So how do we manage these children
with non-organic failure to thrive?
This is the majority of these children.
We certainly support
positive eating behavior.
We try to encourage a
positive eating environment
for these children
and their families.
We will engage a pediatric
dietician to come and assess
how much is this child eating
and what is this child eating
and how can we boost calories.
And these dieticians may recommend
strategies to increase energy intake.
I’ll give you a few examples.
In the younger infants, sometimes
we’ll concentrate the formula.
Normal formula is 20 kcal per ounce.
We might boost that to 22, 24, 27
or very rarely 30 kcal per ounce
to try and increase the amount
of calories the child is eating
without giving the child increased effort
to actually just take in more calories.
In older children, sometimes we’ll
supplement food into their diet.
And by that I mean sprinkle in extra
fat, sprinkle in some extra protein.
There are lots of clever
ways we can actually
sneak extra calories
into children’s food.
Oftentimes, a clinical psychologist
or social services are warranted
to try and help the family deal
with whatever are the stressors
that are causing them
to neglect their child.
A child abuse specialist
consult is indicated
if we suspect child
abuse or child neglect.
It can be incredibly helpful in
not only making the diagnosis
and engaging in a discussion with the family
that is appropriate for a court of law,
but also they can help us in terms
of followup with these children
if there’s no followup
available in the community.
Typically, we only admit
children six months of age
because we want to track
growth very carefully
or in children who have
severe failure to thrive
and have a concern for
Refeeding syndrome is an unusual
problem in these children,
but let’s review it briefly.
As you recall, in people who
have significant starvation,
if we refeed them too quickly,
they have large pools of ADP.
They can make their ATP
because they have no sugar.
As a result, when they
are acutely refed,
the ADP is rapidly
transferred into ATP,
driving down their serum phosphate levels
and a very low serum phosphate level
is a potential risk for sudden death.
So we don’t want to refeed children
who have been starving very quickly.
We want to do it slowly.
And this is often done
in a supervised setting.
So what are the outcomes?
The outcomes are tricky especially in these
children with social failure to thrive
because some of those outcomes
are a result of being brought up
in a dysfunctional environment.
However, what we often see in these
children who don’t eat well early
in life is a continued
undereating throughout life.
Sometimes parents can be
very frustrated with this.
They just can’t get their kids
to eat as much as they want.
But also, sometimes parent
don’t quite understand
what the expectations of
their child’s growth are.
Remember, at the start of our lecture,
we looked a couple of children
who are growing appropriately at
a very low level of the curve.
If that’s where that child is,
sometimes parent get frustrated
because they can’t get their
child to a percentile
that’s really than where
that child is going to go.
These children will typically
and they may have some
short-term impaired development
as they’re untreated
until they are treated.
An example would be often in children
or infants with failure to thrive,
there’s a delay in rolling over, sitting
up or standing or walking or talking,
but once they’re fed,
they rapidly catch up.
If children are untreated, they
are at risk for short stature.
They’re at risk for secondary
because if you don’t have much protein,
it’s harder to make antibodies
and they are gravely at risk for long-term
cognitive and behavioral problems
as they grow into young adults.
So this is our classic case, we have a
two-year-old male who’s not growing.
His parents are going through a divorce
and begin arguing in the office
and they’re asked
to leave the room.
The nurse assesses the
child’s height and weight
and the pediatrician immediately is
worried, noticing that this child
has not changed in weight from the
last visit, which was already low.
There’s stress in this family,
this child is not changing in his height
and weight for the last few visits
and now is below the
What are the facts of
this that are concerning?
Well, certainly this child is
now below the second percentile
and probably we have a few measurements
that are corroborating this fact.
Remember, one low level may
just be an abnormal scale.
Notice it’s from the last
visit, which was already low.
Additionally, we can here his
parents are going through a divorce
and begin arguing in the office
and are asked to leave the room.
This is probably a sign that this child
has a social cause of failure to thrive.
This is a classic example of
what we might see in the office.
Thanks for your attention.