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Poor weight gain, growth failure, and failure to thrive (FTT) are conditions that involve a vast array of potential causes. The root of the problem may involve (1) inadequate caloric intake, (2) decreased ability to metabolize the ingested food, (3) increased caloric expenditure, or (4) abnormal caloric requirement. Whatever be the cause, a child’s weight is a sensitive indicator of his or her general health. In the case of weight gain, health must be broadly defined and includes family, psychosocial, and socioeconomic causes as well as possible diseases and disorders.

Many cases of growth failure are diagnostically solved in the outpatient setting without the need for hospitalization. However, in some extreme cases, either because the growth delay is so significant or because the child is at a vulnerable age for long-term development, hospitalization is required. At times, the indication for hospitalization (Table 6-1) is a complex and/or obscure problem that requires a more intensive diagnostic evaluation.

Table 6-1. Indications of Hospitalization of Children with Failure to Thrive.

Cause and Frequency

Growth failure is not a diagnosis on its own as it is a symptom of an underlying cause that must be identified to implement the appropriate intervention. The causes can be divided into broad categories of inadequate caloric intake, increased caloric wasting, increased caloric expenditure, and altered growth potential regulation (Table 6-2).

Table 6-2. Causes of Inadequate Weight Gain by Etiology.

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