Yet, a child with severe acid reflux who appears to be in pain while eating may also make a caregiver hesitant to offer sufficient feedings. Inadequate caloric intake
Inadequate caloric intake indicates that an insufficient amount of food and nutrition is entering the body, whether due to lack of food, anatomical differences causing difficulty eating, or psychosocial reasons for decreased food intake. Malabsorption/caloric retention defect
Malabsorption and caloric retention defects cause the body to the unable to absorb and use nutrients from food, despite an adequate amount of food physically entering the body. Increased metabolic demand
Increased metabolic demand suggests a state of increased energy needs and caloric expenditure. This state causes greater difficulty taking in enough nutrition to meet the bodys energy needs and allow for normal growth. Epidemiology
Failure to thrive is a common presenting problem in the pediatric population in both resource-abundant and resource-poor countries. While epidemiology may vary by region, inadequate caloric intake remains the most common cause of FTT in both developed and developing countries, and poverty is the greatest risk factor for FTT worldwide. Resource-abundant regions
Failure to thrive is prevalent in developed countries, with literature from Western studies demonstrating a prevalence of about 8% among pediatric patients. Presentations of FTT comprise about 5-10% of children seen as outpatients by primary care physicians and 3-5% of hospital admissions for children. Failure to thrive is more prevalent in children of lower socioeconomic status in both rural and urban areas. FTT is also associated with lower parental education levels.
Incidence of refeeding syndrome is high, with one prospective cohort study showing 34% of ICU experienced hypophosphatemia soon after feeding was restarted. Low resourced settings
Community-based management of malnutrition (CMAM) has been shown to be effective in many low resourced regions in the past two decades. This method includes providing children with ready-to-use therapeutic food (RUTF) and then following up with their health at home or at local health centers. RUTF is readily-consumed, shelf-stable food that provides all the nutrients required for recovery. It comes in different formulations, is generally a soft, semisolid paste, and can be sourced locally, commercially, or from agencies like UNICEF. In terms of efficacy, clinical experience and systemic reviews have shown higher recovery rates using CMAM than previous methods, such as milk-based formulas. While this is an efficient outpatient method to address FTT, children with underlying pathologies would require further inpatient workup.RUTF should be treated as prescribed medication to the child experience FTT, and thus should not be shared with others in the family. The recommended feeding protocol is 5-6 servings a day for about 6–8 months, at which time many children will fully recover. Children should have a follow up every week or two looking at weight and upper arm circumference. Follow ups can be decreased if there is progress without complications, but if the child is not improving, then further evaluation for underlying issues is recommended.