areas have grown in parallel. The landscape of ‘General Paediatric Fellowship’ (GPF) Programs in Canada is not well described; this knowledge is needed to promote standardization and high-quality training across Canada. This study explores the structure and components of existing GPFs in Canada and identifies the interest and barriers to providing such programs. Methods A questionnaire was created to explore the landscape of GPF Programs in Canada. Invitations to participate were sent to leaders of General Paediatric Divisions across Canada, with a request to forward the survey to the most appropriate individual to respond within their local context. Results A total of 19 responses (95%) representing 17 different Canadian universities were obtained. Eight universities offered a total of 13 GPF Programs in 2019, with one additional university planning to start a program in the coming year. Existing programs were variable in size, structure and curriculum. Most programs identified as Academic Paediatric Programs, with an overlap in content and structure between Academic Paediatrics and Paediatric Hospital Medicine programs. The majority of respondents felt there was a need for GPF Programs in Canada but cited funding as the most common perceived barrier. Conclusion A growing number of GPF Programs exist in Canada. Current fellowship programs are variable in structure and content. Collaboration between programs is required to advance GPF training in Canada.

BACKGROUND Failure to thrive (FTT) is prevalent in 5% of the paediatric population and results from the interactions between the child’s health, behaviour, development and social environment. A multi-disciplinary team approach to treat FTT is effective but resources are not always available. OBJECTIVES To characterize biopsychosocial factors and feeding behaviours in children presenting with failure to thrive in our clinic. DESIGN/METHODS A retrospective cross-sectional chart review of children referred to our academic growth and feeding clinic was performed. Children between the ages of 2 months and 5 years with a first clinic visit between 1st January 2015 and 31st of December 2016 were included. Data from the patient’s first visit was included in the study. In a REDCAP database, anthropometric measures according to WHO growth curves, medical history and concurrent developmental delays were recorded. Factors important to the child’s social environment (e.g. maternal mental health, financial problems) were identified. These factors were self-reported by parents to the clinic team or noted on the patient’s referral. Specific attention was paid to the identification of feeding behaviours of children (e.g. vomiting, gagging) and parents (e.g. force feeding, use of distractions). Descriptive statistics were used to analyze the data. RESULTS The study included n = 138 (53.6% male) children with a mean age of 16.9 (SD 10.8) months. The mean weight-for-age percentile was 16.0 (SD 24.3), mean height-for age percentile was 23.8 (SD 30.7), and mean weight-for-length percentile was 16.8 (SD 23.4). 88 (63.8%) children had both growth and feeding behaviour concerns. 26 (18.8%) children were born prematurely and 24 (17.4%) were small for gestational age. 57 (41.3%) children had a history of gastro-oesophageal reflux. In 10 (7.2 %) children, a genetic diagnosis was identified. Concurrent developmental delays were described in the gross motor (20.3%), fine motor (8.0%), speech and language (20.3%) and social domains (6.5%). Feeding developmental milestones that were delayed included not-self feeding (17.4%) and a diet inappropriate for age (20.3%). Important factors that were identified in the child’s social environment were: maternal depression (5.1%), CAS involvement (10.1%) and financial problems (7.2 %). Maternal anxiety was reported but difficult to define. In more than half (50.7%) of the children, feeding behaviours of vomiting, gagging and/or crying and arching were described. Parents used force feeding (14.5%) and distractions (47.1%), and reported mealtimes longer than 30 minutes (70.3%). Most commonly used distractions were television (25.4%) and mobile screens (14.5%). CONCLUSION In our academic population of children with FTT, there is a high incidence of concurrent developmental delays, delayed feeding milestones and feeding behaviour problems. Almost half of the parents used distractions and even more parents prolonged mealtimes to make their child eat. These results underscore the importance of a multi-disciplinary team approach to address feeding behaviours and child development in our population of children with FTT.