The Portal of Geriatrics Online Education

Warning message

This material has not been reviewed or updated in over 3 years and may contain information that is no longer current or up to date. All materials posted to POGOe are subject to review every 3 years for clinical accuracy and relevancy. If you are an author of this material, and would like to review and update it, please contact

Failure to Thrive

Failure to Thrive

University of Iowa Roy J. and Lucille A. Carver College of Medicine
Margo Schilling, MD
Donald W. Reynolds Foundation
POGOe Id: 
Date Posted: 
Date Reviewed/Updated for Clinical Accuracy: 
CME available CME credits available

This product is part of the GeriaSims series of interactive patient care simulations. In this simulation, learners ask history questions, perform virtual physical exams, order tests, and consult with specialists and other health care professionals. They make decisions about diagnosis, treatment, and other issues in the care of an elderly patient with severe weight loss, and receive feedback about all actions and decisions. Learners may also ask questions of a simulated mentor to access didactic information about failure to thrive. Depending on the learner's level of experience and interest, the simulation takes one to two hours to complete.

GeriaSims interactive patient care simulations are available online, both to accredited medical education institutions for use with students, residents, and fellows. For more information about the GeriaSims series, go to

GeriaSims are also available to practicing physicians, physician assistants, nurses and nurse practitioners for CME or CEU credit. To receive continuing education credit, you must register for the Geriatric Lecture Series. For more information, go to

Educational objectives: 

GeriaSims are interactive experiences during which the learner diagnoses and treats simulated patients. The simulations are designed to provide interactive learning experiences about geriatric syndromes and other issues that are often encountered in the primary care of elderly patients. Learners will be able to improve their overall knowledge about managing common geriatric syndromes and will understand the unique health care needs of older patients. They will learn about differences in the management of common clinical conditions, and how physiologic changes associated with aging impact management. They will develop a working knowledge of important legal and ethical issues associated with end-of-life care; and understand and apply principles of the multi-disciplinary geriatric assessment.

The learning objectives of this particular simulation are:

  1. Recognize the clinical presentation of undernutrition.
  2. Identify the common contributing causes of undernutrition in community-dwelling elders.
  3. Develop a plan, including tests and consults, to evaluate weight loss in an older adult.
  4. Determine which factors precipitating a patient's failure to thrive are potentially reversible.
  5. Formulate a treatment plan to correct a patient's failure to thrive. 6. Recognize when to call on the expertise or programs offered by other practitioners.
Additional information/Special implementation requirements or guidelines: 

These simulations were developed using a software template created by the University of Iowa. They are used in primary care residency programs and rotations for medical students in the clinical years at the University of Iowa, and also offered online for CME credit.

To use GeriaSims, a 256K or faster DSL, cable modem, LAN/Intranet, or other broadband Internet connection; Internet Explorer 6.0 or higher, Netscape 8.0 or higher, Firefox 1.0 or higher, Mozilla 1.7.5 or higher, or Safari 1.3 or higher web browser, with Java script enabled; version 8 or later of the Flash Player; and Adobe Reader 5 or later are required. A sound card and speakers are recommended. GeriaSims are best viewed at a screen resolution of 1024 x 768, but can be viewed at 800 x 600.

Conflict of Interest Disclosure: 
No, I (we) have nothing to disclose.
Contact Person/Corresponding Author:

Suggested Citation:
Margo Schilling. Failure to Thrive. POGOe - Portal of Geriatrics Online Education; 2009 Available from:


Submitted by zhurd on

Geri Sims in general are fabulous products though very time intensive. They also can be a little unforgiving in terms of requring that you complete every step before proceeding to the next frame or scenario.-This can be good in terms of fostering thoroughness but may make an advanced learner impatient and a beginning learner discouraged.

Submitted by zhurd on

Discussion of goals of care is a key part of this case. It really shows a thoughtful work up (ie, not just switching the pt to hospice immediately once failure to thrive is noted) and a thoughtful effort to include low-burden treatments with palliative treatments.

Submitted by K_Callahan on

This simulation is extensive, with a detailed unfolding case that enables the learner to explore further history, examine the "patient", and use multiple interdisciplinary "consults" to help guide care. It provides in-depth coverage of the definition of, work up for, and management of failure to thrive. A good exercise for any clinician wanting to further their knowledge on failure to thrive.

Strengths are its interactive format, its detailed evaluation, the format of the unfolding case and generation of clinical questions which teach clinical decision making as well as content.

Weaknesses include its strict format, and though it touches on many of the medical student competencies, it does not fully address any.