# Failure to Thrive (Faltering Growth in Infants) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph) · NICE Guideline NG75: Faltering growth 2017 · WHO Child Growth Standards Guidance - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph) - Failure to Thrive - disease-level clinical article (failure-to-thrive-infant-clinical.txt) ## Treatment metadata - Multivitamin + Iron — oral.liquid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text FAILURE TO THRIVE (FALTERING GROWTH IN INFANTS) Sources: Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph) · NICE Guideline NG75: Faltering growth 2017 · WHO Child Growth Standards Guidance Review status: REVIEWED against Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph), Failure to Thrive - disease-level clinical article (failure-to-thrive-infant-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Parents may report feeding refusal, texture preferences, trouble swallowing, gagging, belly pain, or vomiting with feeds [abdominal pain · difficulty swallowing · vomiting] - Warning signs include blood or mucus in stool, bulky foul-smelling stools, or new nighttime stool urgency or leakage in a previously toilet-trained child - A history of prematurity, being small for gestational age, low blood sugar, or jaundice at birth is relevant [hypoglycaemia · jaundice] - Fast breathing, tiring, or sweating during feeds can point to an underlying heart problem [sweating · tachypnoea] - A falling weight percentile worries more than a child who has always tracked low and may simply be meeting their own growth potential - Red flag: untreated it ends in stunted growth, and it is associated with developmental delay and other long-term effects on a developing child [developmental delay · stunted growth] - The effect on the brain is worst in children under 2 and when the malnutrition has run longer - It has been linked to a lower IQ, to ADHD and learning difficulty, and to impaired communication [learning difficulty] SIGNS - what you find (3) - Exam may reveal dysmorphic features, oral-motor problems, thyroid nodules or goiter, a heart murmur, fast breathing, lung findings, or an abdominal mass or enlarged organ [abdominal mass · dysmorphic features · goitre · heart murmur · tachypnoea] - Often the only exam finding is poor weight gain and a thin build, without any other clue to a specific cause [failure to thrive] - Actual weight loss since the last visit is a red flag, since a normally thriving child should not lose weight [weight loss] TESTS (10) - Malnutrition severity is graded by weight-for-length z-score: -1 to -1.9 mild, -2 to -2.9 moderate, and below -3 severe - First-line labs are a CBC to check for anemia, an iron panel since iron deficiency is the most common type at this age, and a metabolic panel for hydration and organ function - When refeeding syndrome is a risk, phosphorus and magnesium levels are added to the standard metabolic panel - An ESR can flag nonspecific underlying inflammation - Thyroid function is checked with TSH and free T4 - Urinalysis and urine culture screen for kidney disease and a common chronic infection - Stool studies including culture, occult blood, fecal calprotectin, and reducing substances are sent for abnormal stool patterns - A celiac panel with tissue transglutaminase IgA and total IgA is checked for GI symptoms - The consensus definition is a weight for age below the fifth percentile, a drop of more than 2 major percentile lines, or under 80% of the median weight for height - For a baby born early, correct the growth percentile for gestational age until the child is 2 years old IF NOT THIS - what else fits (4) - Primary short stature, defined by a height z-score of -2 or below, is a key alternative diagnosis to weight-based failure to thrive - Growth hormone deficiency, constitutional delay, familial short stature, and idiopathic short stature can all cause isolated short stature - Cushing syndrome, thyroid dysfunction, and hypopituitarism can all present with poor linear growth - Long-term systemic steroid use is an iatrogenic cause of poor growth to consider Source StatPearls "Failure to Thrive" - disease-level clinical article Status traced to the source above 1. MULTIVITAMIN + IRON [1st line] Adult Not applicable - pediatric entry x 3-6 months under growth monitoring Peds Only where iron deficiency is identified. Egyptian formulary paediatric dose: ferrous fumarate 140 mg/5 mL syrup 0.5 mL/kg/day in 2-3 divided doses, maximum 20 mL a day - that is 4.5 mg/kg/day of elemental iron, ceiling 180 mg. Premature infants up to 3 kg: 0.5 mL a day. Source Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph) Why Iron replacement where the iron panel shows deficiency, the commonest micronutrient deficiency at this age, while the calorie deficit and any organic cause are investigated. The iron figure is the Egyptian formulary's; no guideline states a dose for the multivitamin half of a combination syrup. Caution PRIMARY CARE ROLE: Perform detailed feeding history, observe feeding session, calculate caloric density. The red flags requiring urgent pediatric referral are organomegaly, dysmorphic features, developmental regression, severe anemia, and abnormal urinalysis. Do not rely solely on vitamin supplements without addressing caloric deficit and psychosocial factors. Dose a combination multivitamin+iron syrup by the elemental iron its carton states, not by the volume above - the figure here is the formulary's ferrous fumarate syrup. No guideline doses the vitamin component for faltering growth; give it per its own product label. Egypt FERNISAL 120 ML SYR ORGANIX > SAL... 75.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Failure to Thrive - disease-level clinical article (failure-to-thrive-infant- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The hospitalization criteria are severe malnutrition, dehydration, suspected abuse or neglect, and failed outpatient management. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)