This starts with a dietary assessment including not only the type and amount of oral intake but also specific behaviors surrounding eating, and in infants, the preparation of formula, because incorrect mixing can lead to decreased caloric intake, as well as the potential for electrolyte abnormalities, such as hyponatremia. At times, the etiology can be mixed as an underlying diagnosis may be compounded by inadequate intake secondary to its presenting symptoms.Ī detailed history is often helpful in narrowing the differential diagnosis. Table 11.2 lists some of the more common diagnoses associated with failure to thrive.
A more accurate description of this abnormal pattern of growth can be classified as inadequate intake, maldigestion, malabsorption, ineffective use of calories, or increased metabolic demand. Most failure to thrive, by Waterlow criteria, is marked by decreased weight for height, with initial sparing of height for age and head circumference for age, with gradual loss in height and head circumference for age as the undernourished state continues. As previously stated, caution must be used when weight gain consistently tracks below the third percentile, because this may reflect a normal growth pattern based on standard weight distribution patterns ( Fig. The term failure to thrive is a descriptive term used to depict inadequate weight gain over time, often used when weight for age crosses two percentile isopleths or when weight for age falls below the third percentile for age. Zitelli MD, in Zitelli and Davis' Atlas of Pediatric Physical Diagnosis, 2018 Failure to Thrive
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