A. What is patient's height (recumbent length in infant) and head circumference? Failure to thrive (FTT) is growth failure confined to weight, unless the deprivation is of long duration. Low weight for height suggests a short-term problem. Low weight and height, or head circumference, or all three, suggests long-term deprivation or organic disease rather than familial disease.
B. What are past growth parameters? Evaluate the growth trend. Values that consistently fall below the 3rd percentile support an etiology of prematurity, familial, or chronic disease. FTT is often defined as a 2-standard-deviation decline in weight velocity (two major percentile lines on growth curve).
C. What is patient's feeding history? FTT is undernutrition, regardless of etiology. Decreased caloric intake is the most common cause, but FTT may also result from increased caloric requirements or decreased absorption of calories. Ask about appetite, routine meals, and fluid intake (what is offered and when). Specific questions include:
1. Is formula mixed properly? Overly dilute formula results in decreased caloric intake.
2. How much formula does infant actually ingest from each bottle?
3. Is there evidence of effective breast feeding (eg, latching on, milk production, time at breast)?
4. Are other foods and fluids being offered?
D. Any feeding difficulties? In an infant, choking, slow feeding, tiring with feeding, poor suck, vomiting, or regurgitation suggests GI, cardiac, or neurologic disorder. In a toddler or older child with decreased appetite, consider dental disease, constipation, chronic illness, or apathy.
E. What is the prenatal history and birth history? Relevant information includes maternal nutrition, prenatal laboratory values, perinatal infections, illnesses, medications, delivery complications, extended nursery or NICU stay, and newborn screening tests.
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