Treatment of Failure to Thrive

Addressing Underlying Medical Conditions

The American Academy of Pediatrics recommends optimizing pancreatic enzyme replacement therapy (PERT) if malabsorption is present, as inadequate enzyme dosing is a common reversible cause of growth failure 1
The American Academy of Pediatrics suggests treating gastroesophageal reflux with proton pump inhibitors, particularly when oral aversion or feeding difficulties are present 2
Managing constipation and intestinal dysmotility with appropriate bowel regimens can significantly impact nutritional intake, according to the American Academy of Pediatrics 2
Correcting specific micronutrient deficiencies (trace elements, vitamins) through targeted supplementation is recommended by the American Society for Nutrition 3

The American Society for Nutrition recommends increasing caloric density of existing diet by fortifying foods with extra oil or fat, rather than simply increasing volume 1
Providing more frequent feedings for breastfed infants with poor weight gain is suggested by the American Academy of Pediatrics 1
Using high-energy/protein infant formulas or carefully supervised concentrated feeds for formula-fed infants is recommended by the American Academy of Pediatrics 1
Adding oral nutritional supplements (ONS) to normal food intake is recommended by the American Society for Nutrition, as nutritional counseling alone is insufficient to improve nutritional status 3

The American Academy of Pediatrics recommends fortifying expressed breast milk for breastfed infants who fail to gain weight despite optimized PERT 1
Addressing linoleic acid deficiency may eliminate the need to increase overall energy intake, according to the American Academy of Pediatrics 1
Initiating feeding therapy at the first sign of oral aversion can prevent long-term feeding difficulties, suggests the American Academy of Pediatrics 2

The American Academy of Pediatrics recommends monitoring growth at every clinic visit for infants, every 3 months for older children and adolescents, and every 6 months for adults 1
Assessing serial measurements over time rather than single evaluations can signal treatment failure, according to the American Academy of Pediatrics 1

Referring to gastroenterology for persistent feeding difficulties, reflux, or poor growth despite initial interventions is recommended by the American Gastroenterological Association 4
Considering specialized referrals to endocrinology, genetics, or neurology when initial evaluation does not identify a cause is suggested by the American Academy of Pediatrics 4

The American Society for Nutrition warns against relying on nutritional counseling alone, as multiple studies demonstrate it is insufficient to improve nutritional status in FTT 3
The American Academy of Pediatrics advises against delaying tube feeding in children with severe oral aversion, as prolonged malnutrition has permanent neurodevelopmental consequences 2