From the Guidelines
Yes, you should consult a gastroenterologist for a case of failure to thrive, especially if there are signs of gastrointestinal issues such as severe feeding problems, gastroesophageal reflux, or constipation. Failure to thrive can have various underlying causes, and gastrointestinal issues are common contributors, as seen in conditions like cardio-facio-cutaneous syndrome 1. In such cases, an early evaluation by a gastroenterology specialist is recommended to guide testing and decisions regarding the necessity of supplemental feedings or surgeries 1. The gastroenterologist can differentiate between constipation caused by intestinal dysmotility and other less common conditions, and they can also treat gastroesophageal reflux with proton pump inhibitors, which may be of some value 1.
Key considerations for consulting a gastroenterologist include:
- Presence of digestive symptoms
- Failure to identify a clear cause after initial evaluations by a primary care provider
- Need for specialized tests like endoscopy, colonoscopy, or specific blood tests to identify gastrointestinal causes
- Evaluation for less obvious digestive issues preventing proper nutrient absorption
- Development of a treatment plan based on the underlying cause, which may include dietary modifications, supplements, medications, or enteral nutrition support 1.
Given the potential impact of prolonged failure to thrive on a child's cognitive development and overall health outcomes, early intervention by a gastroenterologist is crucial when gastrointestinal causes are suspected 1.
From the Research
Failure to Thrive and Gastroenterologist Consultation
- Failure to thrive (FTT) is a condition where a child's weight or rate of weight gain is significantly below that of similar children of the same sex and age 2.
- The majority of children with FTT have nonorganic etiologies, and laboratory, imaging, and endoscopic evaluations are rarely positive 3, 4.
- A comprehensive history and thorough physical examination are essential in assessing a child with FTT, and some basic laboratory screening tests may be helpful in the evaluation 2.
- Consultation with a gastroenterologist (GI) may be necessary in cases where there are clear symptoms of organic disease or when children fail to grow with behavioral and nutritional interventions 3, 4.
Diagnostic Yield of Investigations
- Routine evaluation with laboratory tests, imaging studies, and endoscopy results in an etiology of FTT in less than 1.4% of cases 4.
- The diagnostic yield of hospitalization and laboratory testing is low, and most cases of FTT are due to social or environmental factors 5.
- A multidisciplinary team approach, featuring surgeons, gastroenterologists, dietitians, pharmacists, and nurses, may be necessary in complex cases of intestinal failure 6.
Therapeutic Interventions
- Increasing calories, avoiding grazing, and structuring meals and snacks are common therapeutic interventions for FTT 3.
- Adherence to standardized interventions leads to improved growth, and children who are adherent with these interventions show a higher positive change in z scores for weight and body mass index 3.