Failure to Thrive Health Article

Definition

Failure to thrive (FTT) is a term used to describe children whose physical growth over time is inadequate when compared to a standard growth chart.

Description

There is no universally accepted definition of failure to thrive, though it has been recognized as a medical condition since the early 1900s. It describes a condition rather than a specific disease. Children are considered as failing to thrive when their rate of growth does not meet the expected growth rate for a child their age. The difficulty lies in knowing what rate of growth is expected for any individual child, since many factors, including race and genetics, may influence growth.

Recognizing abnormal growth requires an understanding of normal infant growth. Infants normally lose up to 10 percent of their weight in the first few days of life. However, this weight should be regained within two weeks. The average full-term baby doubles its birth weight by six months and has tripled it by one year. Children with failure to thrive are often not meeting those milestones. If a baby continues to lose weight or does not gain weight as expected, he or she is probably not thriving.

Children who fail to thrive are either not receiving or have an inability to take in or retain adequate nutrition in order to gain weight and grow. If the condition progresses, the undernourished child may become irritable and/or apathetic and may not reach typical developmental markers such as sitting up, walking, and talking at the usual ages.

Demographics

The incidence of growth failure of American children is difficult to assess. Failure to thrive is believed to affect up to 5 percent of the population but is most common in the first six months of a child's life. It is commonly seen in babies born prematurely. Most diagnoses of failure to thrive are made in infants and toddlers in the first few years of life. An estimated 10 percent of children seen in primary care settings have symptoms of failure to thrive. The condition can appear in all socioeconomic groups, although it is seen more frequently in those families experiencing poverty. There is an increased incidence among children receiving Medicaid, those living in rural areas, and in children who are homeless.

Causes and symptoms

Failure to thrive may have several underlying causes. The causes of failure to thrive are typically differentiated into organic and non-organic. Organic causes are those caused by an underlying medical disorder. Inorganic causes are those caused by a caregiver's actions. However, these definitions are simplified, as both medical and behavioral causes often appear together.

Organic causes of failure to thrive may include:

• premature birth, especially if the fetus had intrauterine growth retardation
• maternal smoking, alcohol use, or illicit drugs during pregnancy
• mechanical problems present, resulting from a poor ability to suck or swallow, for example, presence of cleft lip and cleft palate
• unexplained poor appetites that are unrelated to mechanical problems or structural abnormalities, for example, breathing difficulties that can result from congestive heart failure (Any difficulty in breathing makes eating more difficult and can result in FTT. Inadequate intake also can result from metabolic abnormalities, excessive vomiting caused by obstruction of the gastrointestinal tract, or kidney dysfunction. In addition, gastroesophageal reflux causing regurgitation of formula or refusal of feeding.)
• poor absorption of food, inability of the body to use absorbed nutrients, or increased loss of nutrients

Some examples of non-organic causes of failure to thrive are:

• poor feeding skills on the part of the parent
• dysfunctional family interactions
• difficult parent-child interactions
• lack of social support
• lack of parenting preparation
• family dysfunction, such as abuse or divorce
• child neglect
• emotional deprivation

Studies show that only between 5 percent and 26 percent of FTT cases are due to a purely organic cause. Children in abusive or neglectful families are at higher risk of FTT, but these cases make up only a small proportion of the total. The most common cause of failure to thrive is malnutrition, either as part of an organic problem or simply because of an energy imbalance.

The following symptoms are possible indications of failure to thrive:

• delayed social and mental skills
• delayed development of secondary sexual traits in adolescents
• height, weight, and head circumference in an infant or young child not progressing as expected on growth charts
• edema (swelling)
• wasting
• enlarged liver
• rashes or changes in the skin
• changes in hair texture

When to call the doctor

Parents should notify their physician if their child does not seem to be developing at a normal pace. If parents notice a drop in weight or if the baby does not want to eat, the doctor should be notified. A major change in eating patterns also warrants contact.