Summary
Definition
History and exam
Key diagnostic factors
- faltering growth
- signs of malnutrition
- poor social history
- poor quantity or quality of food or fluid intake
- lack of clarity in communication between parent and child
- abnormal feeding/eating behavior
- perinatal complications
Other diagnostic factors
- family history of faltering growth
- increased caloric loss
- gastrointestinal symptoms
- comorbid medical history
- recurrent ear infections
- recent surgery/burns
- dehydration
- cleft lip and/or palate
Risk factors
- small for gestational age (SGA)
- gastrointestinal problems (reflux, celiac disease)
- poor caregiver knowledge
- poor caregiver-child interaction
- cerebral palsy
- prematurity
- poverty
- lack of family mealtime routine
- autism
- chronic medical problems
- allergies
- swallowing disorder or history of choking
- caregiver depression
Diagnostic tests
1st tests to order
- according to clinical assessment
- CBC
- iron studies
- chemistry panel
- urinalysis
Tests to consider
- blood lead level
- serologic testing for celiac disease
- stool analysis
- HIV testing or other infectious screen
Treatment algorithm
all patients
Contributors
Authors
Howard Dubowitz, MD
Professor
Department of Pediatrics
University of Maryland School of Medicine
Baltimore
MD
Disclosures
HD declares that he has no competing interests.
Maureen Black, PhD
Professor
Department of Pediatrics
University of Maryland School of Medicine
Baltimore
MD
Distinguished Fellow
RTI International
Research Triangle Park
Durham
NC
Disclosures
MB declares that she has no competing interests.
Peer reviewers
Kerri Gosselin, MD, MPH
Director of Pediatric Nutrition
UMass Memorial Children’s Medical Center
Worcester
MA
Disclosures
KG declares that she has no competing interests.
Catherine Larson-Nath, MD
Assistant Professor of Pediatric Gastroenterology, Hepatology, and Nutrition
University of Minnesota
Minneapolis
MN
Disclosures
CLN declares that she has no competing interests.
Margot Tang, MD, MPH
Assistant Professor of Pediatrics
Boston University Chobanian & Avedisian School of Medicine
Boston Medical Center and Boston Children’s Hospital
Boston
MA
Disclosures
MT declares that she has no competing interests.
References
Key articles
Tang MN, Adolphe S, Rogers SR, et al. Failure to thrive or growth faltering: medical, developmental/behavioral, nutritional, and social dimensions. Pediatr Rev. 2021 Nov;42(11):590-603. Abstract
Becker P, Carney LN, Corkins MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract. 2015 Feb;30(1):147-61.Full text Abstract
Kleinman R. American Academy of Pediatrics. Nutritional needs of the preterm infant. In: Kleinman RE, ed. Pediatric nutrition handbook, 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2004:36.
Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11. 2002 May;(246):1-190.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Small but healthy
- Small for gestational age
- Prematurity
More DifferentialsGuidelines
- Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition
- Faltering growth: recognition and management of faltering growth in children
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