II. Definitions
- Growth Faltering (previously known as Failure to Thrive)
- Inadequate weight gain (or Weight Faltering) over time
- Malnutrition due to inadequate Caloric Intake or absorption, or excessive caloric expenditure
III. Epidemiology
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Incidence
- Hospitalized children <2 years: 1-5%
- Families with Medical, psychosocial problems: 10%
IV. Risk Factors
- Low socioeconomic status
- Children of Refugees
- Children with Developmental Delay
- Autism associated feeding difficulties are common (RR 4)
- Low birth weight
- Intrauterine Growth Retardation (IUGR)
- Gastrointestinal Disorders
- Congenital Disorders
- Chronic Infections (e.g. HIV Infection, Tuberculosis)
V. Causes
VI. Signs
- Weight is affected first by Malnutrition
- Length and Head Circumference affected in severe cases
- Cognition and failure to meet Developmental Milestones may occur in very severe cases
VII. Diagnosis: Growth Faltering (Failure to Thrive)
- See Growth Faltering Diagnosis (Failure to Thrive Diagnosis)
- Growth Faltering Screening relies on accurately recorded weight and height on growth chart over time
- Weight below 5th percentile for gender and Corrected age OR
- Weight for Length <5th percentile OR
- BMI for age <5th percentile OR
- Decreased Growth Velocity with Weight for Length falling by more than 2 major percentile lines
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Growth Faltering Diagnosis is based on anthropometric Z-Scores
- Z Scores are calculated from Weight for Length or BMI for age and range from -3 to +3
- Negative Z Scores represent lower than expected weight
- More negative values represent more severe Malnutrition (-1=mild, -2=moderate, -3=severe)
- Drop in Z-Score over time is also used to determine severity (drop of 1 = mild, drop of 2 = moderate, drop of 3 = severe)
- Resources
VIII. Evaluation
IX. Management
X. Prognosis
- Nonorganic Failure to Thrive risks poor outcomes
- Risk of cognitive delay and school difficulty
- Lower Wechsler Intelligence Scale for Children
- Poorer language development and reading skills
- Social immaturity
- More frequent behavior problems
- Risk of cognitive delay and school difficulty
- References