Some children with FTT will benefit from hospitalization to help ensure appropriate caloric assessments can be made.Calcium and phosphorus levelsВ ( Rickets?).With evidence of severe malnutrition, may also be helpful to know:.Urinalysis and Urine CultureВ вЂ“ occult urinary tract infection, reducing substances?.Chemistry panelВ вЂ“ sodium derangement, hyperkalemia, acidosis, renal impairment?.CBC with DifferentialВ вЂ“ anemia, pancytopenia?.Screening labs to assess for the potential for occult organic causes is reasonable.Lab and radiographic evaluations should be based on H+P, but occasionally, there is still not a clear cause.Significant family history?В Cystic Fibrosis? HIV exposure?.BruisingВ that is not appropriate for developmental stages or not over bony prominences? AgainвЂ¦ consider Non-accidental Trauma.Hx of parental substance/ETOH abuse?В Consider Non-accidental Trauma.Parental depression, marital strife, divorce?В Consider Non-accidental Trauma.Dysmorphic features?В Consider underlying genetic or congenital abnormalities.Hepatomegaly?В Perhaps inborn errors of metabolism or congenital heart disease is the etiology.Wise to check a sodium and glucose level though! Discovered formula mixing errors?В Perhaps caloric intake has been inappropriately low.The evaluation should be predicated on a thorough History and Physical.Reflexive lab testing and imaging are NOT useful.With a vast differential and list of possible causes, the evaluation and work up can be equally diverse and broad.These patients may still improve weight gain with behavioral modifications (so cannot use weight gain during hospitalization as a discriminating tool to вЂњrule-outвЂќ organic causes).Defective use of available calories, such as seen with inborn errors of metabolism, can also present with FTT.Anything that increases the metabolic demands will increase caloric requirements (ex, hyperthyroidism, chronic respiratory disease, congenital heart disease).Malabsorption due to inflammatory bowel disease, celiac disease, or cystic fibrosis can play a role.Often has psychosocial component, but while we may want to blame the formula and вЂњprotein sensitivityвЂќ, be awareвЂ¦.Obviously, vomiting for GI mechanical abnormalities is not going to allow appropriate caloric intake.Difficulty ingestion can also be related to congenital conditions (ex, dyspnea related to congenital heart disease, TE-fistula).Poor appetite may be related to organic disease too (ex, anemia).Often has psychosocial component, but it is not just simply poor feedingвЂ¦.Calories CountВ and discerning whether the patient has one or a combinationВ of the following will be helpful in determining a useful evaluation strategy.Additionally, while the primary cause may be an вЂњorganicвЂќ one, it can become exacerbated by вЂњnon-organicвЂќ causes.вЂњOrganicвЂќ вЂ“ typical require medical interventions.вЂњNon-organicвЂќ вЂ“ typically warrant behavioral interventions.This is, conceptually, helpful, but not accurateВ as there is much overlapВ between the two.Typically, the conditions that lead to FTT are divided into вЂњOrganicвЂќ vs вЂњNon-organicвЂќВ causes.Can certainly also involve child neglect or abuse.Often involves some combination of organic disease and behavioral dysfunction.PovertyВ is the greatest single risk factor for FTT worldwide.Failure to Thrive is often Multifactorial!.

Like ALTEВ (or BRUE), the question still remains of вЂњWhy?вЂќ are we having FTT.

Normal variations in growth do occurВ and may appear to met these criteria.

Were вЂњoverweightвЂќ and height gain increased while weight gain decreased.

< 2 yrs child whose weight crosses two Major Percentiles downwardВ (using 90th, 75th, 50th, 25th, 10th, and 5th percentiles).

< 2 yrs child who has weight < 80% of ideal weight for age.

< 2 yrs child with weight < 3rd-5th percentileВ on more than one occasion.

Definitions may vary between groups, but FTT in a child can be described as:.

Growth is compared to growth percentile curvesВ ( see CDC.gov).

FTT is associated with cognitive, behavioral, and constitutional consequences.As condition persists, FTT can also include length and head circumference deficits.Failure to Thrive (FTT) describes growth failure primarily based on weightВ or rate of weight gain.LetвЂ™s briefly review some of the issues we should consider ( yes, even in the Emergency Department) when we are dealing with a child who has has Failure to Thrive: Occasionally, that single job of growth becomes too difficult to achieve. We have discussed some Growth and Development topics previously (ex, Milestones, Infant Formula, Growth Estimates). The one job young children have is growing. Fox on twitter have very few responsibilities and even fewer jobs ( just ask my kids). Originally published at Pediatric EM Morsels on April 20, 2018.

Failure to thrive meaning infants