Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting

Abstract

Background Failure to thrive is a common reason for referral to paediatric services. Malnutrition or inadequate caloric intake is the most common cause, while organic form is unlikely in children who are asymptomatic and healthy on examination. By this study we evaluate the application of a cost-effective flow chart that helps the clinician in a hospital setting discern accurately organic and non-organic failure to thrive. Methods Conduct a prospective single-center study in children up to 2 years of age with growth faltering. The pediatricians used a practical flow chart, took the medical history, created a growth chart, performed clinical examinations, and requested blood test and consultations in a step by step approach. Results Among the 74 subjects included in the study, the diagnosis of organic failure to thrive was reached by 42%. Gastrointestinal and genetic diagnoses were the most frequent. Patients with organic failure to thrive had significantly lower gestational age and birth weight. Age at diagnosis and Z-score weight were lower in organic than in non-organic forms. Most patients with non-organic forms (88%) did not undergo in-depth blood test or specialist advice. Conclusion The flow chart we presented was accurate for diagnosing children with failure to thrive in a hospital setting and distinct organic and non-organic forms. It was cost-effective to avoid unnecessary blood test or consultations in most non-organic diagnoses.

Failure to thrive and it's Risk factors among children under 5 years old in Al-Batool Teaching Hospital in Baquba city

“…Considering gender, in this study there was no significant correlation between gender and the incidenc of failure to thrive, which agreed with the studies [22] , [11], [14] , [27].…”

“…In this study there was a significant correlation between birth weight less than 2.5kg and the development of failure to thrive. most of studies agreed with the fact that birth weight less than 2.5 kg has direct correlation with growth impairment as in studies [11], [ 40] , [14] , [17].…”

Characteristics of gastroesophageal reflux disease in children with interstitial lung disease

“…In infants, GERD often causes a decrease in the rate of body weight gain as a consequence of disrupted feeding. 27 The groups we studied did not differ in terms of clinical symptoms, including regurgitation, nausea, vomiting, or heartburn. However, it should be noted that the resistance of respiratory epithelium to components of the refluxate is radically different from that of the esophagus.…”

“…We did not find that the diagnosis of GERD significantly influenced various clinical characteristics, including nutritional status. In infants, GERD often causes a decrease in the rate of body weight gain as a consequence of disrupted feeding 27 . The groups we studied did not differ in terms of clinical symptoms, including regurgitation, nausea, vomiting, or heartburn.…”

New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine

“…Generally, the presence of an organic cause is suspected on the basis of a detailed medical history and the presence of specific signs and symptoms and confirmed by specific tests. It is interesting to note that in large series of hospitalized patients diagnosed with failure to thrive in which patients with recognized organic disease were excluded the most common final diagnosis was “purely nutrition” failure to thrive because of inadequate caloric intake, and that extensive diagnostic workup was rarely helpful to reveal the etiology [ 28 ] In conclusion: 1) an important diagnostic role is played by the family pediatrician who can, with a few targeted tests, make an initial diagnosis; 2) hospitalization should be reserved for patients with specific characteristics and it is useful for the diagnostic procedure to follow specific flow charts step by step to avoid unnecessary laboratory and / or radiological investigations [ 29 ]; 3) in most cases the therapy involves the collaboration of a team that can intervene on the nutritional and behavioral aspects.…”