Failure to Thrive or Growth Faltering: Medical, Developmental/Behavioral, Nutritional, and Social Dimensions

1. Margot N. Tang, MD, MPH* 2. Soukaina Adolphe, MD* 3. Stephen R. Rogers, MD† 4. Deborah A. Frank, MD* 1. *Department of Pediatrics, Boston University School of Medicine, Boston, MA 2. †Boston University School of Medicine, Boston, MA * Abbreviations: AAP: : American Academy of Pediatrics ASD: : autism spectrum disorder ASPEN: : American Society for Parenteral and Enteral Nutrition CDC: : Centers for Disease Control and Prevention FASD: : fetal alcohol spectrum disorder GI: : gastrointestinal HIV: : human immunodeficiency virus IgA: : immunoglobulinA SGA: : small for gestational age SNAP: : Supplemental Nutrition Assistance Program WHO: : World Health Organization WIC: : Special Supplemental Nutrition Program for Women, Infants, and Children Beyond recognizing the medical and nonmedical dimensions that often interact to cause childhood growth faltering and malnutrition, it is important to understand the role of pediatric feeding disorders, to screen for and address social determinants of health, and to understand the multidisciplinary model of treatment. After completing this article, readers should be able to: 1. Diagnose growth faltering and childhood malnutrition. 2. Understand the pathogenesis and differential diagnosis of growth faltering. 3. Take a complete relevant history starting with the prenatal period that includes parental heights (if appropriate), nutritional and feeding details, developmental progress, and social determinants of health. 4. Understand the role of diagnostic testing, including first-line laboratory examinations such as complete blood cell count with differential count, iron studies, lead, chemistry panel, and celiac evaluation with immunoglobulin A and tissue transglutaminase antibodies. 5. Evaluate growth faltering in special populations of children with a history of prematurity, intrauterine growth retardation, small for gestational age, autism, and prenatal substance exposures. 6. Understand the role of social determinants in child undernutrition and the screening and resources to address conditions of poverty and inequality, including but not limited to food insecurity. 7. Demonstrate cultural competence when counseling families regarding growth, nutrition, and feeding. 8. Understand multidisciplinary treatment, including medical, nutritional, and often behavioral/feeding therapy, and developmental and psychosocial support, with close follow-up, use of pharmacotherapy when needed, and collaboration among providers and programs. Failure to thrive is an archaic term—now often replaced with growth faltering, weight faltering, or poor weight gain —to describe a symptom of many forms of primary and secondary undernutrition, usually in young children. (1)(2) We use the term growth faltering herein. Worldwide, childhood malnutrition is still a major cause of morbidity and mortality, with 45% of mortality in children younger than 5 years linked to undernutrition. (3) In the United States, the epidemiology of …