Infant Malnutrition/Failure to Thrive (FTT) Clinical Pathway — Inpatient

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Infants with Malnutrition (Failure to Thrive) < 12 mos

Failure to thrive (FTT) is a symptom, not a diagnosis. Malnutrition is a diagnosis that more accurately describes inadequate nutrition and can be determined via clinical assessment.

Team Assessment

Concern for malnutrition due to malabsorption or increased metabolic demands, consider appropriate specialty consult.

Malnutrition Secondary to Inadequate Intake

Assess for:
- Dehydration, Hypoglycemia, and Risk for Refeeding Syndrome
- Check Newborn Screen
Routine laboratory and radiology studies are not generally recommended

Initiate Feeding Recommendations Using Infant Malnutrition Order Set

Consult Inpatient Dietitian, adjust feeding per recommendations
Consider Social Work consult
Additional consults as clinically indicated
Establish discharge goals, family education

Monitoring Weight Gain

Daily weights
Strict Intake and Output
- Breastfeeding infants pre-/post-weights for each feed
Average daily weight gain

Inadequate Weight Gain after 2-3 Days

Adequate Weight Gain or Problem Remedied

Follow Secondary Feeding Recommendations

Meeting Intake Goals

Not Meeting Intake Goals

Reconsider Differential Diagnosis

Review Causes
Consider Additional Consults
Consider NG Initiation

Posted: March 2019
Last Revised: May 2025

Authors:
- M. Dunn, MD;
- I. Rasooly, MD;
- C. Bennett, MD;
- J. Welc, SLP;
- R. Lessen, IBCLC;
- J. Cockerham, RN;
- E. Crane, RN;
- S. Cohen, MD;
- A. Maqbool, MD;
- E. Lourie, MD;
- W. Chua, MD;
- K. Rochelle, MSN;
- K. Brown, MSN;
- M. Fendrick, RD

Editors: Clinical Pathways Team

Evidence

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