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

Abstract

Background: Decades of data demonstrate the overwhelming rates of failure to thrive (FTT) nutritional causes (80-90%) even in patients with complex medical conditions and diagnoses. Primary care providers (PCPs), the initial FTT evaluators, have been underrepresented in the FTT literature, despite their pivotal role in overseeing management. Our purpose was to assess PCPs' FTT referral strategies and their concerns for their FTT patients referred to an academic pediatrician diagnostic clinic. Methods:We surveyed PCPs who referred FTT patients to a diagnostic clinic (the Diagnostic Referral Group (DRG)) for their main concern prompting referral, and next management if consult was unavailable. Chart review determined the hospitalization rates of FTT patients, and DRG interventions.Results: Of the 81 PCP responses, 66.7% were most concerned with an uncertain underlying diagnosis, contrasting with the 20.6% of patients that DRG providers suspected to have an organic etiology. PCPs' next preferable management was subspecialist referral (58.0%) and hospitalization (22.2%). DRG providers most commonly recommended nutritional interventions such as increasing caloric density, decreased snacking and juice, and structured meals for 72.4% of patients.Conclusions: This study suggests that FTT due to nutritional causes continues to be a challenging diagnosis for PCPs. More investigation is needed to identify interventions to empower primary providers to diagnose nutritional causes, such as practical standardized assessments to evaluate the nutritional and psychosocial FTT contributors.