Outpatient Clinical Pathway for Evaluation/Treatment of Infants at Risk for Malnutrition (Failure to Thrive)

  • Related Order Set
  • Outpatient Infant Malnutrition Management Smart Set
Failure to thrive (FTT) is a symptom, not a diagnosis. Malnutrition is a diagnosis that more accurately describes inadequate nutrition and is determined by clinical assessment.
Clinical Assessment
Consider Red Flags
  • Abnormal vital signs
  • Signs of dehydration
  • Altered mental status/seizure
  • Respiratory distress
  • ED or Specialty Referral as indicated
Concern for Signs/Symptoms of Underlying Disease
  • Differential Diagnosis
    • Increased Metabolic Demand
    • Malabsorption
  • Primary care evaluation or Specialty Referral/ED as indicated
Likely Inadequate Intake
Assess High Risk for Malnutrition
Assess High Risk for Malnutrition
High Risk for Malnutrition
< 1 month Not regaining birth weight by > 21 days old
Continued weight loss after day 7
1 month to
12 months
No weight gain
Weight loss
Weight for length z-score of -2 or lower
Routine labs, radiology studies are generally not recommended
No
Yes
Initial Interventions
High Risk Interventions
Adequate Weight Gain
Inadequate Weight Gain
Schedule visits as indicated
Continued family education
Initiate High Risk Interventions
Adequate Weight Gain
Inadequate Weight Gain
Schedule visits as indicated
Continued family education
Consider admission for additional work up and possible NG tube placement and supplementation
Posted: April 2021
Authors: V. Goh, MD; J. Owusu-McKenzie, MD; M. Girten, RD; L. Drabinksy, CRNP; R. Lessen, IBCLC; S. Galbally, SLP; G. Pitsakis, LCSW; M. Miano, LCSW; L. Archambault, SLP; E. Smith, RD; D. Bartholomew, RD; M. Hewson, MD