589 PHYSICIANS FAILURE TO ALTER FAILURE TO THRIVE (FTT)

Abstract

Non-organic failure to thrive often results in expensive, but ineffective hospital stay, which occurs without adequate prior outpatient work-up. To improve the management of these pts., we performed a 1 year retrospective review of children over 12 mos. admitted and discharged with 1° dx. of FTT. 10 of 21 cases were non-organic FTT. All pts. had at least 1 prior physician contact and adequate immunization status. 5 children had received prior dietary instruction. Our results indicate that even when hospitalized, these children did not receive adequate nutritional assessment: 1) Dietary hx. by physician either lacking or inadequate; hx. by a hospital dietitian often contributed the only clues to the pt.'s problem. 2) Anthropometric data for all pts. included only ht., wt., & growth charting; often missing was head circ., MAC, TSF, or data on parental and family stature. 3) P.E. specified nutritional status indicators only 50% of the time. 4) Biochemical evaluation revealed an average/pt. of 14 diagnostic tests, of which all WNL except FE/TIBC(2) and HCT/Hb(3). The course of the hospital stay included daily wts. (90% of cases), calorie counts (100%) and nutrition consults (50%). Outcomes were: We conclude that 50% of admissions could have been prevented initially by additional counseling and reassurance. 50% of pts. required significant social intervention for which hospitalization and subsequent follow-up did little.