failure to thrive: a dilemma for community health care

juanita hernandez is an 18-month-old hispanic, the younger of two children. juanita was at the 25th percentile for height and weight at birth, but both measurements fell to just below the 5th percentile during her first year. for the last 6 months however, her rate of growth has been normal and her height and weight curves lie parallel to just below the 5th percentile. juanita appears quite small, but her parents and older sibling also appear to be smaller than average. her development is normal. should she be referred for a diagnostic evaluation? the community health nurse (chn) frequently encounters infants and young children who appear small for their ages. the difficulty in making correct assessments of these children can lead to over referral, costing the family and community time, money, and unnecessary concern. however, reluctance to refer may cause serious illness to be missed. what constitutes failure to thrive (ftt)? is it a common problem? what are the components of a nursing assessment of small-for-age children? what referral criteria should be used? to address these questions, this article reviews the literature for the defining characteristics and incidence of ftt. organic and nonorganic ftt are differentiated. tools for nursing assessment of small-for-age children are discussed. criteria for referral of small-for-age children to medical evaluation are suggested, and recommendations for further study are made.