Infant Malnutrition/Failure to Thrive (FTT) Clinical Pathway — Inpatient

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Patients with Infant Malnutrition (Failure to Thrive) < 12 months

Failure to thrive (FTT) is a symptom, not a diagnosis. Malnutrition is a diagnosis that more accurately describes inadequate nutrition and can be determined via clinical assessment.

Frontline Ordering Clinician (FLOC)/RN Assessment

Signs/Symptoms of Underlying Etiology

Differential Diagnosis
- Malabsorption
- Increased Metabolic Demands

Differential Diagnosis
- Malnutrition Secondary to Inadequate Intake

Routine laboratory and radiology studies are not generally recommended.

Assess for:
- Dehydration, Hypoglycemia, and Risk for Refeeding Syndrome
- Check Newborn Screen

Initiate Feeding Recommendations on Admission

Use Infant Malnutrition Order Set
Consult to Clinical Nutrition Inpatient Dietitian, adjust feeding
per recommendations
Consider Social Work consult
Additional consults as clinically indicated
Establish discharge goals, family education

Monitoring Weight Gain

Daily weights
Strict Intake and Output
- Breastfeeding infants pre-/post-weights for each feed
Average daily weight gain

Inadequate Weight Gain after 2-3 Days

Follow Secondary Feeding Recommendations

Adequate Weight Gain or Problem Remedied

Meeting Intake Goals

Reconsider Differential Diagnosis

Not Meeting Intake Goals

Review Causes
Consider Additional Consults
Consider NG Initiation

Posted: March 2019
Last Revised: October 2024

Authors:
- M. Dunn, MD;
- I. Rasooly, MD;
- L. Bell, MD;
- C. Bennett, MD;
- V. Scheid, MD;
- C. Schulman, RD;
- J. Welc, SLP;
- R. Lessen, IBCLC;
- J. Cockerham, RN;
- E. Marvill, RN;
- R. Hendricks, MSS;
- G. Bogan, RN;
- J. Readman, RN;
- S. Cohen, MD;
- A. Maqbool, MD

Editors: Clinical Pathways Team

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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Inpatient Clinical Pathway for Evaluation/Treatment of Infants with Malnutrition (Failure to Thrive) < 12 months

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