Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting
Roberto Franceschi1, Caterina Rizzardi2, Evelina Maines2
1Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy. roberto.franceschi@apss.tn.it.
Insights
A new flowchart accurately and cost-effectively diagnoses organic and non-organic failure to thrive in children. This approach helps clinicians avoid unnecessary tests for non-organic cases, improving patient care.
Area of Science:
- Pediatrics
- Clinical Diagnostics
- Growth Disorders
Background:
- Failure to thrive (FTT) is a frequent pediatric referral, often due to malnutrition.
- Organic causes of FTT are less common in asymptomatic children.
- Distinguishing organic from non-organic FTT is crucial for appropriate management.
Purpose of the Study:
- To evaluate a cost-effective flowchart for diagnosing organic and non-organic FTT in a hospital setting.
- To assess the flowchart's accuracy in differentiating FTT etiologies.
- To determine the flowchart's impact on reducing unnecessary investigations.
Main Methods:
- A prospective, single-center study involving children up to 2 years with growth faltering.
- Pediatricians utilized a structured flowchart, medical history, growth charts, clinical exams, and targeted tests.
- A step-by-step diagnostic approach was implemented.
Main Results:
- 42% of 74 subjects were diagnosed with organic FTT, primarily gastrointestinal and genetic.
- Organic FTT cases showed lower gestational age and birth weight.
- Non-organic FTT patients (88%) avoided extensive blood tests or specialist consultations.
Conclusions:
- The presented flowchart accurately distinguishes organic and non-organic FTT in hospitalized children.
- The flowchart proved cost-effective by minimizing unnecessary tests and consultations for non-organic FTT.
- This diagnostic tool aids efficient and accurate FTT management.
Background:
Failure to thrive is a common reason for referral to paediatric services. Malnutrition or inadequate caloric intake is the most common cause, while organic form is unlikely in children who are asymptomatic and healthy on examination. By this study we evaluate the application of a cost-effective flow chart that helps the clinician in a hospital setting discern accurately organic and non-organic failure to thrive.
Methods:
Conduct a prospective single-center study in children up to 2 years of age with growth faltering. The pediatricians used a practical flow chart, took the medical history, created a growth chart, performed clinical examinations, and requested blood test and consultations in a step by step approach.
Results:
Among the 74 subjects included in the study, the diagnosis of organic failure to thrive was reached by 42%. Gastrointestinal and genetic diagnoses were the most frequent. Patients with organic failure to thrive had significantly lower gestational age and birth weight. Age at diagnosis and Z-score weight were lower in organic than in non-organic forms. Most patients with non-organic forms (88%) did not undergo in-depth blood test or specialist advice.
Conclusion:
The flow chart we presented was accurate for diagnosing children with failure to thrive in a hospital setting and distinct organic and non-organic forms. It was cost-effective to avoid unnecessary blood test or consultations in most non-organic diagnoses.
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