Infant Malnutrition Clinical Pathway — Outpatient Specialty Care and Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

Related Pathways
Malnutrition/Failure to Thrive, Infant, Inpatient
Malnutrition (Undernutrition), Inpatient

Infant < 12 mos at Risk for Malnutrition

Clinical Assessment

History and Physical
- Review of Systems
- Feeding and Elimination
- Newborn Screen
- Social History
- Assess growth charts, weight for age trend, height, and head circumference
Observe Feedings

If concern for abnormal vital signs or dehydration, refer to ED as indicated

Findings Suggestive of
Alternative Diagnosis
- Malabsorption
- Increased Metabolic Demand
Primary care evaluation or specialist referral as indicated

Likely Inadequate Intake

Assess High Risk for Malnutrition

High Risk for Malnutrition
< 1 mo	Not regaining birth weight by > 21 days old Continued weight loss after 7 days old
1-12 mos	No weight gain Weight loss Weight for length z-score of -2 or lower

Yes

Initial Interventions

Feeding
- Feeding Recommendations
- Determine frequency of weight checks
- Appropriate solid foods (after 6 mos)
- Consider Pre/Post Breastfeeding weight
- Breast Milk or Formula Fortification
Routine labs, radiology studies generally not recommended
Referrals
- Ensure WIC Referral
- Specialty Providers

High Risk Interventions

Feeding
- Feeding Recommendations
- Determine frequency of weight checks
- Appropriate solid foods (after 6 mos)
- Consider Pre/Post Breastfeeding weight
- Breast Milk or Formula Fortification
Consider Other Diagnostic Conditions
- Labs
- Review Differential Diagnoses
Referrals
- Ensure WIC Referral
- Specialty Providers
- ED evaluation/admission

Adequate Weight Gain

Inadequate Weight Gain

Schedule visits as indicated
Continue family education

Adequate Weight Gain

Inadequate Weight Gain

Schedule visits as indicated
Continue family education

Consider admission for additional work up and possible NG tube placement and supplementation

Posted: April 2021
Revised: February 2024

Authors:

Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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

Evidence

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

Evidence

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