II. Precautions

  1. First define if growth is truly abnormal (See Failure to Thrive Diagnosis)
  2. Failure to Thrive Red Flags suggest organic cause

III. Causes: Normal Physiologic

  1. Half of infants under age 2 years shift weight, height by 25%
  2. Familial Short Stature (Short Parents)
    1. Most common reason for Short Stature in children

IV. Causes: Nonorganic - Insufficient Caloric Intake (80% of cases, no Failure to Thrive Red Flags)

  1. Accidental error in formula preparation or Breast Feeding
    1. Improper feeding technique
    2. Misconception about nutrition needs
    3. Breast fed infants with insufficient Caloric Intake (e.g. poor latching, insufficient supply)
    4. Formula too dilute
  2. Economic deprivation or limited access to food
    1. Food insecurity is present in 14% of U.S. families
  3. Emotional deprivation
  4. Child neglect
  5. Child Abuse
  6. Caregiver Major Depression
  7. Cultural or religious food restriction

V. Causes: Organic - Insufficient Caloric Intake

  1. Infant or toddler
    1. Cleft Palate
    2. Choanal Atresia
    3. Pediatric Gastroesophageal Reflux
    4. Lead Toxicity
  2. Child or adolescent
    1. Pediatric Gastroesophageal Reflux
    2. Avoidant or restrictive food intake disorder
    3. Eating Disorder (e.g. Anorexia Nervosa)
    4. Major Depression in Children
    5. Poor motor coordination (Neuromuscular disorders, Down Syndrome)

VI. Causes: Organic - Defect in food assimilation or absorption

  1. Infant or Toddler
    1. Food Allergy (e.g. Cow's milk Protein allergy)
    2. Inborn error of metabolism
    3. Giardiasis
    4. Protein losing Enteropathy or other malabsorption
    5. Gastrointestinal malformation
      1. Pyloric Stenosis
      2. Biliary atresia
      3. Tracheoesophageal fistula
  2. Child or adolescent
    1. Food Allergy
    2. Celiac Disease or other malabsorption
    3. Cystic Fibrosis
    4. Inflammatory Bowel Disease (Crohn Disease, Ulcerative Colitis)
    5. Chronic Diarrhea
    6. Inborn error of metabolism
    7. Infections (e.g. Parasitic Infection, Helicobacter Pylori)

VII. Causes: Organic - Increased energy requirements, expenditure

VIII. Causes: Organic - Prenatal

  1. Intrauterine infection
  2. Maternal Malnutrition
  3. Maternal smoking
  4. Fetal Alcohol Syndrome
  5. Fetal Hydantoin Syndrome
  6. Chromosomal disorders
  7. Dysmorphic syndromes

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