Infant Failure to Thrive Evaluation and Management
Key Points
- Failure to thrive (FTT) is persistent inadequate weight gain, often defined as weight below the fifth percentile for age and sex.
- FTT may be organic (medical disease) or nonorganic (feeding, psychosocial, or resource barriers), and many cases are multifactorial.
- Reliable diagnosis depends on dietary history, growth trends, home-context assessment, and targeted diagnostics.
- The clinical goal is to reverse growth failure and restore safe catch-up growth through coordinated multidisciplinary care.
Pathophysiology
FTT reflects a mismatch between caloric needs and effective intake or utilization. Organic causes include malabsorption, food allergy, metabolic disorders, chronic cardiopulmonary disease, hyperthyroidism, and immunologic disease that increase metabolic demand or limit nutrient absorption.
Nonorganic contributors include incorrect formula preparation, breastfeeding difficulties, restricted diets, neglect, and behavioral feeding barriers. Regardless of cause, prolonged growth faltering increases risk for developmental delay, recurrent illness, and family distress.
Classification
- Organic FTT: Medical etiology causing increased energy use or impaired nutrient absorption.
- Nonorganic FTT: Feeding technique, psychosocial, or resource-access barriers.
- Mixed-pattern FTT: Combined medical and social contributors, common in real practice.
- Severity pattern: Mild deceleration, persistent plateau, or progressive weight loss.
Nursing Assessment
NCLEX Focus
Distinguish whether poor growth is from inadequate intake, poor absorption, or excess metabolic demand before choosing interventions.
- Assess weight trajectory and percentile trend across serial measurements.
- Assess 5-day diet/feeding pattern, formula preparation method, and feeding interaction quality.
- Assess gastrointestinal symptoms suggesting malabsorption or intolerance.
- Assess psychosocial context, food security, and caregiver capacity with social-work collaboration.
- Assess indicated diagnostics (CBC, micronutrient studies, stool studies, lead/zinc, parasite testing) based on clinical cues.
Nursing Interventions
- Implement individualized nutrition plan focused on safe caloric advancement and catch-up growth.
- Teach caregivers accurate formula preparation, feeding frequency, and hunger/satiety cue interpretation.
- Coordinate multidisciplinary care with pediatrics, nutrition, social work, and feeding specialists.
- Schedule close follow-up for weight trend review and rapid plan adjustments.
Delayed Multidisciplinary Escalation
Treating growth faltering as a single-cause issue can miss mixed etiologies and prolong developmental risk.
Pharmacology
Medication strategy depends on identified organic causes and may include treatment of endocrine, infectious, inflammatory, or metabolic contributors while nutrition therapy proceeds.
Clinical Judgment Application
Clinical Scenario
A 7-month-old has crossing-down weight percentiles, prolonged feeding times, and inconsistent formula preparation at home.
Recognize Cues: Ongoing growth deceleration with likely intake and technique concerns. Analyze Cues: Mixed etiology is likely, with both feeding-practice and possible medical contributors. Prioritize Hypotheses: Priority is inadequate effective intake with risk of continued growth failure. Generate Solutions: Structured feeding education, nutrition consult, and targeted medical workup. Take Action: Launch multidisciplinary pathway and frequent weight reassessment. Evaluate Outcomes: Weight trajectory improves and caregiver technique becomes reliable.
Related Concepts
- neonatal-bonding-feeding-and-newborn-screening - Early feeding support reduces downstream growth complications.
- well-care-anticipatory-guidance-and-immunization-across-the-lifespan - Serial well visits identify growth faltering early.
- nutrition-assessment-lifespan-and-cultural-dietary-patterns - Comprehensive diet review is central to diagnosis.
- growth-vs-development-lifespan-milestones-and-play-patterns - Poor growth can affect developmental progression.
- person-and-family-centered-care - Care plans must match family context to be sustainable.
Self-Check
- Which findings help separate organic from nonorganic causes of FTT?
- Why are serial growth trends more useful than a single weight value?
- When should social-work and feeding-specialist referral occur in FTT workup?