Failure to thrive

Definition

Failure to thrive is a description applied to children whose current weight or rate of weight gain is significantly below that of other children of similar age and sex.

Alternative Names

Growth failure; FTT

Causes, incidence, and risk factors

Infants or children that fail to thrive seem to be dramatically smaller or shorter than other children the same age. Teenagers may have short stature or appear to lack the usual changes that occur at puberty. However, there is a wide variation in normal growth and development.

In general, the rate of change in weight and height may be more important than the actual measurements.

It is important to determine whether failure to thrive results from medical problems or factors in the environment, such as abuse or neglect.

There are multiple medical causes of failure to thrive. These include:

• Chromosome abnormalities such as Down syndrome and Turner syndrome
• Defects in major organ systems
• Problems with the endocrine system, such as thyroid hormone deficiency, growth hormone deficiency, or other hormone deficiencies
• Damage to the brain or central nervous system, which may cause feeding difficulties in an infant
• Heart or lung problems, which can affect how oxygen and nutrients move through the body
• Anemia or other blood disorders
• Gastrointestinal problems that result in malabsorption or a lack of digestive enzymes
• Long-term gastroenteritis and gastroesophageal reflux (usually temporary)
• Cerebral palsy
• Long-term (chronic) infections
• Metabolic disorders
• Complications of pregnancy and low birth weight

Other factors that may lead to failure to thrive:

• Emotional deprivation as a result of parental withdrawal, rejection, or hostility
• Economic problems that affect nutrition, living conditions, and parental attitudes
• Exposure to infections, parasites, or toxins
• Poor eating habits, such as eating in front of the television and not having formal meal times

Many times the cause cannot be determined.

Symptoms

Infants or children who fail to thrive have a height, weight, and head circumference that do not match standard growth charts. The person's weight falls lower than 3rd percentile (as outlined in standard growth charts) or 20% below the ideal weight for their height. Growing may have slowed or stopped after a previously established growth curve.

The following are delayed or slow to develop:

• Physical skills such as rolling over, sitting, standing and walking
• Mental and social skills
• Secondary sexual characteristics (delayed in adolescents)

Signs and tests

The doctor will perform a physical exam and check the child's height, weight, and body shape. A detailed history is taken, including prenatal, birth, neonatal, psychosocial, and family information.

A Denver Developmental Screening Test reveals delayed development. A growth chart outlining all types of growth since birth is created.

The following laboratory tests may be done:

• Complete blood count (CBC)
• Electrolyte balance
• Hemoglobin electrophoresis to determine the presence of conditions such as sickle cell disease
• Hormone studies, including thyroid function tests
• X-rays to determine bone age
• Urinalysis

Treatment

The treatment depends on the cause of the delayed growth and development. Delayed growth due to nutritional factors can be resolved by educating the parents to provide a well-balanced diet.

If psychosocial factors are involved, treatment should include improving the family dynamics and living conditions. Parental attitudes and behavior may contribute to a child's problems and need to be examined. In many cases, a child may need to be hospitalized initially to focus on implementation of a comprehensive medical, behavioral, and psychosocial treatment plan.

Do not give your child dietary supplements like Boost or Ensure without consulting your physician first.

Expectations (prognosis)

If the period of failure to thrive has been short, and the cause is determined and can be corrected, normal growth and development will resume. If failure to thrive is prolonged, the effects may be long lasting, and normal growth and development may not be achieved.

Complications

Permanent mental, emotional, or physical delays can occur.

Calling your health care provider

Call for an appointment with your health care provider if your child does not seem to be developing normally.

Prevention

The best means of prevention is by early detection at routine well-baby examinations and periodic follow-up with school-age and adolescent children.