Nonorganic failure to thrive: an outpatient approach

This article reviews our experience, as well as the medical literature, regarding the treatment of failure to thrive (FTT) on an outpatient basis. Nonorganic FTT can be accidental, neglectful, or deliberate. Accidental FTT occurs with errors in formula preparation, diet selection, or feeding technique. These errors can usually be corrected by education and demonstration. Deliberate underfeeding is rare, and these children usually require placement in foster care. Neglectful FTT usually occurs because the mother is overwhelmed or psychologically disturbed. Children with neglectful FTT do not automatically require hospitalization. If the degree of FTT is mild to moderate, the mother-child interaction is positive, the mother is not severely disturbed, and the baby has no inflicted injuries or deprivational behavior, the baby can be safely and more economically managed as an outpatient. Management includes new feeding instructions, a stimulation program, social work intervention, home visits by a public health nurse, and weekly weight checks. Most infants respond to this one-month therapeutic trial with an appropriate weight gain. Even after normal weight is attained, many of these families require long-term follow-up to help them deal with multiple psychosocial issues.