![]() Potential risk factors such as poverty, neglect, birthweight, parity, maternal-child interaction, maternal age, parental education, feeding difficulty, and postnatal depression have been evaluated with conflicting or mixed results. Furthermore, epidemiological studies may represent a hospital-based population rather than a general population leading to referral or selection bias. Thus, lack of agreement regarding the best anthropometic index makes defining and determining frequency difficult. Using another accepted method in the same population, the rate is closer to 1%. ![]() For example, decreasing weight across 2 centile lines may have a prevalence rate of 15-20%. There are several definitions for failure to thrive, and the concurrence between them is poor. The exact prevalence is unknown, and the lack of consensus regarding definition is partly the reason. The literature typically refers to failure to thrive as being a common pediatric problem. Most failure to thrive is believed to be due to non-medical causes and inadequate intake of calories in particular. What causes this disease and how frequent is it? Whether any observed effects of failure to thrive such as behavioral problems diminish over time is unknown. ![]() Outcomes are dependent on the cause of the growth failure although chronic undernutrition may lead to delayed development and failure to reach full growth potential.Ĭognitive, behavioral, and developmental problems have been studied in infants and children with failure to thrive with contradictory results. Increased mortality, particularly in developing countries, has been associated with undernutrition. Hyperglycemia What are the possible outcomes of failure to thrive? ![]() Metabolic abnormalities seen with refeeding syndrome: Protein is not restricted during refeeding, but total calories in general and carbohydrates in particular are started low and advanced slowly. Monitoring and correction of electrolyte abnormalities is critical. Refeeding syndrome can be avoided by slowly refeeding calories beginning with as low as 10% of resting energy expenditure and increasing slowly from there. Also, suddenly increased intravascular volume may predispose the undernourished patient to develop congestive heart failure. Electrolyte abnormalities can be associated with significant morbidity and mortality including cardiac arrhythmias. There are several electrolyte abnormalities that can occur, and hypophosphatemia is the hallmark. Refeeding syndrome is the metabolic derangement that occurs when someone is suddenly shifted from a catobolic state to anabolism. Patients with severe undernutrition who are receiving nutritional therapy should be watched closely for refeeding syndrome. What are the adverse effects associated with each treatment option? Specific treatment would depend on the initial cause of the undernutrition although observation of growth over time is very important regardless of the initial cause. When medical disease is responsible for undernutrition, controlling that disease is a critical part of correcting the co-existent undernutrition. There are several organic or identifiable medical diseases responsible for causing undernutrition such as heart disease or endocrine disorders. Social workers, feeding therapists, dieticians and medical staff can further evaluate and address the particular issues regarding each individual patient.Įvaluates calorie intake and recommends goal calories for catch-up growthĮvaluates feeding skills and may recommend a swallow study and initiate oral/feeding therapy as indicatedĮvaluates psychosocial issues affecting the family/child and helps provide resources to address concernsĬoordinates the team and insures that goal calories are provided and medical issues have been addressed. This team approach is often more convenient in the hospital setting. Because failure to thrive is often multifactorial, a team approach is generally considered the best approach (Table I). If recommendations for increasing calorie intake are not working, then the patient with suspected failure to thrive is further evaluated/treated in a hospital setting. This may be done with the involvement of a dietician who recommends a caloric intake goal based on desired catch-up growth. If you are able to confirm that the patient has failure to thrive, what treatment should be initiated?Ĭalorie replacement is frequently the first step in the management of suspected undernutrition. All patients with suspected failure to thrive should have a calorie assessment. There are several commonly described symptoms of failure to thrive including a decrease in weight-for-age ≥ 2 percentiles, weight-for-age 2 percentiles).Ī detailed history including social and diet history, physical examination findings and growth chart measurement review are required for confirming the diagnosis.
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