Failure to Thrive in the Outpatient Clinic: A New Insight

Abstract

Failure to thrive (FTT) is an abnormal growth pattern determined by inadequate nutrition. It is a common problem in children, representing 5% to 10% of patients seen in an outpatient setting. Many definitions have been proposed based on anthropometric deterioration; however, they show poor concordance. No single definition is sufficiently sensitive in identifying faltering growth whilst a combination of multiple criteria seems more accurate. In light of the recent redefinition of pediatric malnutrition as a disequilibrium between requirements and intakes of energy, and macro- and micronutrients, a wider conception of FTT as an unsatisfactory nutritional status related to poor growth and health is useful. Although the most severe problems of micronutrient malnutrition are found in developing countries, people of all regions of the world can be affected by micronutrient deficiencies (MNDs), a form of undernutrition with relevant effects on growth and health. Changes in diets and lifestyle, elimination diets, food insecurity, and food intake disorders create the conditions at risk of faltering growth and MNDs. This new insight integrates the “classical” anthropometric criteria for definition and treatment, in the aim of warranting both a regular increase in size and an overall adequate development and health status.

Primary Care Referral Perspectives in Pediatric Failure to Thrive and Outcomes From a Diagnostic Clinic

“…Despite overwhelming rates, 80-90%, of nutritional pediatric failure to thrive (FTT), nutrition evaluation is not routine prior to extensive testing and subspecialty referral [1][2][3][4]. FTT management is challenged by the absence of consensus diagnostic criteria and lack of a practical nutritional assessment tool in clinics [3,4].…”

“…Despite overwhelming rates, 80-90%, of nutritional pediatric failure to thrive (FTT), nutrition evaluation is not routine prior to extensive testing and subspecialty referral [1][2][3][4]. FTT management is challenged by the absence of consensus diagnostic criteria and lack of a practical nutritional assessment tool in clinics [3,4]. The importance of nutritional causes and low utility of exhaustive testing have been shown in both populations with underlying medical conditions and otherwise healthy children [4][5][6][7].…”

“…FTT management is challenged by the absence of consensus diagnostic criteria and lack of a practical nutritional assessment tool in clinics [3,4]. The importance of nutritional causes and low utility of exhaustive testing have been shown in both populations with underlying medical conditions and otherwise healthy children [4][5][6][7]. Primary care providers (PCPs), the initial evaluators of FTT patients, have not been included in the FTT management research conversation.…”

Nutrition in Pediatric Gastroenterology

“…Nutritional status and its modifications are pointed out by two review papers [2,3]. The review published by our group summarizes the new definitions and currently used classification of acute malnutrition, as well as the diagnostic assessment and treatment, which can be conducted in primary care with nutrition-specific interventions in most cases [2].…”

“…The review published by our group summarizes the new definitions and currently used classification of acute malnutrition, as well as the diagnostic assessment and treatment, which can be conducted in primary care with nutrition-specific interventions in most cases [2]. Additionally, Diamanti et al [3] present a new insight for the definition and management of failure to thrive (FTT), integrating the "classical" anthropometric criteria for definition and treatment with a more complete definition which takes into account both the clinical and anthropometric worsening, and the overall nutrition status, including the micronutrient status. Notably, some predisposing conditions for FTT and micronutrient deficiencies are explored, such as elimination diets (in food allergies, lactose intolerance, vegetarian/vegan diet), family dysfunction with food insecurity and avoidant/restrictive food intake disorders.…”