The majority of patients with infant malnutrition (failure to thrive) in General Pediatrics will fall under the inadequate intake category.
It is important to consider a broad differential diagnosis of potential underlying organic etiologies.
| Etiology |
Symptoms |
Recommendations |
| Inadequate Intake |
- Long intervals between feeds (Sleep > 3 hrs when < 2 months old)
- Falling asleep during feeds
- Limited number and volume of feedings per day
- Improper mixing of formula
- Lactation problems: poor supply, difficulty with latching
- Limited urine diapers (< 1 wet diaper per 8 hrs)
- Food insecurity/inability to access food resources (i.e., WIC or SNAP)
- Excessive vomiting/spitting up/reflux
- Increased hunger cues/caregiver isn’t recognizing cues
- Symptoms of maternal depression
- Birth weight not regained in 2 weeks
- Signs of oral motor dysfunction
|
Continue following Inadequate Intake Section |
| Malabsorption |
- High volume, extremely loose stools
- Clay colored stools
- Greasy or significantly foul smelling stools
- Chronic diarrhea
- Abdominal distention, gassiness with diarrhea
- Blood in stools
|
- Verify newborn screen negative for cystic fibrosis
- Quantify and qualify stools
- If abnormal stools, consider initial malabsorption workup
- Labs: CBC, CMP, GGT, CRP, Prealbumin, ESR
- Stool Studies: hemoccult, reducing substances and stool pH, Fecal elastase
- GI consult as clinically indicated
|
| Increased Metabolic Demands |
- Cardiac: heart murmur, tachypnea, sweating or cyanosis with feeds, feeding fatigue
- Respiratory: noisy breathing, tachypnea, difficulty breathing with feeds, nasal obstruction
- Neurologic: increased or decreased tone, abnormal movements
- Neuro-oncologic: diencephalic tumor causing nystagmus, strabismus, macrocephaly, papilledema,
vomiting/lethargy
- Metabolic/genetic: abnormal newborn screen, dysmorphic features
- Renal: urologic abnormalities, renal tubular acidosis
- Endocrinology: tachycardia, diaphoresis
|
Testing and consultation based on clinical assessment |