Outpatient Clinical Pathway for Evaluation/Treatment of Infants at Risk for Malnutrition (Failure to Thrive)
- Related Pathway
- Malnutrition/Failure to Thrive, Infant, Inpatient
- Malnutrition (Undernutrition), Inpatient
- Related Order Set
- Outpatient Infant Malnutrition Management Smart Set
Patients 0-12 months at Risk for Malnutrition
(Failure to Thrive)
(Failure to Thrive)
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
- History & Physical
- Consider Red Flags
- Feeding and elimination
- Newborn Screen
- Social history
- Assess growth charts, weight for age trend, height, and head circumference
- Review of Systems screening
- Signs, symptoms of underlying disease
- Observe feedings
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
< 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
- Feeding
- Feeding Recommendations
- Determine frequency of weight checks
- Appropriate solid foods (after 6 months)
- Consider Pre/Post Breastfeeding weight
- Breast Milk or Formula Fortification
- Referrals
- Assure WIC Referral
- Specialty Providers
High Risk Interventions
- Feeding
- Feeding Recommendations
- Determine frequency of weight checks
- Appropriate solid foods (after 6 months)
- Consider Pre/Post Breastfeeding weight
- Breast Milk or Formula Fortification
- Consider other diagnostic conditions
- Labs
- Review Differential Diagnosis
- Referrals
- Assure WIC Referral
- Specialty Providers
- ER evaluation/admission
Adequate Weight Gain
Inadequate Weight Gain
Schedule visits as indicated
Continued family education
Continued family education
Initiate High Risk Interventions
Adequate Weight Gain
Inadequate Weight Gain
Schedule visits as indicated
Continued family education
Continued family education
Consider admission for additional work up and possible NG tube placement and supplementation
Evidence
- Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Indicators
- Faltering Growth in Children: Summary of NICE Guidance
- Failure to Thrive: Diagnostic Yield of Hospitalisation
- Identifying Malnutrition in Preterm and Neonatal Populations: Recommended Indicators
- Comprehensive Malnutrition Indicators Table
- ABM Clinical Protocol #2: Guidelines for Hospital Discharge of the Breastfeeding Term Newborn and Mother: "The Going Home Protocol,"
- Pediatric Manual of Clinical Dietetics
- Faltering Growth—recognition and Management of Faltering Growth in Children