From the Guidelines
Failure to thrive patients should be managed with a comprehensive approach that includes nutritional intervention, identification and treatment of underlying medical conditions, and multidisciplinary support. This approach is based on the most recent and highest quality study available, which emphasizes the importance of early intervention and a team-based approach to managing FTT patients 1.
Key Components of Management
- Nutritional intervention: calculating caloric needs and implementing high-calorie feeding strategies, such as concentrating formula to 24-27 kcal/oz or using commercial calorie supplements like Duocal 1.
- Identification and treatment of underlying medical conditions: such as gastroesophageal reflux, which can be treated with medications like ranitidine 2-4 mg/kg/day divided twice daily 1.
- Multidisciplinary support: including dietitians, occupational therapists, and social workers to address feeding difficulties, nutritional planning, and family support 1.
Monitoring and Follow-up
- Close follow-up with weekly weight checks initially, then biweekly as improvement occurs 1.
- Hospitalization may be necessary for severe cases, malnutrition, suspected abuse/neglect, or failed outpatient management 1.
Additional Considerations
- Enteral tube feeding may be necessary for patients who fail to achieve adequate nutritional status with oral diet and supplements, as supported by guidelines for nutrition care in cystic fibrosis patients 1.
- The decision to initiate intensified nutritional support should be based on nutritional status and intervention, with consideration of factors such as weight, length, and BMI percentile 1.
Overall, a comprehensive and multidisciplinary approach to managing FTT patients is crucial to supporting growth and development, and addressing the underlying causes of FTT. This approach should be guided by the most recent and highest quality evidence available, and should prioritize the unique needs and circumstances of each individual patient 1.
From the Research
Managing Failure to Thrive Patients
To manage failure to thrive (FTT) patients effectively, it is crucial to understand the condition and its various etiologies. FTT is characterized by a gradual decline in physical and/or cognitive function, often accompanied by weight loss and social withdrawal, without an immediate explanation 2. The management approach may vary depending on the patient's age and the underlying cause of FTT.
Diagnostic Evaluation
The diagnostic evaluation of patients with FTT includes:
- A review of the patient's activities of daily living
- Assessment of cognitive function and mood
- A targeted history and physical examination
- Selected laboratory studies 2, 3
Etiologies and Management
Common etiologies of FTT include:
- Dementia
- Depression
- Delirium
- Drug reactions
- Chronic diseases 2
- In pediatric patients, obtaining a thorough history and physical examination can reveal the cause of FTT, with laboratory testing and radiologic testing indicated in specific circumstances 3
Impact of Admission Diagnoses
The use of non-specific terms like "failure to thrive" as an admission diagnosis can lead to delays in care, premature diagnostic closure, and prolonged hospital stays 4. It is essential to avoid using such labels and instead focus on identifying and addressing the underlying causes of FTT.
Other Considerations
While some studies have explored the effects of certain substances on adrenal cortex function 5, this information is not directly relevant to the management of FTT patients. Therefore, the primary focus should be on the diagnostic evaluation and management strategies outlined above.