Monday, April 4, 2011

Evaluation of a child with "failure to thrive"

"Failure to thrive is a term used to describe inadequate growth or the inability to maintain growth, usually in early childhood," begins an updated review of this topic in the April 1st issue of AFP. Accurate identification of failure to thrive should rely on a combination of anthropometric criteria, using the 2006 child growth standards established by the World Health Organization. According to Drs. Sarah Cole and Jason Lanham, 5 to 10 percent of children in primary care settings in the U.S. have failure to thrive, with the vast majority presenting before 18 months of age.

The diagnostic evaluation of failure to thrive includes "a detailed account of a child's eating habits, caloric intake, and parent-child interactions," as well as observations of breast or bottle feeding technique. Unless the child presents with one or more red flag signs or symptoms suggesting a non-behavioral cause of failure to thrive, routine laboratory testing is not recommended. Treatment usually consists of nutritional counseling and supplementation to achieve catch-up growth, with frequent follow-up visits to monitor progress.

As a previously published AFP Curbside Consultation has illustrated, however, diagnosing a psychosocial cause of failure to thrive is often challenging. The difference between neglect and parental ignorance of appropriate feeding habits may not be clear, especially when parents delay seeking medical attention for a child with apparently obvious signs of malnutrition and growth delay. When you recognize a child with failure to thrive in your practice, under what conditions would you consider referring him or her to a child protective services agency for investigation of parental neglect?