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AAP Conference Preview: Hospitalist aims to standardize care for failure to thrive patients :

October 7, 2016

Editor’s note: For more on educational sessions and events at the 2016 AAP National Conference & Exhibition in San Francisco, read the preview issue of AAP News Today. To register for the conference, visit

A pediatric hospitalist, Joyee Vachani, M.D., M.Ed., FAAP, noticed that a lot of patients were being admitted to the hospital for failure to thrive who either didn’t need to be or who were subjected to unnecessary lab work.

It got her thinking: “Is what we are doing really the right thing that we should be doing for our patients.”

So Dr. Vachani began searching the literature for evidence-based guidance on which children with failure to thrive should be admitted to the hospital and how they should be managed. She found very little.

Since then, she has made it her mission to standardize care across institutions. She developed an algorithm based on available evidence and gives numerous presentations on the topic. Her message: Do enough but don’t do too much.

Dr. Vachani will review diagnostic and management strategies during a session titled “Failure To Thrive: the ‘Growing’ Body of Evidence.” The session will be held from 8:30-9:15 a.m. (F3036) and from 5-5:45 p.m. (F3170) on Oct. 24 at the AAP National Conference & Exhibition in San Francisco.

Dr. Vachani, a member of the AAP Section on Hospital Medicine, will provide an update on evidence in the literature, including admission criteria, utilization of lab data and discharge criteria as well as information from large databases of patients admitted, discharged and followed for failure to thrive.

She also will discuss a systematic approach to the differential diagnosis of failure to thrive and introduce her management algorithm. Using illustrative cases, Dr. Vachani will outline what the pediatrician should look for when taking a history, during the physical exam and in the growth chart to determine whether lab work, watching and monitoring, or hospital admission would be appropriate.

“With these talks or whatever else I’m working on with this topic, I really want to try as much as we can to standardized the care that we deliver to these patients both in our institution and across institutions because ultimately that’s what I think will help them the most,” said Dr. Vachani, assistant professor of pediatrics and director of quality and safety, Section of Pediatric Hospital Medicine, Baylor College of Medicine/Texas Children’s Hospital.

Dr. Vachani defines failure to thrive as a complex interaction between a child’s medical, nutritional and social issues.

Previously, failure to thrive was categorized as either organic due to a medical condition such as reflux, anatomic structural issue or metabolic disease or inorganic due to environmental or social factors such as feeding issues. It now is recognized that both can play a role.

“Although rare, the more organic and structural concerns have to be ruled out,” said Dr. Vachani. “So it’s extremely important to do a thorough history and physical in order to risk stratify those patients to determine which patients truly need a large workup and which ones can be managed either outpatient or with minimal workup.”

Studies have shown that there is gradual improvement in weight and height over the preschool years, but there are some lasting deficits in adolescence, she said. In addition, some studies show variable deficits in IQ.

“There are definitely some major concerns for prognosis,” Dr. Vachani said, “so it is something that we want to identify quickly and act on quickly to prevent some of those issues.”

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