Failure to Thrive — SAQ

Stem

An 11-month-old infant is brought to clinic. Weight has fallen from the 25th to below the 3rd centile over 4 months. She takes 400 mL of cow's milk daily and eats poorly at meals. Height is on the 10th centile and head circumference on the 25th. Development is normal. [1]

Questions

a) What is the most likely diagnosis? (2 marks) [1]

Non-organic failure to thrive (inadequate caloric intake). Evidence: weight falling centiles while height (10th) and head circumference (25th) are relatively preserved — brain growth prioritised. Excessive milk consumption (400 mL) may be filling her up and displacing nutritious foods. Normal development and social interaction support non-organic cause. [1]

b) What key history is needed? (3 marks) [1]

1. Detailed feeding diary: 3-day food diary — what, when, how much, mealtime behaviour
2. Social history: family income, housing, parental mental health, family dynamics
3. Birth and developmental history: prematurity, neonatal complications, milestone trajectory
4. Screen for organic symptoms: diarrhoea, vomiting, cough, recurrent infections
5. Family growth patterns: parental heights [1]

c) What is the initial management? (3 marks) [1]

1. MDT referral: dietitian (nutritional assessment), health visitor (home visit, feeding support)
2. Feeding advice: reduce milk to under 500 mL/day, offer 3 meals + 2 snacks, energy-dense foods, avoid juice, structured mealtimes
3. Oral nutritional supplements if dietary changes insufficient
4. Monitor: weekly weighing initially, then fortnightly; plot on growth chart
5. Consider investigations if no catch-up growth: FBC, ferritin, TFTs, coeliac screen, urine MC&S [1]

d) What would be a safeguarding concern? (2 marks)- Parental hostility or refusal to engage

• Child appears unkempt, dirty, or has unexplained injuries
• No weight gain despite adequate support and feeding plan
• Inconsistent history between caregivers
• Signs of developmental delay or emotional neglect
• Follow local safeguarding procedures; involve social services if concerned [1]

References

1. [1]Goodwin ET, Buel KL, Cantrell LD. Growth Faltering and Failure to Thrive in Children. Am Fam Physician, 2023.PMID 37327159